Panic attacks landed me in the ER 3 times due to perimenopause hormone drops and a slew of nasty medications multiple doctors prescribed.
This is personal for us so we're going to investigate every aspect of panic attacks and panic disorder to see how CBD affects their pathways.
We've covered many aspects of anxiety pathways and CBD but panic attacks and panic disorder are different from general anxiety.
Some of the same actors are at work though so there's some interesting crossover.
They are still a bit different in cause since panic attacks generally do not have a significant cue or source.
Needless to say, panic attacks are one of the most common forms of anxiety in the Western world and intimately tied to well-being.
They're also more likely to affect women and very prevalent during perimenopause so a hormone aspect is at play.
That's just the beginning of where we're going.
Wait till you see the effects of prior trauma, stress, and infection below!
We're going deep into areas of the brain that most articles never touch on:
- dPAG - where we anticipate and react to bad things
- The habenula (seat of dread feeling)
- Orexin - the hormone of "vigilance" and if too much...panic attacks
The reason for this exploration is important...there is real research now on what drives panic attacks.
We're going to look at all of that and then find out if CBD can help with the specific pathway at work.
You'll learn about what drives panic attacks in the brain and body either way!
We'll cover these basic questions that come up:
- What is happening in the brain during a panic attack
- Can panic attacks cause brain damage or affect memory
- How do hormones affect panic attacks
- Can CBD help with panic attacks
- How much CBD to take for panic attacks
- What's the best CBD to take for panic attacks
Let's get started.
Of course, we'll start where panic attacks start….in the brain!
What is happening in the brain during a panic attack
First...to distinguish the two...panic attacks are one-off feelings of dread, fear, and have a host of physical and emotional reactions.
Panic disorder is when you have multiple panic attacks in a given period of time.
We'll just use panic attacks going forward but the same mechanism is at play for panic disorder.
Two main players come into play with panic attacks and panic disorder.
- dorsal periaqueductal gray matter (DPAG)
That last one is a doozy but stay with us...it's very interesting.
The Amygdala is part of our "reptilian" brain...the very old parts that we share with all animals and yes….even reptiles.
It's that old evolutionarily speaking.
It's the center of our fear and emotional processing.
If you read our CBD benefits for anxiety article (or any of them for that matter), you'll see the Amygdala looms large.
If it's overactive or not kept in check by the "rational" part of our brain...the prefrontal cortex, anxiety can spike.
Where things get interesting with panic attacks is the other part at play.
This is the part of the brain in charge of how we'll respond to life or death threats.
An interesting study looked at brain scans under different threat situations.
For example, if a bear is 50 feet away, this is processed in the prefrontal cortex (just behind the forehead).
This is our rational brain since we still have plenty of time to analyze the threat.
If the bear is 5 feet away however, the activity shifts to the DPAG.
No time to rationally process the situation….react!!
Fight or flight. Freezing. All this behavior resides here. It's the brain processing center for dread!
Read more here:
Researchers found hyperactivity in scans during panic attacks at the DPAG area:
Stimulation of the dorsal and lateral aspects of the PAG can provoke defensive responses characterized by freezing immobility, running, jumping, tachycardia, and increases in blood pressure and muscle tonus.
That sounds relevant to panic attacks.
Researchers went on to say…
When our defense mechanisms malfunction, this may result in an over-exaggeration of the threat, leading to increased anxiety and, in extreme cases, panic.
This speaks to some of the symptoms of panic attacks such as freezing up and even depersonalization (an extreme protective major symptom when faced with significant threats).
Let's also talk about the two key neurotransmitters most prominently targeted for panic attacks.
- GABA (should be well acquainted from any of our anxiety articles)
- Serotonin - less prominent but at the heart of how SSRI's work (if they do work)
See our article on can CBD boost GABA for anxiety
First, GABA since it's the biggest IMMEDIATE lever for anxiety and panic attacks.
It's the brake pedal in our brain.
It slows down activity and one result of this is to remain calm.
Too much stress, glutamate, inflammation, and/or histamine can all eat up GABA in the brain.
Benzo's directly boosted levels of GABA (till tolerance goes the other way) as their primary weapon against GABA (see CBD versus benzos here).
See our article on comparing CBD and anxiety medication.
As for research on the matter:
There is considerable evidence that dysfunction of GABA(A) receptors plays an important role in the pathophysiology of panic disorder.
Serotonin is a little more nuanced.
It's a workhorse across the brain and body with many different effects.
Serotonin has been implicated in both anxiety and panic disorder although with less direct effect than with depression.
As in a variety of psychiatric disorders, the serotonergic neurotransmitter system has previously been implicated both directly and indirectly in panic disorder.
This article is not an easy read but it goes on to show how serotonin signaling (not levels) appear to have an impact on panic attacks.
It also points to brain imaging of the DPAG and hippocampus for abnormal activity during panic attacks.
We've touched on the DPAG above and the hippocampus is part of our "reptilian" brain along with the amygdala above.
Put a checkmark for all of those as we'll come back around to them.
One final piece of the puzzle that's fascinating.
It's a small pea-sized area of our ancient brain.
Research is showing this to be the area in charge of dread or the expectation of bad and painful events.
Another way to say dread.
Interestingly, it also is tied in with our pain sensitivity system.
Just the expectation of pain causes our pain system to signal.
The expectation of bad events hurts!
So much so that we'll take electric shots earlier to get them over with:
This is an interesting intersection at the habenula as it pertains to panic attacks:
Both anxiety sensitivity and pain-related anxiety were significantly and uniquely predictive of post-challenge panic attacks, total post-challenge panic attack symptoms, and intensity of cognitive panic attack symptoms
We'll come back to the habenula below when discussing our endocannabinoid system.
Those are the major players (both brain areas and neurotransmitters).
Let's move on!
Can panic attacks cause brain damage or affect memory
This is a common question.
It's hard to determine the "arrow" when looking at panic attacks and inflammation.
We have an entire article on anxiety and inflammation here.
The tricky part is knowing which comes first.
More research keeps popping up which shows inflammation may be at the heart of anxiety and depression.
This makes sense since stress has been shown to cause damage to key areas of the brain.
Chronic restraint stress produced approximately 3% reduction in hippocampal volume
See our article on can CBD stimulate the hippocampus neurogenesis for anxiety and brain repair.
Remember the hippocampus from above?
Inflammation, stress, and immune response can all negatively impact hippocampus volume.
This is directly tied to anxiety, depression, and a host of mental health issues.
Anxiety figures into this…
Pathological anxiety and chronic stress are associated with structural degeneration and impaired functioning of the hippocampus and the prefrontal cortex (PFC), which may account for the increased risk of developing neuropsychiatric disorders, including depression and dementia
This issue there is "pathological" and "chronic".
We want to avoid ongoing panic attacks or panic disorder.
Here's the exciting piece.
Early life stress, infection, and trauma can directly drive FUTURE risk of panic attacks:
different traumatic experiences in childhood are predictive of social anxiety (SAD) or panic disorder (PD) in adulthood.
Other researchers have actually found the genes responsible for this brain loss:
Let's introduce the henchmen of stress...corticosterone. It carries out the orders in the brain and nervous system.
Acute corticosterone treatment is sufficient to induce anxiety and amygdaloid dendritic hypertrophy
It is also responsible for some of the damage caused by intense stress.
We have some really good news on this below with CBD so for now, just note hippocampus loss.
How do hormones affect panic attacks
Fluctuations of hormones like estrogen can affect anxiety in general but generally not panic attacks or panic disorder. In men's brains, testosterone is converted to estrogen via aromatase!
There is, however, another hormone called orexin.
Too little of it and you can get narcolepsy.
Too much of it???
Panic attacks are 2.5% more likely in women than men.
Women also suffered more severe symptoms.
Orexin, produced in a circuit emanating from the brain's hypothalamus, regulates arousal, wakefulness, and reward
There's an ingenious experiment in which the researchers used a special salt (sodium lactate) which causes panic responses.
It directly boosts levels of orexin in the brain.
When they blocked the genes for orexin production, the panic response went away.
When they looked at people...it got more interesting:
Those with panic disorder had higher levels of orexin than those without panic disorder. In addition, those with only panic anxiety had significantly higher orexin levels than those with major depression accompanying their panic anxiety.
Might this affect the gender difference for panic disorder and anxiety in general?
Increased orexin expression and activation were observed in females compared to males.
Orexin is called the "vigilance" hormone.
Evolutionarily, you could see how there might be a gender difference in importance there!
We'll look at how CBD affects orexin directly below (very exciting).
How to improve CBT treatment for panic attacks with CBD
We go through all the major current treatments for panic disorders at the link below:
All have very significant downsides that you can research at our CBD versus anti-anxiety medications here.
A different approach is Cognitive Behavioral Therapy or CBT.
This is basically retraining the brain on how to process responses.
It can be very effective but requires a great deal of time and effort.
You're literally creating new pathways in the brain!
This requires a process called neurogenesis to function correctly.
There may be a way to speed up the process with CBD.
CBD has been shown to spur neurogenesis in the hippocampus.
This may be the root of CBT's ability to retrain our behaviors and responses to stress:
Increased hippocampal volume and gene expression following cognitive behavioral therapy in PTSD
CBD appears to work on this same pathway with profound effects on anxiety and panic attacks:
CBD induced a substantial increase in net neurogenesis by a CB1 receptor-dependent mechanism
We'll touch on this below in terms of CBD and panic attacks directly.
We have an entire article on how CBD, meditation, and exercise have been shown to increase neurogenesis for anxiety.
Let's get into that now.
Can CBD help with panic attacks
What about panic attacks specifically (although there is some overlap with anxiety)?
First, there's the powerful study on public speaking which has strong parallels (if not outright similarities) to panic attack reactions.
We've written extensively on CBD and public speaking here but the net result:
Pretreatment with CBD significantly reduced anxiety, cognitive impairment and discomfort in their speech performance, and significantly decreased alert in their anticipatory speech.
It's a fascinating read so check out our entire review of this experiment.
Public speaking symptoms are very similar to panic attacks and different from generalized anxiety.
Freezing. Depersonalization. Heart rate and blood pressure jump.
It's a great proxy for panic attacks.
Another important aspect of the study was this.
The effects occurred with diagnosed social anxiety patients...not healthy subjects:
After CBD (600 mg, p.o.) treatment, however, a significant reduction in anxiety-related measures obtained during their speech performance was observed.
Social anxiety also has some elements in common with panic attacks and you can learn about CBD and social anxiety here.
Let's look at panic disorders directly.
In an animal study with mice exposed to snakes, there was a clear lessening in the common symptoms of panic attacks:
Cannabidiol caused a clear anti-aversive effect, decreasing explosive escape and defensive immobility behaviors
Remember that dPAG area we discussed above?
It's the key area in the brain for our fight or flight response and is overactive in people during panic responses.
In another test on rats, there's was a clear effect from CBD administered after stimulating the Dpag:
Intra-dorsal periaqueductal gray administration of cannabidiol blocks panic-like response by activating 5-HT1A receptors.
There's the DPAG (dorsal periaqueductal gray)!
More importantly...did you see the 5-HT1A at the end there?
Hmmm….the plot thickens!
That's serotonin….the main lever of SSRI's, a common medication used for anxiety and panic attacks.
CBD has been shown to support serotonin signaling.
It doesn't just jack up levels of serotonin-like the SSRI's (which can cause a laundry list of issues….see CBD versus SSRI's here).
It helps to balance the signaling of serotonin.
This is incredibly important to depression and a host of mental health issues….including panic attacks.
Cannabidiol modulates serotonergic transmission and reverses both allodynia and anxiety-like behavior in a model of neuropathic pain
Essentially, it "rescued" serotonin fuction, reduced anxiety and pain sensitivity.
This gets to the heart of the panic disorder.
Everyone might experience panic attacks at some time during their life.
Recurring panic attacks or panic disorder is a different deal.
Serotonin signaling deficiencies may be key to partially address this.
The study found that long term use of CBD offset the panic responses as opposed to one-off dosing:
The results showed that repeated but not acute peripheral administration of CBD decreases escape responses in the ETM, suggesting a panicolytic effect.
This speaks to CBD literally supporting new brain connections and areas.
Speaking of long-term effects on panic disorder, remember the whole hippocampus area discussed above and neurogenesis (making new brain mass and connections)?
This may be our favorite aspect of CBD across a host of mental health issues and aging in general:
In addition to serotonin, other mechanisms might be involved in the anti-panic effects of CBD. For instance, chronic treatment with CBD can increase the anandamide levels within the hippocampus with concomitant increases of hippocampal neurogenesis
Anandamide is back-up stres buffer response when serotonin is exhausted:
Now we're going to introduce two pathways of CBD on panic disorders that you probably won't find anywhere online (except deep in NIH research).
They're too fascinating not to include.
After all, we crafted IndigoNaturals based on research!
We touched based on the two areas tied to panic attacks:
- Habenula - pea-sized part of our old brain tied to dread anticipation
- Orexin - the "vigilance" hormone tied to panic response when too high (gender-specific)
Does CBD have any influence there?
We'll start with the Habenula.
The Lateral Habenula Directs Coping Styles Under Conditions of Stress via Recruitment of the Endocannabinoid System.
The habenula is tied to our response to stress. This is partially governed by the endocannabinoid system which CBD supports.
When researchers block the CB1 receptor, anxiety effects and poor stress response were displayed. When they boosted CB1 activity:
CB1R blockade increased basal corticosterone, augmented proactive coping strategies, and reduced anxiety-like behavior.
Focus on the word corticosterone.
We looked at it above as the actual chemical that causes the stress response during a panic attack.
What does CBD do with anandamide (primary CB1 receptor actor) with panic response?:
For instance, chronic treatment with CBD can increase the anandamide levels within the hippocampus with concomitant increases of hippocampal neurogenesis
Check out CBD and the endocannabinoid system.
This is going in the right direction.
What about orexin?
CBD, Orexin, and Panic Attacks
Too much orexin has been directly tied to panic attacks.
This may partially explain why women are 2.5 times more likely to have panic disorder over men.
Researchers are just starting to tease out how the endocannabinoid system interacts with orexin (hypocretin system) but there's definitely a relationship.
Let's remind why this is important for panic attacks:
Here we show that activation of ORX-synthesizing neurons is necessary for developing a panic-prone state in the rat panic model
Orexin may be a key component of the difference between panic disorder and general anxiety disorder.
Until the researchers tease out the exact mechanisms between the cannabinoid system in our body and orexin, we can look at known relations.
GABA and orexin!
Remember that GABA is our inhibitory or "calming" neurotransmitter.
It's does most of the heavy lifting of offsetting excitatory chemicals like Glutamate, Histamine, Cortisol, and...orexin!
Our results demonstrate that orexin neurons are under inhibitory control by local GABAergic neurons
You'll notice from all our articles that GABA is the key lever for anxiety-related issues.
There is considerable evidence that the dysfunction of GABAA receptors or dysregulation of GABA concentrations in the CNS (or both) plays an important role in the pathophysiology of panic disorder.
Perhaps run-away orexin is overwhelming GABA is the key. By the way, progesterone manages the orexin pathway and it's dropped by 50% at age 40.
So what does CBD do there?
You can read all about CBD's effects on GABA levels for anxiety here.
A quick take away…
The maximal level of enhancement seen with either CBD or 2-AG were on α2-containing GABAA receptor subtypes, with approximately a 4-fold enhancement of the GABA EC5 evoked current
2-AG is naturally occurring endocannabinoid in our brain that CBD supports by the way.
4x's signal potential from CBD on GABA.
This boosts our ability to balance orexin production.
Goodness...this is a chemistry class.
It's the chemistry of panic attacks though and clearly CBD directly and positively affects the pathways of panic disorder.
You can learn all about CBD versus anti-anxiety medications here to understand why its safety offers such a better profile.
One final note....there's interesting research on two fronts that we can directly impact:
- Histamine and Panic attacks
- B6 and Iron for panic attacks
First the histamine side. Researchers were looking at reduced histamine diets for allergies.
Although the allergic reactions didn't go down, those participants who had panic attacks saw them go away as a result of the low histamine diet!
As for B6 and Iron, another set of researchers found the following:
We found that both Vit B6 and iron levels were significantly lower in the PA/HVA group than in the volunteer group.
Just important tools we can actually use now.
So...how much CBD should we take for panic disorders?
How much CBD to take for panic attacks
The studies above ranged from 300-600 mg of CBD but we have some insightful guidance from research on anxiety which is very important.
In a particular study, they found that levels from 100-600 mg had anti-anxiety effects but the 300 mg had the best neurogenesis effect which is key to long term brain changes for panic disorder.
For this reason, we wouldn't look higher than that level.
Check out how many mg of CBD for anxiety article here.
Always start low (25-30mg) and test how your body reacts.
The public speaking study was 600mg cbd isolate 1 hour before a very stressful situation.
The side effects and safety profile of CBD is very strong but it must be isolate to match what is used in research.
That's why we focus on Isolate (as opposed to full-spectrum)...that's where the research is!
Let's look at that piece.
What's the best CBD to take for panic attacks
We talked about how orexin is excitatory (not enough and you have narcolepsy...too much and you have panic attacks).
Another highly excitatory chemical in the brain is histamine!
Check out histamine, CBD, and anxiety here.
In fact, a powerful antihistamine is also known to have a powerful anti-anxiety effect!
We focus on CBD Isolate for a reason.
All the plant material in "full-spectrum" that everyone is selling (based on scant research) is likely to cause a nasty histamine response.
40-60% of people have histamine issues.
That number goes higher for women and higher yet for women over 40!
We found that out the hard way by trying 3-4 big brands of full-spectrum CBD (because we were told they were so much better) with nasty side effects.
That's how we eventually found CBD Isolate and based on our experience and research (see above...we don't mess around), crafted IndigoNaturals.
We really want people to feel better and at the lowest cost per mg of CBD available with:
- Organically grown in the US
- 3rd party tested
- THC free (huge histamine issue plus other problems)
- CO2 processed
- Bacteria free
- Mold free
- Heavy metal-free
Our whole family uses IndigoNaturals (anxiety was one issue...see our story here).
Perimenopause hormone drop sent me to the ER 3 times with panic attacks.
I know all too well how this feels and what CBD can do for it!
The anxiety and panic attack toolkit:
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.