Key Takeaways

From the Authors As published in the article
  1. Treatment resistance represents a significant challenge in the treatment of anxiety disorders in young people, with nearly half of all patients not achieving remission despite evidence-based treatment with selective serotonin reuptake inhibitors and/or cognitive-behavioral therapy.
  2. Anxiety severity decreased significantly in young people with treatment-refractory anxiety who received cannabidiol in daily doses between 400 mg and 800 mg for 12 weeks. Randomized clinical trials are required to confirm the efficacy of cannabidiol for anxiety disorders.
  3. Consistent with previous clinical trials, cannabidiol demonstrated an acceptable safety profile in this trial.
Extended Takeaways
  1. This was a highly treatment-experienced sample: the median duration of prior treatment as usual was 25.5 months, and among the 21 participants also taking antidepressants, the median duration was 19 months with a median number of 2 medication changes due to lack of efficacy or side effects.
  2. Symptom gains extended beyond anxiety during the 12-week intervention, with QIDS-A17 scores decreasing by −3.5 (4.2) points, or 29.9%, and SOFAS improving by 6.4 (8.9) points, or 11.3%, suggesting possible benefit in depressive symptoms and functioning alongside anxiety reduction.
  3. Clinician-rated global improvement was notable by week 12: 26 (86.7%) of 30 participants were rated as improved, 16 (53.3%) of 30 as substantially improved, and the proportion rated markedly or severely ill fell from 17 (56.7%) to 5 (16.7%).
  4. Higher cannabidiol exposure did not clearly translate into better outcomes in this trial, as plasma CBD concentrations at week 12 (r = −0.14, P = .46) and maximum plasma concentrations during treatment (r = −0.004, P = .83) were not correlated with reduction in OASIS scores.
  5. Adverse effects did not appear dose-related, but concomitant antidepressant use may warrant closer monitoring: participants taking antidepressants were more likely to experience at least one adverse event (OR = 6.4; 95% CI, 1.16–35.44; P = .03).
  6. Potential pharmacokinetic interaction is a practical concern when combining cannabidiol with SSRIs, as 5 of 6 participants taking citalopram or escitalopram showed increases in plasma concentrations after 12 weeks’ treatment with CBD.
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