Endocannabinoid signaling as a potential biomarker in anxiety spectrum disorders – A case series

The endocannabinoid system (ECS) is widely distributed across anxiety-related brain regions and represents an underexplored therapeutic and biomarker target. We present two cases of anxiety spectrum disorders showing marked clinical improvement after cannabidiol (CBD) administration. We explore whether peripheral anandamide levels, a key ECS substrate, will correlate with treatment response. Both patients were assessed post-CBD intervention. Symptom reduction correlated with an increase in anandamide levels. Baseline anandamide levels were not available. This case series highlights the putative clinical value of ECS modulation in anxiety spectrum disorders and raises the potential utility of anandamide as a peripheral biomarker. However, limitations include the absence of baseline levels, variability in peripheral ECS expression, and confounding factors such as CBD’s multi-receptor action.