Condition · ICD-11 6B00
Anxiety disorders
Reviewed by Dr. Placeholder C (HPCSA MP0XXXXX · Psychiatry) · Last updated · Published
Generalised anxiety disorder (GAD), social anxiety, and panic disorder collectively affect a significant slice of South African adults. First-line treatment is evidence-based psychotherapy — CBT in particular — combined with an SSRI or SNRI where pharmacotherapy is indicated. Cannabinoid-based therapy is a developing area. It is considered in South Africa only as an adjunct to ongoing psychological care, with careful attention to cannabinoid class: CBD-dominant formulations are typically preferred over THC-dominant products, because higher-dose THC can paradoxically worsen anxiety.
What the evidence says
A 2019 systematic review (Soltani et al) found modest anxiolytic effects of CBD in healthy volunteers and patients with social anxiety at controlled doses, but clinical-trial evidence for sustained efficacy in generalised anxiety remains limited. Whiting et al (JAMA 2015) noted low-quality evidence for cannabinoids in anxiety. THC at higher doses has a documented biphasic effect — small doses may reduce anxiety, larger doses can worsen it. The South African Society of Psychiatrists treats cannabinoid therapy as second-line at most.
How the doctor will evaluate you
Expect questions about symptom duration, triggers, functional impact, current SSRI / SNRI trial history with dose and duration, concurrent psychological therapy, substance-use screening, and family history of psychosis or bipolar-I disorder. If first-line treatment has not been trialled, the doctor will generally recommend that before discussing cannabinoids. A CBD-dominant formulation is typically considered first if cannabinoid therapy is approved, with careful low-and-slow titration.
When to see a doctor urgently
- Personal or family history of psychosis or bipolar-I disorder
- Active suicidal ideation requiring acute mental-health review
- Active substance-use disorder, including problematic alcohol use
- First-line psychotherapy never trialled
- Symptoms driven by an untreated medical cause (thyroid, cardiac) — work this up first
If any of the above apply, seek in-person medical care — do not wait for a remote Section 21 consultation.
The South African Section 21 pathway
Anxiety is evaluated case-by-case in the Section 21 pathway. Applications are stronger with a treating psychologist or psychiatrist’s letter documenting first-line treatment history. THC-dominant formulations are unusual first-line choices; CBD-leaning products are more commonly considered. Authorisations are time-limited with mandatory review points.
Frequently asked
- Does CBD work for anxiety?
- The evidence is modest and largely short-term. CBD appears to reduce acute anxiety in experimental settings, but robust data for sustained relief in chronic anxiety disorders is still limited. It is considered alongside — not instead of — psychotherapy and conventional medication.
- Can THC make anxiety worse?
- Yes. Higher-dose THC can trigger or worsen anxiety, panic, or paranoia — particularly in patients with no prior cannabinoid exposure. Doctors typically avoid THC-dominant formulations for anxiety or use very low doses under close review.
- Will cannabinoids interact with my SSRI?
- CBD and THC are CYP450 substrates and can affect the metabolism of several SSRIs. Fluoxetine, sertraline, and citalopram all have plausible interactions at higher CBD doses. The doctor will review your full medication list and may choose to monitor you more closely.
Related conditions
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