Panic over - CBD to the rescue
Anastasiia Myronenko is a Medical Physicist actively practicing in one of the leading cancer centers in Kyiv, Ukraine. She received her master’s degree in Medical Physics at Karazin Kharkiv National University and completed Biological Physics internship at GSI Helmholtz Centre for Heavy Ion Research, Germany. Anastasiia Myronenko specializes in radiation therapy and is a fellow of Ukrainian Association of Medical Physicists.
- What is CBD?
- How does CBD work?
- Is CBD safe for my child?
- How quickly will CBD work?
- Does CBD have side effects?
- How to choose the right CBD product?
- Frequently Asked Questions (FAQs)
SummaryPanic attacks are sudden periods of intense fear that may include sweating, shortness of breath, shaking, numbness, or a feeling of impending doom. Panic attacks can be triggered by serious life stress, a traumatic event, major changes in your life, smoking or excessive caffeine intake. Panic disorder can be treated with psychotherapy, medication, or both. CBD has shown to be helpful for generalized anxiety disorder, social anxiety disorder, panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder (PTSD).
Panic attack syndrome is more common than you might imagine - about 5% of the worldwide population is affected by this disorder. Despite the difficulty of differentiating panic as a separate disorder, most affected people are relatively young - from 20 to 30 years old. Moreover, women suffer from panic attacks more often than men. Panic as a natural reaction to stress is familiar to many, but why does it sometimes occur "out of the blue" for no apparent reason?
For a long time, medical classifications did not distinguish panic disorder as a separate diagnosis. Neurologists gave the currently dubious diagnosis of vegetative-vascular dystonia, which is more of a group of symptoms than a diagnosis, and the treatment offered was not sufficient. Generally, there was little information in the medical community about panic attacks as a psychological phenomena and bearing mental disorder elements.
Panic attacks were considered part of the usual disorders of anxiety, which in previous editions of the International Classification of Diseases (ICD) belonged to neuroses. Only in 1999 did panic disorder finally appear as a separate clinical category.
A panic attack was perceived as an exacerbation of some illness and so patients called an ambulance. Paramedics measured blood pressure and carried out a cardiogram. As a result, they did not draw any terrible conclusions but were advised to be examined. Patients could go to different specialists for a long time, trying to understand what was wrong with them. Fear of what was happening to them increased their anxiety, leading the patient to believe they were seriously ill, while the doctors lacked competence to understand what was occuring. It is only recently that the path from a panic attack to a psychiatrist or psychotherapist has become shorter. Happily, today, we know more about panic attacks and are able to apply new therapeutic targets.
A panic attack is a very intense feeling of fear or panic, which is accompanied by somatic (bodily) reactions like:
- increased blood pressure
- heart palpitations
- sweating or chills
- fluctuating emotions
- hyperventilation (experiencing shortness of breath despite rapid breathing due to lack of oxygen)
- numbness, tingling, or dizziness
Sometimes, with a panic attack, a state of derealization or depersonalization can occur. In the first case, the world seems altered, detached, as if in a haze. With depersonalization, one's own body and/or mental processes appear to be changed. Simultaneously, a person cannot say for sure what the essence of the change is and what is wrong with them; they experience a "feeling of alienation."
During panic attacks, patients may begin to fear that they will lose consciousness, go crazy, lose control of themselves, and begin to act up, which others will consider mentally ill. The symptoms of panic in the body can be so intense that a person may even feel like they are going to die. A shortage of breath, the heart about to jump out of the chest, fear of heart attack or stroke - these are called secondary symptoms.
Secondary fears play a decisive role in the development of the panic disorder. If a person has had one panic attack, this does not mean that they will be recur regularly. A person can experience a panic attack once or twice in a lifetime, but panic disorder (that is, regular panic attacks) develop only when persistent secondary fears occur.
The mechanism that triggers a panic attack is an evolutionarily inbuilt psychophysical reaction to danger. There is a release of adrenaline and the sympathetic nervous system is activated. Blood rushes to the internal organs, blood pressure rises, hyperventilation begins. This is a "reaction to danger in the absence of danger".
Typically, the first panic attack occurs against a background of changes in physical or mental conditions that cause the sympathetic nervous system to be mobilized. This can happen after excessive physical exertion, such as intense exercise or from overwork or exhaustion. A panic attack often occurs due to alcohol abuse or some stimulants like tea or coffee. A panic attack can be the result of a conflict, difficult situation, or chronic stressful condition. First, a person feels that something is wrong (for example, his heart is beating violently), followed by a catastrophic interpretation of what is happening, which increases anxiety, and therefore, bodily symptoms.
Ultimately, we can say that the leading psychological cause of the development of a panic attack is a distorted interpretation of bodily sensations. Psychological research shows that a tendency to avoid negative emotions, a lack of understanding of one's feelings, and the difficulty to accept negative emotions increases vulnerability to panic disorder.
If the secondary fears are intense, the likelihood of repeated panic attacks increases. These fears create tension, force a person to close down, engage in less vigorous activities, and stay home. Agoraphobia joins the panic attacks because people are convinced that they cannot get help if they become ill in a public place. In such cases, the panic disorder becomes chronic. Formally, it is difficult to call it a disability, but if you look at the limitations that a person faces, everything resembles one.
People in this state cannot work and live a relatively full life. It is clear that restrictions lead to increased depression and anxiety because a person who is afraid to go out lives in a deficit of emotions and experiences. The result is a vicious circle of concern; a person limits himself within the house because of the fear of a panic attack. The lack of activity and communication that accompanies this leads to depression and increased nervousness.
The factors that predispose one to the panic disorder include genetic characteristics. If someone in the family suffers from anxiety or depressive disorders, their relatives will be more likely to develop regular panic attacks.
And finally, besides more common reasons for panic attacks, there are other factors which can trigger this condition:
- withdrawal from medication
- low blood sugar
- use of stimulants, such as cocaine, caffeine, or amphetamines
- an overactive thyroid gland
To prevent panic attacks, it is crucial to understand the difference between a panic attack and panic disorder. It's essential to work with cognitive biases (thinking errors). In particular, the catastrophizing of panic attack symptoms leads to tension and anxiety. People who manage to cope with catastrophizing are less likely to develop a chronic disorder.
A healthy lifestyle is an essential element of prevention. As discussed above, alcohol can be a catalyst for panic attacks. It is necessary to eat normally, not to abuse psychoactive substances, to protect yourself from exhaustion, both physical and mental.
Often friends and colleagues give advice like “Don't be nervous”. This can create an additional tension mechanism - the person is already worried, but is required to suppress their worries. A secondary cause for tension develops that hinders and aggravates rather than helps and relieves.
However, do ask for support from loved ones if the attacks happen suddenly and don’t last long. It can be helpful if someone is with you who can support you and assure you that everything will work out, and these symptoms do not pose a threat to your life.
Do breathing exercises. If breathing becomes faster during panic attacks, breathing exercises may relieve some symptoms. Try to breathe through your nose as slowly, calmly, and deeply as possible. Exhale through your mouth, just as slowly and calmly. The relief will come within minutes.
Take care of the quality of your life so that there are as few reasons to worry as possible. Even in large, busy cities, some people are able to avoid being nervous because they have created an appropriate level of life satisfaction. If however, a person's lifestyle is conducive to being always worried, therapy may be a good place to start before panic attacks and other anxiety disorders can set in.
Being proactive in facing anxiety head on can be extremely empowering and one way of doing this is to try CBD as an alternative or complementary treatment.
What is CBD?
Cannabidiol (CBD) is the principal non-psychotic constituent of the Cannabis sativa plant. It is one of 85 unique compounds of this plant, combined into one group under the general name "cannabinoids." Until recently there was a ban on research, but since the legalization of marijuana in some countries, we now know more about the most famous cannabinoids found in cannabis which are CBD and tetrahydrocannabinol (THC). These two components take part in most scientific studies and have already shown a wide range of useful properties and applications.
In most cases, diseases of various complexity are treated with pharmaceuticals, but many are either addictive or have numerous side effects. CBD offers an excellent, non-toxic substitute with more potent results. With its anti-anxiety properties, CBD is suggested as an alternative for treating anxiety disorders and potentially as an alternative to antidepressants.
Although our body produces cannabinoids by itself, CBD oil can help with clinical deficiencies. There are endocannabinoids - substances produced naturally in the human body, and there are phytocannabinoids - components that are obtained from plants.
With a lack of endocannabinoids, health begins to worsen. In the case of serious diseases, such as PTSD, Parkinson's disease, multiple sclerosis, migraine, IBS, etc., drugs with terrible side effects are usually attributed. CBD helps to increase the number of endocannabinoids in the body, without causing adverse reactions.
CBD affects several neurotransmitter receptors and, therefore, improves life quality, reduces pain, and regulates appetite, sleep, nausea, anxiety, and inflammation. Simultaneously, hemp with a high CBD content has virtually no unwanted effects as with THC.
How does CBD work?
As mentioned, our body knows how to keep itself in balance, and the Endocannabinoid System (ECS) is responsible. This complex system maintains our brains, including the parts related to feelings of panic. More specifically, the central amygdala controls emotional learning and stress responses. In other words, it teaches our brains how to react to triggers and handle anxiety. Furthermore, the amygdala contains CB1 receptors that bind to cannabinoids. So we can use cannabinoids like CBD to tap into the amygdala's ability to regulate itself.
Two of the most-studied endocannabinoids in our body are:
They both act as agonists of the cannabinoid receptor 1 (CB1) and cannabinoid receptor 2 (CB2). Although CBD has a very low affinity for these receptors in vitro, it can still facilitate endocannabinoid signaling by inhibiting the cellular uptake and enzymatic hydrolysis of endocannabinoids.
TCH has the following effects on the CB1 receptor:
Whereas on the CB2 receptor there are immunomodulatory effects but notably no psychoactive effects. The CB2 receptor is expressed in body cells controlling immune function and (potentially) the central nervous system (CNS).
CBD and anxiety
A myriad of studies found that CBD exerts antidepressant effects directly through the serotonin system. This cannabinoid activates vanilloid (TRPV1) receptors and reduces anxiety through 5-HT1A serotonergic receptors activation (Soares V. et al.,2012). CBD is so effective in anxiety-like disorders because serotonin is the primary molecule responsible for feelings of overall well-being and happiness. When serotonin production is altered, a person is likely to experience negative emotions such as depression, anxiety, insomnia, and even feeling similar to a panic attack. Pre-clinical studies in mice have demonstrated that systemically consumed CBD triggers anxiolytic-like effects in several animal models that have been associated with generalized anxiety (GAD), such as the elevated plus-maze (EPM), the Vogel conflict test, and aversive conditioning.
CBD and fear of public speaking
In humans, pharmacodynamics (PD) responses have been assessed in healthy volunteers and panic patients submitted to controlled conditions of psychological or chemical-nature stimuli (Zuardi A. et al., 1993). For instance, in the simulated public speaking (SPS) test, the participant had to prepare a speech and talk in front of a video camera. During the trial, indices of anxiety and other emotional states were obtained by applying scales, such as the Visual Analog Mood Scale (VAMS) and the Self-Statements during Public Speaking Scale.
Regarding CBD, Zuardi and co showed that a single oral dose of CBD (300mg) decreased anxiety after the SPS test in healthy volunteers. A significant reduction in anxiety-related measures obtained was also observed in a different study after taking a 600mg oral dose of CBD.
CBD and bad memories
CBD was shown to block the reconsolidation of aversive memories in rats. Studies by Stern C. et al., 2012 investigated whether CBD would affect the reconsolidation of fear memory and tested 51 contextually conditioned rats. All examined animals were randomly allocated to five groups based on the systemic treatment of various CBD doses. Results showed that CBD could disrupt 1-7 days-old memories when administered immediately, with 10mg/kg as the most effective dose. Another important observation was that the effect of cannabidiol is time-specific and dependent on both memory reactivation and activation of cannabinoid type-1 receptors. Although such early-stage studies were carried out on rats, such findings encourage further investigations of this compound's clinical potential.
Is CBD safe for my child?
Interestingly, marijuana has been used by people for hundreds of years for various purposes, but only recently has CBD appeared in the world market. Although CBD has not been extensively tested for use in children, and so far, there are no longitudinal studies, there is potential for CBD to be used for several conditions in children, like autism, PTSD, epilepsy, attention deficit hyperactivity disorder (ADHD), and social anxiety disorder. However, the only medical condition approved to date by the Food and Drug Administration (FDA) is epilepsy.
CBD does not get you high; it is not hallucinogenic, psychoactive, or intoxicating. Although a medication made from CBD has to be prescribed by a trusted medical practitioner, CBD on its own can usually be purchased over-the-counter without a prescription (EpidiolexTrusted Source).
How quickly will CBD work?
The relationship between CBD and the human body is rather complicated, so it is easier to look at this question from the point of how CBD travels through the body. The actual digestion process is also dependent on the means of CBD consumption, quality of the product, and individual peculiarities.
Typical methods of consumption are:
- Sublingually placing a few drops of CBD tincture under your tongue before swallowing. CBD is absorbed by mucous membranes located in the mouth, bypassing the digestive system and liver. CBD molecules are broken down in the liver, allowing it to get into the bloodstream within 50-60 minutes. Within the "first-pass effect," liver enzymes will digest CBD, hence, reducing its overall concentration. So it is better to keep the oil in your mouth for a while.
- Eating CBD pills, edibles, gummies, chocolates, or any other food supplements. The same digestive principle works here. It can take about one hour for the effect to kick in.
- Smoking a high-CBD strain or using a vaping pen seems the quickest way to obtain a CBD effect. Cannabinoids go directly into your lungs, where they reach the bloodstream and circulate throughout the body. CBD comes to its peak concentration after three-five minutes.
- Applying CBD topicals locally in the form of creams and lotions which are absorbed through the skin. Although such a way of consumption seems easy and convenient, it takes about ninety minutes to overcome the skin absorption barrier. Such method is mostly used for chronic pain relief.
CBD efficacy factors
Besides the actual intake method, it is essential to understand that various human factors can play a vital role in CBD absorbance, such as:
- Body Mass Index (BMI). As CBD is stored in fat cells and is expelled with urine or excretions, somebody with a larger body mass requires a bigger dosage of CBD to feel the effect.
- Frequency of use. Many studies proved that CBD is safe to use; however, it is better to start with a small amount and increase it gradually to see how well you can tolerate the product.
- Metabolism. This process is very individual and depends upon how long a person’s body takes to break down and synthesize the compound.
Does CBD have side effects?
A review of potential side effects in humans found that CBD was well tolerated across a wide dose range, up to a daily oral dose of 1500mg/day, with no reported psychomotor slowing, adverse mood effects, or vital sign of abnormalities noted (Bergamaschi MM et al., 2011).
However, rare side effects may still occur:
- feeling dizzy or sleepy
- elevated liver enzymes
- diminished appetite
- feeling weak
- Sleep issues, such as insomnia and low sleep quality
How to choose the right CBD product?
Many companies worldwide manufacture CBD oil, and for consumers, there's no easy way to know exactly what's in a particular product. But here are some tips which can help you to find a trusted CBD product:
- Read the label carefully. Have a look at the amount of CBD per recommended dose.
- Search for CBD oils that have undergone third-party testing and have lab results you can verify. Avoid buying CBD from companies that do not provide lab reports which confirm the presence and the concentration of CBD in the product. Lab reports also state the absence of possibly toxic chemicals like pesticides, fertilizers, or heavy metals. These products should have a certificate of analysis (COA). Look for COAs from labs with certifications from one of these organizations: the Association of Official Agricultural Chemists (AOAC), the American Herbal Pharmacopoeia (AHP), or the U.S. Pharmacopeia (USP).
Frequently Asked Questions (FAQs)
What are the major causes of a panic attack?
Evolutionarily, a panic attack is a psychophysical reaction to danger, which happens due to a release of adrenaline and the activation of the sympathetic nervous system. Some factors may lead to panic attacks, such as stress caused by serious illness, family history of panic attacks, a traumatic event, such as a serious accident, significant changes in your life, such as a divorce or baby delivery, smoking or excessive caffeine intake.
Are panic attacks severe?
Experiencing panic attacks, people may fear losing consciousness, losing control of themselves, and acting up like mentally ill. The symptoms of panic can be so intense that a person may feel like they are going to die. Although panic attacks can feel like a heart attack or other severe condition, they will not cause anyone to die. However, this condition is serious and needs to be treated. If it happens on a regular basis, it is important to contact your doctor for further help.
How can a panic attack be treated?
Panic disorder is mainly treated with psychotherapy, medication, or both. Your doctor can recommend the best treatment for you. Psychotherapy, known as cognitive-behavioural therapy (CBT), is helpful as a first-line cure for panic disorder. Relaxation techniques and deep breathing can also help stop a panic attack.
Does CBD help prevent a panic attack?
Studies have found that CBD might reduce anxiety symptoms in people suffering from a social anxiety disorder. Research suggests CBD may help with panic disorder, generalized anxiety disorder, social anxiety disorder, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder. It is important to remember that taking CBD for panic disorder can be helpful but may not be fast-acting to help during a panic attack.
Does CBD cause side effects?
CBD is commonly well-tolerated even if taken in high doses. However, oral intake of CBD may cause some side effects. Sometimes people taking CBD reported feeling sleepy, appetite loss, diarrhoea, feeling weak, sleep issues, including insomnia and low sleep quality.