A panic attack is a prime example of the physical strain that anxiety can have on your body. Your chest becomes tighter. Your breath shallower. Your heart faster. It’s a battle of mind over matter; your rational mind knows that you’re safe and not in danger, but your body is telling you that this one is worse than the last.
There is an urgent need for effective anti-anxiety therapies that aren’t limited by side effects. As researchers are beginning to unveil the therapeutic wonders of cannabinoids, could CBD be used to stop panic attacks?
What are panic attacks?
A panic attack is a sudden onset of intense fear that triggers a surge of frightening physical symptoms, lasting between 5 and 20 minutes. According to research published in the Depression and Anxiety journal, 13.2% of the population have experienced a panic attack.
If someone experiences recurrent and unexpected panic attacks, this is classified as panic disorder. It is a recognised anxiety disorder that affects nearly 2% of the UK population.
Panic disorder can also be linked to phobias. A phobia is an extreme, irrational fear of something- most commonly an object, a situation, or a place. Although panic attacks can occur spontaneously with no obvious cause, a phobia can generate intense feelings of fear that will often trigger a panic attack.
There are several phobias that are commonly associated with recurrent panic attacks:
- Social phobia, also termed social anxiety disorder, is an extreme avoidance of social interaction out of fear of being judged by others.
- Agoraphobia is a fear of not being able to escape a situation. It typically stems from having a panic attack in a public setting, which hard-wires a sense of fear when in or thinking about a particular environment.
Symptoms of a panic attack
Panic attacks feel different for everyone. There is a long list of uncomfortable physical symptoms, the most common of which include:
- Heart palpitations
- Breathlessness
- Dizziness
- Chest pain
- Trembling and shaking
- Chills or sweats
- Feeling of disembodiment
Although your body is not truly under threat, a panic attack can mimic the symptoms of a life-threatening emergency; many describe a panic attack as feeling like they’re going to die.
This is, understandably, a hugely distressing experience. It can trigger a self-perpetuating cycle of fearing your next panic attack, making your day-to-day anxiety worse.
What causes panic attacks?
Scientists can’t say for certain what causes us to develop panic disorder, though it is likely due to genetic factors or is a psychological response to a traumatic event.
Understanding what triggers your panic attacks can be a complex task. Panic attacks can occur as a result of pent up stress, sudden changes, dangerous situations, or specific phobias. For many, a panic attack will come out of nowhere, without an obvious trigger.
How can I stop a panic attack?
Once a panic attack starts, it can be very difficult to stop. The best thing to do is to let it happen. Ride the wave. They are scary, but they won’t harm you; try to remind yourself that you’re not in immediate danger and the anxious feeling will pass.
Young Minds advise you to seek a safe space when you begin to panic. They also say to focus on your breathing, your senses, and your surroundings; these grounding techniques have shown to be an effective way to relieve anxiety.
Panic disorder can be challenging to treat. As it can be hard to get yourself out of a panicked mindset, preventative strategies hold the most promise.
Psychological treatments aim to address the underlying trigger. Cognitive behavioural therapy (CBT) is a form of psychotherapy that has proven to be effective at treating anxiety. By altering our thinking patterns, CBT makes us less inclined to panic. It’s effective, but it takes time; the NHS recommends between 5 and 20 weekly sessions.
Even some of the current pharmacological treatments don’t provide immediate relief. Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for anxiety. They combat anxiety by boosting levels of serotonin- also known as the ‘happy hormone’- in the brain. Frustratingly, they take between 4-6 weeks to improve symptoms.
Benzodiazepines, such as diazepam, can also be prescribed for anxiety. They may be quicker to improve symptoms of anxiety, but there are considerable risks with their use. Both SSRIs and benzos have some nasty side effects. They also have a high potential for dependence; you can’t suddenly stop taking them, or you may experience withdrawals.
Current treatments have long-term success in less than half of patients with panic disorder. But it isn’t all doom and gloom. Researchers are making a huge effort to reshape how we treat anxiety. One compound that is showing huge promise is CBD.
What is CBD?
Cannabidiol (CBD) is an active ingredient found in the Cannabis sativa plant. It exhibits therapeutic potential in the treatment of epilepsy, chronic pain, Multiple Sclerosis, and more.
It is one of 113 known cannabinoids from the cannabis plant, another of which is tetrahydrocannabinol (THC). This compound is responsible for the psychoactive properties, or ‘high’, that many associate with cannabis.
In the UK, CBD is completely legal and widely available- and because it contains negligible amounts of THC, it can’t get you high.
How CBD works
CBD interacts a biological system called the endocannabinoid system (ECS). The ECS is responsible for regulating our immunity, appetite, memory, and even our mood.
The ECS controls our mood through its involvement in serotonin signalling. CBD can interact with the ECS to increase the availibility of serotonin in the brain. So, if CBD can have a similar effect on our mood as SSRIs, could it be used to treat anxiety?
CBD & panic attacks: the science
Research into CBD as a treatment for mental health disorders is in its early stages. So far, most studies of CBD use in anxiety are preclinical; there have been no clinical trials to assess the effect of CBD on panic disorder.
There is, however, some preliminary evidence to suggest that CBD has both anti-panic and anti-anxiety properties.
The most recent review of the research into CBD on panic behaviour was published in Current Neuropharmacology in 2017. The existing evidence suggests that CBD may be an effective treatment for panic disorder, but there is an urgent need for human clinical trials.
Animal model evidence
Animal models are an effective way to investigate phobias and panic behaviours. In these disorders, anxiety is a hard-wired response. If CBD can help interfere with an animal’s fear instincts, it may be able to help humans to overcome anxious thinking patterns.
In a study published in Nature in 2012, researchers investigated CBD using mice and a snake in a prey vs predator dynamic. CBD had an anti-aversive effect, meaning the mice were less inclined to escape from threat. The escape behaviours of the mice modelled human panic attacks, suggesting that CBD could alleviate symptoms of panic disorder.
In another study, CBD was injected into the dorsal periaqueductal gray (dPAG), a brain region highly involved in fear behaviours. CBD had anti-panic action by activating serotonin receptors. The rats displayed reduced avoidance and escape behaviours, which were used as a model of human anxiety and panic, respectively.
In a study from 2006, CBD was found to have similar anti-anxiety effects to diazepam. In fear-conditioned rats, both CBD and diazepam reduced behavioural and cardiovascular responses to the fear stimulus.
It would be hugely beneficial to investigate whether these findings translate to humans. As CBD has been shown to exhibit far fewer side effects than benzodiazepines, this begs the question: could CBD be a better treatment for anxiety?
Human evidence
There are far fewer studies of CBD on panic disorder in humans. This is because there are significant ethical concerns about anxiety research, as inducing panic responses in humans would be hugely distressing.
In one human study, 48 participants were conditioned to associate fear with a coloured box, using small electric shocks. Researchers showed that 32 mg of CBD enhanced extinction learning, which is the gradual decrease in response to a conditioned stimulus. In other words, CBD helped to reduce learned fear responses in humans, which suggests that it may play a role in unlearning phobias and panic triggers.
Scientists have also looked at how CBD affects the brain. Using a neuroimaging technique called fMRI, researchers looked at how blood oxygen levels changed after a 600 mg dose of CBD. Blood oxygen correlates with brain activity; the more active a brain region is, the more oxygen it uses.
Participants were shown images of fearful faces to evoke a mild panic reaction. Those that took CBD exhibited significantly reduced activity in a brain region called the amygdala. As the amygdala is responsible for signalling fear, these findings suggest that CBD may be able to reduce our neurological panic response.
There is also an abundance of evidence to support the use of CBD in the treatment of social anxiety disorder. Reducing symptoms of social anxiety may, in turn, help to stop panic attacks caused by social phobia.
How to use CBD for panic attacks
Researchers may not be able to say for certain whether CBD can stop panic attacks, but the products are available for those who wish to see for themselves. There are countless ways to take CBD, and these are just a few of the most popular methods:
CBD oil
A CBD oil is typically administered under the tongue. This way, it can get into your bloodstream quickly and you can feel the effects almost immediately. You can tailor your dosage to your needs, so this is a really popular way to consume CBD.
CBD vape
If the strong taste of CBD oil isn’t for you, a vape may be a better choice. CBD vapes have a rapid onset and are easily transportable, which is beneficial for those prone to anxiety when out and about. Though, be wary, the long-term effects of vaping are yet to be studied.
CBD capsules
If you’re after a more consistent daily dosage of CBD, capsules and gummies are a good option. They take a bit longer to kick in, typically 30 minutes and 2 hours. The dosage isn’t usually very high, but it’s a convenient way to add CBD to your routine.
With many products out there, it can be hard to know where to start. If you’re looking to try CBD and need some advice, see our beginners guide to CBD.
Whilst the experimental evidence suggests that CBD may stop panic attacks, there is limited clinical evidence to support this claim.
There is, however, an ongoing clinical trial of CBD in the treatment of panic attack-related fear. Researchers are investigating whether CBD has the potential to attenuate fear when recalling a past panic attack, and it is due for completion in January 2022.
Beyond this, there is an urgent need for clinical trials that assess whether CBD can prevent panic attacks in a real-time setting.
As research progresses, CBD offers a glimmer of hope for the treatment of panic attacks. CBD could soon provife relief for those who experience this distressing symptom of anxiety.
