Do you wake up in the morning having feelings of worry and stress? At times, anxiety can be present in our bodies and sink in before we are alert and able to provide ourselves with typical coping mechanisms we might use, especially if already diagnosed with a generalized anxiety disorder (GAD). This is often referred to as the non-medical term of “Morning Anxiety” and relates to the cortisol awakening response (CAR). 

Cortisol is known as our “stress hormone” and increases in the second half of the night and then steadily into morning. The night awakening is suggested to not coincide with actual experiences, where CAR is speculated to serve a specific function of preparing individuals for the upcoming demands of the day. Research has stated that “it is likely that individuals with an excessive number of duties and tasks already engage in the process of coping with these duties as soon as they wake up in the morning”. For healthy individuals, this may be useful for thinking about how to manage their day. However, one with an underlying anxiety disorder may find it to be paralyzing. 

Studies have found many psychosocial factors and physical and mental disorders may be at increased risk for an increased morning stress-response. For example, CAR has been observed in relapsing-remitting multiple sclerosis, upper respiratory symptoms, obesity, women with metabolic syndrome, peritraumatic dissociation and acute stress disorder, and major depression. 

Managing morning anxiety can look like:

• Eating a magnesium-rich breakfast while limiting caffeine and sugar
• Physical activity 
• Breathing and/or meditation practices
• Establishing routines for better quality sleep
• Seeking alternative therapies/treatments for an underlying disorder

Cannabinoid therapy may provide benefits to our mental health in a number of ways. Let us take a closer look at how they may supplement our journey to waking up with less debilitating anxiety. 

Depression and Anxiety

It has been suggested that the endocannabinoid system may be involved in the pathophysiology of depression. Evidence shows that endocannabinoids and CB1 receptors are widely distributed in the brain areas that are often related to mood disorders and that their expression is regulated by antidepressants. 

The 5-HT1A receptor is a serotonin receptor that is located in presynaptic and postsynaptic regions. Activating these receptors have been involved in the mechanism of action of anti-anxiety, antidepressant, and antipsychotic medications. Growing research to understand how cannabinoids regulate these receptors supports potential cannabidiol (CBD) and cannabigerol (CBG) use for anti-anxiety, antidepressant, antipsychotic, and stress-reducing effects. 

Data indicate that repeated administration of CBD may produce an effect that is consistent with results from studies testing traditional anti-anxiety and antidepressant medications and that CBG may have strong therapeutic potential as an antidepressant. These are known to be clinically relevant findings as several cannabinoids are known to benefit while exhibiting few side effects, supporting the initiation of clinical trials testing the efficacy of cannabinoid-based compounds for the treatment of mood disorders. 

Realm of Caring was able to collect and publish data on CBD use for anxiety and/or depression. Between April 2016 and July 2020, 538 participants were enrolled in an observational research study between Realm of Caring Foundation and Johns Hopkins University School of Medicine. Upon completion of a baseline survey, participants were invited to complete additional follow-up surveys every 3 months.

Cannabis Users reported lower baseline depression, significantly better past-month sleep quality, a higher overall quality of life, and lower past-month average pain compared to Controls.

Cannabis Users did not report lower baseline anxiety, however baseline Controls who had initiated cannabis use reported a significant reduction in both mean anxiety and depression scores from baseline to follow-up surveys [evaluated using the Hospital Anxiety and Depression Scale (HADS)]. This observation was not realized among non-initiators throughout the study. A similar effect was observed among participants who sustained medicinal cannabis use throughout the study, suggesting an improvement in symptoms of anxiety and depression with both the onset of cannabis use and with extended use. The CBD doses that were used in trials that found anti-anxiety effects were greater than the average reported by participants. 

Sleep

Studies have also shown favorable effects of CBD in sleep disorders, a disorder that is closely related to mental illnesses such as depression. Psychiatric disorders are one of the many causes of insomnia. Not getting enough sleep can have serious implications for our stress-response and high stress levels can contribute to poor sleep quality. 

CBD has been researched for its therapeutic potential for sleep disorders through limiting symptoms that may keep us awake at night but also may contribute to an increase in sleep duration and depth, as well as decrease in the anxiety responses induced by sleep disturbance. 

Studies confirm that a misalignment of the sleep-wake cycle has a negative impact on the stress system. Our circadian rhythm aligns our sleep and wakefulness with day and night to provide stability in restorative rest that enables increased daytime activity. Low doses of CBD may be associated with wakefulness to help our focus and cognition during the day. CBD may modulate waking through activation of neurons in the hypothalamus and dorsal raphe nucleus (DRD). Studies show that therapeutic levels of CBD administration may increase total sleep time and decrease frequency of arousals at night – leading to an increase in total percentage of sleep over time. 

Cannabinoids and Cortisol Levels

While research on CBD and cortisol is its infancy, there have been several clinical trials and one partially controlled trial looking at CBD for stress. All showed that CBD was effective in significantly reducing the stress response and comparable to pharmaceuticals where included. 

To date, findings from two notable studies show that CBD may be used to modulate cortisol responses. 

One study with patients at clinical high risk for psychosis looked at the effect of CBD on cortisol. The purpose was to investigate the effects of short-term CBD treatment for experimentally induced stress in the context of psychosis risk. It was found that CBD may potentially reduce abnormalities in response to acute stress in daily life. 

Another study looked at 11 healthy volunteers who received placebo or CBD at doses of 300 mg or 600 mg. A decrease in cortisol levels was significant when measured two hours after CBD administration. 

These studies provide a pathway for future studies to investigate the potential of CBD to mitigate harmful effects of stress through modulation of cortisol levels. 

Finding Support for Cannabinoid Therapy

When looking to cannabis for medical conditions, we always recommend speaking with a healthcare professional. However, if you are in need of support while on your journey we are here to help. From product selection to dosing guidance to answering questions your family has about your decision to choose cannabis – we are here every step of the way. Send as an email to info@realmofcaring.org, call us at 719-347-5400 or chat with us at realmcaring.org.