Quickly approaching 50, topics that long seemed far in the distance are quickly approaching.
Just last night at a wedding (millennial wedding no less), I gazed in horror as four of us at a dinner table started to talk about allergies, elbow pain, and various health issues.
On the subject of elderly anxiety, however, I'm very optimistic.
This is just coming off a long, in-depth dive into research on CBD and long term anxiety.
Important clues are coming out in studies that point to key drivers of anxiety.
Interestingly, most tend to hinge on age!
We're going to get into that with more detail and even introduce a powerful ally that acts as the precursor to key hormones which also affects elderly anxiety (and everything else for that matter).
- Why does it matter that our hippocampus area of the brain decreases about 1.5% a year until age 70?
- Why does it matter that pregnenolone (the mother of hormones) drops 70% by the same age?
- Should we be concerned that serotonin levels drop as we get older?
We'll look further into why that matters for aging and anxiety below.
See our article on the complete guide to CBD benefits for anxiety.
We're going to start with lots of bad news but probably information you can already guess (if not feel directly).
Following that, we'll look at new research on what can actually be done for elderly anxiety (and really, depression as well).
It's an exciting time in this area after roughly half a century of the same, tired, and occasionally dangerous medications for anxiety (see CBD versus anxiety medications).
We're going to look at the benzos and SSRIs commonly prescribed for the elderly with anxiety as well.
More importantly, we're going to look at research on a host of molecules and practices showing promise for elderly anxiety:
- Key probiotics
- Mindful Meditation and Exercise
We'll touch on these topics:
- Quick overview of elderly anxiety
- Causes of anxiety in the elderly
- Hormones, neurotransmitters, and key nutrients drop with elderly anxiety
- What research shows for CBD and elderly anxiety
- Anti-anxiety medications and elderly anxiety
- Other aids for elderly anxiety according to research
- CBD dosage for elderly anxiety
- Best CBD for elderly anxiety
Let's get started...no time to waste (we appreciate that better than anyone).
Quick overview of elderly anxiety
Anxiety is up across the board over the past few decades but there's a bit of a disconnect for the elderly.
On one hand, anxiety has been shown to decrease for people as they get older:
In the 50- to 64-year age group, prevalence rates decreased. They were lowest in the elderly (65 to 79 years). That means that even without treatment, anxiety disorders do not last until old age in most cases.
It's all relative.
The prevalence of elderly anxiety is multiples higher than for dementia or depression:
Yet, anxiety disorders surpass the other well-known "geriatric giants" in their prevalence among older adults (10-20%), being twice as common as the dementias (8%) and four to eight times more prevalent than a major depressive disorder (1-3%)
Interestingly, GAD or general anxiety disorder rates increase as we get older with the average onset being 40.
This is a big clue to elderly anxiety!
See our article on can CBD help with general anxiety disorder.
It's also something we can actually unravel and perhaps, help to offset as we'll explain below.
We're not talking about an occasional anxious response but a general trend towards worrying.
It turns out there are many causes for this "trait" anxiety to come as we get older.
Let's introduce the key players and look as causes before seeing if there's something we can use to turn the tide.
Causes of anxiety in the elderly
Before we look at causes, we'll need to introduce key players in the anxiety circuit.
We're going to investigate three primary drivers of elderly anxiety:
- Reduced levels of brain connectivity and repair
- Reduced levels of key hormones, neurotransmitters, and nutrients
- Increased inflammation and immune response
New research is really pointing to these drivers for anxiety in general and the results of aging are all over them.
Let's start with brain connectivity and activity
A quick lay of the land:
- Hippocampus - the control switch for anxiety response
- Amygdala - fear and emotional center which gets switched on
- Prefrontal cortex - rational brain needed to balance amygdala response
- White matter - communication links between all involved
As researchers put it for HEALTHY aging:
Probably the most consistent change during healthy aging in the brain structure in humans is the shrinkage in brain volume and the expansion of the ventricular system
The frontal and parietal cortex together with the putamen, thalamus and accumbens are the most affected areas
The frontal cortex...our reason center that keeps the emotional fear center in check.
What about white matter?
Atrophic changes in white matter  play a major role in the reduction of brain volume. The white matter, of which the integrity is crucial for the communication between brain areas, contains mostly large myelinated axons.
The connecting relays between different brain areas are shrinking.
Put a checkmark next to "myelinated". It's the protective sheath for our nerves body-wide and we're going to look at how to reverse that loss later.
Finally, the Achilles heel of the brain for aging (and in general).
It governs memory, spatial mapping, and….stress response.
What happens as we get older?
Yes, certain things can actually boost hippocampus volume (see CBD, meditation, and exercise for hippocampus neurogenesis here):
Olfactory stimulation, environmental enrichment, and exercise, and associated neurotransmitters such as nitric oxide, glutamate, and serotonin, can also modulate the production of new neurons.
What about aging?:
However, the most important risk factor for impaired neurogenesis is the age of the organism.
Neurogenesis just means building new brain!
So the repair and replenish feature of the brain declines as we get older.
Hippocampus, being one of the most prolific sources of new neurons bares the brunt:
However, a significant decline in neuronal number was detected in several brain regions such as the subiculum and hilus regions of the hippocampus
For good reason.
It's the most vulnerable area of the brain to all insults: chronic stress, inflammation, immune response, and….aging!
MRI scans of human brains have found that the human hippocampus shrinks by around 13 percent between the ages of 30 and 80.
If you need a silver bullet to see how powerful the hippocampus is for anxiety, researchers blocked new neurons in this brain area.
First of all, selective obliteration of neural precursors in the hippocampus by inducible over-expression of the pro-apoptotic protein Bax increased anxiety-related behavior
They chemically blocked hippocampus growth and anxiety resulted!
Maybe, more importantly, the only trait affected was...anxiety!:
The effect did not depend on non-specific changes in locomotor activity or differences in exploratory behavior, and specifically affected anxiety, without altering other affective behaviors such as depression.
This all sounds dire, but we'll discuss ways to offset it below!
A few more interesting pieces of research look at changes in the brain for elderly anxiety.
Remember the Amygdala (fear center) and it's countering force, the prefrontal cortex?
A study that explored the neural basis of emotion regulation in elderly GAD reported that, compared with non-anxious subjects, the GAD participants failed to engage the prefrontal structures during worry reappraisal [17, 18], while engaging subcortical structures such as the paraventricular nucleus and the amygdala
Let's translate this since it gets to the heart of our discussion.
Basically, when provided with a threatening situation, elderly people with anxiety did not enlist their prefrontal cortex (the rational part of the brain) and relied more heavily on the emotional fear center (amygdala).
Then, there's stress.
The relationship between cortisol (or the primary stress hormone) and anxiety is well established:
Aging increases the vulnerability to adverse effects of stress because the homeostatic mechanisms preventing an excessive 53 Page 2 of 7 Curr Psychiatry Rep (2015) 17: 53 biological stress response is diminished
The keyword there is "homeostatic".
It means to find balance.
It's a great segue over to CBD and the endocannabinoid system.
First, we have to touch base on one more critically important area.
Hormones and key nutrient loss tied with elderly anxiety
Hormones, neurotransmitters, and key nutrients drop with elderly anxiety
This section could really be an entire article (if not book!) so we'll hit the highlights.
Check out our comprehensive look at pregnenolone here.
You probably haven't heard of it but it's down at your local Whole Foods or available online here.
It's the precursor to all steroidal hormones which drop naturally with age.
In fact, pregnenolone drops about 70% by age 70.
The tie with cholesterol (which it's made from and also goes up with age) is fascinating.
More importantly for anxiety, hormones are NOT just about reproduction.
They have key roles throughout the body and especially for mood (a collective "duuhhh" from any woman who knows her cycle).
Let's look at just two which may help explain why anxiety hits women at about twice the rate of men.
Estradiol. One of the three estrogens.
See our article on estradiol.
Researchers studied its effect on anxiety in elderly mice:
Thus, an acute E2 regimen produced specific anti-anxiety and anti-depressant effects, independent of effects on motor behavior, when administered to aged female C57BL/6 mice.
It's known that women who have their ovaries removed (where estrogen is produced) are more likely to display anxiety and depression.
Women who underwent bilateral oophorectomy before the onset of menopause had an increased risk of depressive symptoms diagnosed by a physician (hazard ratio = 1.54, 95% CI: 1.04-2.26, adjusted for age, education, and type of interview) and of anxiety symptoms (adjusted hazard ratio = 2.29, 95% CI: 1.33-3.95) compared with referent women.
Those are much higher levels of risk!
It's not just women though. A study looked at the effects of estradiol for women and men in the elderly:
Lower E2 levels are correlated with poor cognitive, behavioral, and functional status in older individuals.
Estradiol and 50 different sex hormones all come from...pregnenolone!
Pregnenolone drops as we get older naturally.
Interestingly, there's research on a bi-directional effect between elderly anxiety and cognitive functioning.
Loss of cognitive functioning can cause anxiety. Anxiety can in turn, negatively affect cognitive functioning.
It's a vicious cycle but one that makes perfect sense.
Of course, we're anxious about our memory not working like it used to!
This may be the most interesting aspect of pregnenolone for the elderly.
Keep in mind that its level drops from about 200 at peak (around age 18) to 50 at menopause or the equivalent age for men.
You can see this relationship here:
In animal models, social isolation is associated with anxiety, depression, and decreased pregnenolone levels, (Serra et al, 2000) whereas pregnenolone administration is associated with improved performance on cognitive tasks
What makes it more interesting is that research is showing it's an endocannabinoid!
This is how pregnenolone protects the brain from THC's effects naturally.
That's a perfect transition to CBD.
In addition to hormones, other key substances drop.
- Serotonin (key to repair and neurogenesis) see CBD and serotonin for anxiety
- GABA - the direct lever for anxiety that benzos target - see CBD and GABA for anxiety
- Vitamins such as D, B's, and others
Some key takeaways as it pertains to elderly anxiety:
Serotonin (5-HT) neuron and neurotransmitter loss in normal aging and neuropsychiatric diseases of late-life may contribute to behavioral changes commonly observed in the elderly population.
Older adults had lower GABA+ concentrations in all voxels in comparison with young adults
Put a checkmark by serotonin and GABA for later.
By the way, these are two targets of the most common medications prescribed for elderly anxiety: SSRI's and Benzos (see CBD versus anxiety medications here).
We have to move on or we'll never get to how to correct some of this.
What research shows for CBD and elderly anxiety
We're going to look at how CBD directly impacts these key pathways of elderly anxiety:
- Stress response and inflammation
- Neurogenesis (especially hippocampus)
- Anxiety studies relevant to the elderly (General Anxiety Disorder)
The goal is simple.
- Reduce future damage (stress and inflammation)
- Repair existing damage (neurogenesis)
- Look at actual studies on CBD's effects on anxiety
First, we need to know where CBD does its work.
The endocannabinoid system.
We all have one.
Evolutionarily speaking, it dates back about 600 million years and we share this key system with all animals (even sea urchins).
It's tasked with balancing other key systems:
- Neurotransmitters (such as serotonin)
- Endocrine system - hormones including cortisol, progesterone, and estriol
- Immune system - inflammatory responders - a key to stress response
See our article on how CBD affects acetylcholine the best kept secret neurotransmitter.
Remember that word "homeostasis" from above?
This is THE system for balancing.
What happens to the endocannabinoid system as a result of aging:
Previous studies have demonstrated that the endocannabinoid system significantly influences the progression of brain aging, and the hippocampus is one of the brain regions most vulnerable to aging and neurodegeneration.
Let's start with reducing the effect of stress as we get older.
Just a refresher.
Several studies found associations between hippocampal volume and biomarkers of inflammation in non-demented middle-aged and older adults with or without other vascular risk factors
So...what does research show for CBD and inflammation or stress response?
Let's look at some key markers.
First, Interleukin B.
A researcher describes it this way:
a pro-inflammatory cytokine associated with brain injury and neurodegenerative disease, including neurological disorders that preferentially target the hippocampus
That's a good target (note the hippocampus focus).
CBD reduced both iNOS and IL-1b protein expression, and also decreased related NO and IL-1b production.31 A 50% reduction of each was found in hippocampal homogenates following treatment with 10 mg/kg of CBD.
Another target that comes up often...IL6.
Why is important?:
In a recent MRI study of healthy adults, a genetic variant associated with an increase in pro-inflammatory cytokine IL-6 was linked to reduced density of gray matter in selected parts of the hippocampus
So, IL-6 levels are bad for brain function.
And what does CBD do there?
RT-PCR analysis of cells that were treated with 50 lM CBD for 30 min, and then stimulated with LPS (3 mg/ml) for 4 h, showed reduced mRNA levels of IL-1b, IL-6, and TNF-a. T
Look...our immune and inflammatory systems are complex!
Those are just two key players but they're interesting!
People with high IL-6 levels were shown to "catastrophize" in response to pain and anxiety.
The impact of anxiety and catastrophizing on interleukin-6 responses to acute painful stress
More importantly, is it's increasing effect as we age:
IL-6 as one of the main signaling pathways modulating the complex relationship between aging and chronic morbidity.
To sum it up…
It has been reported that cannabinoids suppress the production of a variety of pro-inflammatory cytokines in both human cell cultures and animal models, an effect that has been thought to be mediated mainly by CB2 receptor
To translate that, the endocannabinoid system (CB2) is at the crossroad of inflammation in the body.
One final send-off for the CBD's effects on protecting from more damage.
It's our primary stress hormone in the body.
The relationship between chronic cortisol and hippocampus function is a nasty one indeed.
This is especially important for elderly anxiety:
In relation to aging, cortisol levels in aging humans predict memory impairment over 5 years and aged humans with significantly prolonged cortisol elevations showed reduced hippocampal volume and deficits in hippocampus-dependent memory tasks compared with normal cortisol controls
There's a direct relationship between the two:
Moreover, the degree of hippocampal atrophy correlated strongly with both the degree of cortisol elevation over time and current basal cortisol levels
Does CBD affect cortisol and our stress response?
Another crossover study showed that plasma cortisol levels decreased more significantly when given oral CBD, 300 to 600 mg,
Check out CBD and cortisol for anxiety
Also, some interesting topics:
- Can CBD help with long term anxiety
- CBD and general anxiety disorder (the type that increases for elderly)
This is just a smattering of what's out there.
To round it out, what about microglial (brain's immune responder) and oxidative damage?
In this context, cannabidiol (CBD) has emerged as a promising strategy to treat the inflammation that results from microglial hyperactivation , with no psychotropic side effects. Moreover, CBD has been shown to attenuate oxidative and nitrosative stress in several human disease models
Both of these are directly tied to elderly brain dysfunction!
What about actually repairing some of this damage found in elderly anxiety?
We're going to focus on a key driver of neurogenesis:
Serotonin is the main lever for SSRI's, which are becoming the go-to medication for elderly anxiety. (See CBD versus SSRI for serotonin and anxiety).
Studies have shown that their primary effect is by increasing neurogenesis (which should be a big clue as to what's going on).
Can CBD help with serotonin signaling in the brain?
This is where it gets really interesting.
Researchers found powerful antidepressant effects from CBD:
Our results demonstrate that CBD exerts fast and maintained antidepressant-like effects as evidenced by the reversal of OBX-induced hyperactivity and anhedonia.
More importantly, they were able to determine how it did this:
CBD significantly enhanced serotonin and glutamate levels in vmPFCx in a different manner depending on the emotional state and the duration of the treatment
When they blocked the serotonin pathway separately, the effect went away.
Not only does this tie CBD to serotonin but serotonin to depression (which is the most common secondary illness with anxiety in the elderly).
Now, if we want to tie everything we've discussed together with CBD:
The anxiolytic effect of cannabidiol on chronically stressed mice depends on hippocampal neurogenesis: involvement of the endocannabinoid system.
All our pieces are right there:
- Anxiolytic (anti-anxiety)
- Stressed (cause of damage)
- Hippocampus (our vulnerable brain area to stress which is tied to anxiety response)
- Neurogenesis (rebuilding new brain area)
See our article on can CBD stimulate hippocampus neurogenesis for anxiety.
This is the holy grail of protecting our brain as we age.
There are now lots of studies on CBD and anxiety generally but not for elderly anxiety specifically.
Forbes did a survey of 1000 seniors who tried CBD to get their results:
Over 65% of the seniors surveyed that tried CBD said that their quality of life was good, while only 31.1% said the same before trying CBD.
Seniors also reported having reduced anxiety, stress relief, and a more positive mood.
Another study had age ranges up to 70:
Anxiety scores decreased within the first month in 57 patients (79.2%) and remained decreased during the study duration.
We would love to see the results broken out with age as we expect the older the participant, the more the benefits!
Let's talk about the usual alternatives for seniors with anxiety.
Anti-anxiety medications and elderly anxiety
We've covered the typical medications prescribed for seniors with anxiety at our:
They're fascinating reads especially since the elderly are prescribed benzos at twice the rate of other age groups.
We'll leave the heavy lifting to those articles but key points jump out for the elderly.
Let's look at it by class.
CBD versus benzos for elderly anxiety
Benzos work to boost GABA (which we discussed in detail above).
The issue is that benzos (Xanax, Ativan, Valium, and others) only work in one direction.
If you keep boosting GABA without stop, you go through a series of results:
- Anti-anxiety and relaxing
It only works one way.
That's why we're getting more reports of overdoses with benzos in the news.
For the elderly, there are other concerns.
For one, the benzos can impair cognitive function and coordination.
There is suggestive evidence that benzodiazepines, especially compounds with long half-lives, may contribute to falls which are a major health problem in old age.
Don't take our word for it:
The American Geriatrics Society (AGS) placed benzodiazepines on a list of medications that should be avoided in patients over 65 years of age.
It turns out that the primary care doctors (typically prescribing benzos for senior anxiety) are not paying attention:
Despite these recommendations, benzodiazepines continue to be prescribed to a group with the highest risk of serious adverse effects from these medications.3 In the United States, more than 10% of women and 6% of men aged 65 to 80 years filled at least one prescription for benzodiazepines in a 1-year period, approximately one-third of them receiving benzodiazepines for longer than 120 days in a year
Here's the net from the Mayo clinic:
benzodiazepine use is associated with risk of dependence, cognitive deficits, falls resulting in fractures, motor vehicle accidents, and overall mortality
I know first hand how tough getting off of benzos can be. Check out how I used CBD for benzo withdrawals and weaning here if you're in that same sinking boat.
Next, stop...when benzos stop working or cause terrible dependence...SSRI's.
If benzos work by immediately pumping the "brake" in the brain GABA, then SSRI's work by pumping serotonin in the brain.
First of all, you'll notice that most of the literature is about depression, not anxiety for SSRI's.
Granted, the two can be intertwined (since both are affected by brain deterioration from stress and inflammation as we labored through above).
It's been shown that SSRI's primary effect is on neurogenesis which we talked about in-depth above.
New studies are putting the cart before the horse:
In this model lower serotonin levels would merely result when cells stopped making new connections among neurons or the brain stopped making new neurons.
This speaks to why it can take 2 weeks before SSRI's show any benefit.
Doctors usually prescribe benzos during this gap window as anxiety and depression can actually go UP.
Let's look at some other key items to consider for elderly anxiety...if only briefly.
Other aids for elderly anxiety according to research
In our few hours a day head down in NIH studies on CBD and anxiety, we've come across a few interesting possibilities:
- Pregnenolone (see our comprehensive review of pregnenolone)
- Probiotics with specific strains (see CBD and probiotics for anxiety)
- Vitamin B's
We'll quickly look at the first three.
Pregnenolone is probably our favorite...especially for elderly anxiety.
It's the mother of all steroidal hormones!
Men and women have similar levels throughout life but it drops from about 200 at peak (age 18) to 50 when we're older.
You really have to check out the review...why this isn't front-page news is beyond us!
It can be purchased here for about $10/month.
Hormones are critical for elderly anxiety (and just about every health concern).
Next up, Turmeric.
Turmeric or curcumin may be a critical anti-inflammatory as we age.
It appears to also help balance hormone levels.
Both are hallmarks of aging (with a negative association).
A study that looked at curcumin used on rats with their ovaries removed is impressive across a range of factors:
Turmeric (or curcumin) is called an adaptogenic.
This may be due to its influence on the balancing endocannabinoid system:
The CB₁ receptor-mediated endocannabinoid signaling and NGF: the novel targets of curcumin.
Probiotics with specific strains for anxiety and mood.
A new line of study is looking at whether our immune system ages and that triggers a series of other issues.
Vitamin B's (especially methylated if you're MTRR or MTHFR - about 40% of the population) are critical as we get older.
Magnesium has a known anti-anxiety effect (especially the "ates" like glycinate or theorate).
Vitamin D is known to decrease as we get older and is critical across key systems in the body and brain.
All of these are relatively inexpensive and very critical.
I source my family's for the best value from:
Back to CBD, our crown jewel.
How much should we take?
CBD dosage for elderly anxiety
Let's look at research for this.
The anti-anxiety effect is dose-dependent.
Some people have an effect at 40 mg (about 1 dropper at the 1000 mg level)...
Other people need quite a bit more.
The research on neurogenesis, however, is better defined.
They found a bell curve response on neurogenesis where it peaked around 300 mg.
It then started to go down as levels increased to 600 mg when another channel was triggered (pPAR pathway).
For this reason, there's generally not a reason to go higher than 300 mg unless extreme anxiety merits it.
For my most intense perimenopause anxiety, I take 160 in the morning and about 160 at night before bed along with magnesium and bio-identical hormones.
See our how many mg of CBD for anxiety article to learn about the 300 mg max for neurogenesis.
Remember...the goal with elderly anxiety is to repair and rebuild brain areas damaged by age, stress, or synaptic "retrenchment".
What about the best CBD for elderly anxiety?
Best CBD for elderly anxiety
Of course, we need the basic requirements to be met:
- Organically grown in the US
- CO2 processed
- 3rd party tested free of:
- No THC (see THC versus CBD for anxiety article)
- No solvents
- No pesticides
- No mold
- No bacteria
We actually test our CBD twice (biomass and finished product).
After all, our entire family takes it.
That's just the beginning.
This is especially important for the elderly.
Histamine issues go up as we get older (that aging immune system we mentioned above).
Women get especially hard.
Roughly 40-60% of the population has histamine issues and all that plant material for full-spectrum is going the wrong direction.
Histamine actually eats up GABA, the chemical brake in our brain used to calm down anxiety responses.
We also mentioned the higher levels for neurogenesis and how important that is for the elderly.
This brings us a good point...we need sufficient levels at a good cost per mg of CBD.
Personally, that's why I use the 6000 mg bottles (a dropper is roughly 170 mg which I take once in the morning and once at night).
Test the 1000 mg bottle first, but consider cost as we have to be able to afford this.
At roughly 3-6 cents per mg, this is some of the best pricing on the market and for good reason.
We want people to be able to feel better. We've been there and no one should suffer that way.
Especially as we get older!
Master overview of CBD and anxiety pathways to look at various aspects we can directly affect.
Links to CBD and anxiety research with dozens of anxiety-specific topics.
Always work with a doctor or naturopath with any supplement!
The information provided here is not intended to treat an illness or substitute for professional medical advice, diagnosis, or treatment from a qualified healthcare provider.