This open-label, single-group, non-randomized interventional study will evaluate longitudinal changes in anxiety symptoms, sleep quality, psychological well-being, treatment adherence, tolerability, and safety in adults with clinician-confirmed generalized anxiety disorder. Participants will receive CannaRiver CBD Calm, an oral/sublingual broad-spectrum cannabinoid tincture containing cannabidiol (CBD), cannabinol (CBN), and cannabigerol (CBG), at a protocol dose of 0.5 mL approximately every 12 hours for 8 weeks. Follow-up will continue through Week 12. The study has no placebo or concurrent comparator group. The primary outcome is change in the Generalized Anxiety Disorder 7-item scale (GAD-7) total score from baseline to Week 8. Findings will be descriptive and hypothesis-generating; the design cannot establish that any observed change was caused by the product.
Generalized anxiety disorder is a chronic condition characterized by excessive and difficult-to-control worry and associated symptoms that may include restlessness, fatigue, impaired concentration, irritability, muscle tension, and sleep disturbance. Evidence for cannabidiol in anxiety is heterogeneous and formulation-specific. Acute experimental studies involving CBD, including studies associated with the Crippa and Zuardi research programs, provide a rationale for further investigation but do not establish efficacy for generalized anxiety disorder or for the CannaRiver formulation. Evidence for the combined use of CBD, CBN, and CBG in this formulation and schedule is limited. The study will enroll approximately 60 adults with clinician-confirmed generalized anxiety disorder and a GAD-7 score of at least 10 at screening and baseline, subject to the final ethics-approved age range. Participants will receive CannaRiver CBD Calm at 0.5 mL approximately every 12 hours for 8 weeks, followed by assessment through Week 12. The nominal product composition is 5,000 mg CBD, 1,250 mg CBN, and 1,250 mg CBG per 60 mL bottle; actual exposure will be based on the lot-specific Certificate of Analysis. The product will not be titrated routinely. The study is open-label, non-randomized, and single-group. It has no placebo or concurrent control group. The primary outcome is change in GAD-7 total score from baseline to Week 8. Secondary outcomes include trajectories of anxiety symptoms, selected measures of sleep quality and psychological well-being, adherence, retention, and safety. Optional instruments will be included only if their final versions, permissions, language validation, and electronic implementation are confirmed before registration. Scheduled serum AST/TGO and ALT/TGP testing will be performed at baseline/Day 0 before first dose, Week 4 and Week 8/end of treatment. These tests provide transaminase surveillance but are not a complete hepatic panel. Routine urine, toxicology and pregnancy testing is not planned. If results or symptoms suggest liver injury, or if another serious adverse event or urgent condition occurs, the study product will be interrupted when appropriate and the participant will be referred for clinical evaluation and additional diagnostic testing. The protocol remains limited by the possibility of changes between scheduled sampling time points. Data will be collected through the Lidera Health ePRO/eCRF environment, subject to documented validation, role-based access, audit trails, data-processing agreements, privacy-impact assessment, contingency procedures, and human review of safety alerts. The platform will not independently diagnose, determine eligibility, change the dose, assign causality, or replace clinical judgment or emergency services. The protocol will be submitted to the Research Ethics Committee (CEP) via Plataforma Brasil, following CNS Resolutions 466⁄2012 and 510⁄2016. Results will be reportedfollowing STROBE guidelines for observational studies.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
60
CannaRiver CBD Calm Tincture, broad-spectrum oral/sublingual cannabinoid formulation. The current nominal label states 5,000 mg CBD, 1,250 mg CBN, and 1,250 mg CBG per 60 mL bottle. At the protocol dose of 0.5 mL approximately every 12 hours, the nominal daily exposure is approximately 83.33 mg CBD, 20.83 mg CBN, and 20.83 mg CBG. The final record will use the lot-specific Certificate of Analysis and final product manual to describe the exact formulation, excipients, flavor, storage, dosing device, and validated administration instructions.
Change in Generalized Anxiety Disorder 7-Item Scale (GAD-7) Total Score From Baseline to Week 8
The GAD-7 is a 7-item participant-reported measure scored from 0 to 21, with higher scores indicating greater anxiety symptom severity. Change will be calculated as the Week 8 score minus the baseline score. The primary analysis will estimate the mean within-participant change with a two-sided 95% confidence interval using the prespecified repeated-measures model.
Time frame: Baseline to Week 8 (Day 56 ±5 days)
Trajectory of GAD-7 Total Score From Baseline Through Week 12
GAD-7 total scores will be collected at baseline and scheduled follow-up visits to describe the longitudinal pattern of anxiety symptoms during treatment and after treatment. The study is uncontrolled; the trajectory will be interpreted as an observed within-participant pattern rather than a causal treatment effect.
Time frame: Baseline, Weeks 2, 4, 6, 8, and 12
Participants With a Decrease of at Least 4 Points in GAD-7 Total Score at Week 8
The number and percentage of participants with a decrease of at least 4 points from baseline to Week 8 will be summarized. The threshold is a prespecified descriptive benchmark and does not establish that the intervention caused the change.
Time frame: Baseline to Week 8 (Day 56 ±5 days)
Change in World Health Organization 5-Item Well-Being Index (WHO-5) Score From Baseline to Week
The WHO-5 is a participant-reported measure of positive psychological well-being. Scores will be transformed according to the prespecified scoring method, with higher scores indicating greater well-being. The analysis will estimate within-participant change from baseline to Week 8.
Time frame: Baseline to Week 8 (Day 56 ±5 days)
Change in Pittsburgh Sleep Quality Index (PSQI) Global Score From Baseline to Week 8
The PSQI global score is a participant-reported measure of global sleep quality over the preceding month. Change from baseline to Week 8 will be summarized using the prespecified analysis. Higher PSQI global scores indicate poorer sleep quality.
Time frame: Baseline to Week 8 (Day 56 ±5 days)
Adherence to the CannaRiver CBD Calm Dosing Schedule Through Week 8
Adherence will be assessed using electronic dose diaries, participant reports, returned-product reconciliation, and documented dose interruptions. The percentage of expected doses taken during the applicable exposure period will be summarized.
Time frame: From first dose through Week 8 (Day 56)
Treatment-Emergent Adverse Events and Serious Adverse Events Through Week 12
Treatment-emergent adverse events, serious adverse events, events leading to product interruption or discontinuation, clinically suspected liver injury, serum AST and ALT values at baseline/Day 0, Week 4 and Week 8/end of treatment, sedation or psychomotor symptoms, gastrointestinal symptoms, psychiatric deterioration, suicidality, pregnancy, and suspected medication interactions will be collected and summarized. Routine urine, toxicology and pregnancy testing is not planned; additional testing will be clinically indicated when needed.
Time frame: From first dose through Week 12
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