What is the evidence for CBD in social anxiety disorder?

Social anxiety disorder (SAD) is one of the most studied indications for CBD, with a reasonably consistent evidence base. Mechanism: CBD activates 5-HT1A receptors (serotonin receptor implicated in anxiety), reduces amygdala reactivity to threatening stimuli, and modulates prefrontal cortical regulation of fear responses. Key studies: (1) Crippa et al. (2011) fMRI study: 400mg CBD reduced anxiety and altered limbic/paralimbic activity in SAD patients vs. placebo. (2) Bergamaschi et al. (2011): 600mg CBD reduced anxiety, cognitive impairment, and discomfort during a simulated public speaking test in SAD patients — effects comparable to ipsapirone (a 5-HT1A agonist). (3) Masataka (2019): 300mg CBD reduced anxiety in adolescents with SAD during a public speaking task. Limitations: all studies used single doses; no chronic dosing RCTs in SAD; doses used (300–600mg) are far higher than commercial CBD products; no head-to-head comparison with SSRIs or CBT. The evidence is promising but insufficient to recommend CBD as a first-line SAD treatment.