Social anxiety disorder (SAD) is a debilitating disorder, characterized by fear and anxiety in social situations. Evidence suggests that the levels of SAD are rising, in particularly after the COVID-19 pandemic. Serotonin and noradrenaline reuptake inhibitors and cognitive-behavioral therapy are effective treatments for SAD. Nevertheless, a significant number of patients do not respond well to these therapeutic options. During the last years, Cannabis and cannabinoid-containing products have been investigated for the treatment of different neuropsychiatric disorders. Nevertheless, their efficacy for the treatment of anxiety disorders is still a matter of debate. The purpose of this review was to investigate subjective, behavioral, and neurobiological effects of Cannabis and cannabinoids in social anxiety and SAD. A search in the PubMed database for articles published between the years of 2003–2023 was conducted. One hundred and seventeen (117) original studies were identified. After the exclusion criteria, eighteen (18) studies were selected. The studies investigated the effects of the cannabinoids Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in patients or healthy volunteers submitted to tasks that assessed social anxiety. Results showed that CBD decreases social anxiety, producing an inverted U-shaped curve, with anxiety measurements being reduced at intermediate doses administered orally (300–600 mg), but not at lower or higher doses. THC either reduces (lower doses, 6–7.5 mg) or increases (higher doses) social anxiety measurements. CBD attenuates the anxiogenic effects of THC. The effects of THC and CBD in anxiety are associated to the modulation of fronto-limbic regions. Further clinical trials, conducted with male and female patients and larger cohorts are still necessary to consolidate these results.

中文翻译：

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大麻和大麻素对社交焦虑的主观、行为和神经生物学影响

社交焦虑症 (SAD) 是一种使人衰弱的疾病，其特征是在社交场合中感到恐惧和焦虑。有证据表明，SAD 的水平正在上升，特别是在 COVID-19 大流行之后。血清素和去甲肾上腺素再摄取抑制剂以及认知行为疗法是治疗 SAD 的有效方法。然而，大量患者对这些治疗方案反应不佳。在过去的几年里，大麻含大麻素的产品已被研究用于治疗不同的神经精神疾病。然而，它们治疗焦虑症的功效仍然存在争议。本综述的目的是调查主观、行为和神经生物学影响大麻以及大麻素在社交焦虑和 SAD 中的作用。在 PubMed 数据库中检索了 2003 年至 2023 年之间发表的文章。确定了一百一十七 (117) 项原始研究。排除标准后，选择了十八 (18) 项研究。研究调查了大麻素 Δ 的影响9-接受评估社交焦虑任务的患者或健康志愿者体内的四氢大麻酚（THC）和大麻二酚（CBD）。结果表明，CBD 可降低社交焦虑，产生倒 U 形曲线，口服中等剂量（300-600 毫克）时焦虑测量值会降低，但较低或较高剂量时不会降低。THC 可以减少（较低剂量，6-7.5 毫克）或增加（较高剂量）社交焦虑测量值。CBD 可以减弱 THC 的焦虑作用。THC 和 CBD 对焦虑的影响与额叶边缘区域的调节有关。仍需要对男性和女性患者以及更大的队列进行进一步的临床试验来巩固这些结果。