What did I experience? As was the case for Talansky, my sleep improved almost immediately. It wasn’t that I slept more; I felt like I slept better—more soundly, less waking during the night, more often getting out of bed feeling refreshed. By the second week I noticed less overall creakiness while going about daily activities; CBD advocates would say the products had lowered systemic inflammation. Those two changes made me feel like I was recovering better from training, which led to being more eager to train, and feeling better while doing so.
Lidicker added that people’s responses have a lot to do with how they personally process the product, and how cannabinoid receptors are distributed throughout the body. This is why it’s also difficult to standardize dosing recommendations for CBD. I was administering 0.5 ml of CBD oil under the tongue about half an hour before bed every night (that was the amount recommended on the bottle), but it’s worth noting that the concentration of cannabidiol may vary by product and that some people require more or less to feel the effects.
You may be familiar with a concept called the entourage effect. The entourage effect states that cannabinoids work better together than they do alone. In essence, CBD is more effective when combined with other cannabinoids like CBG, CBN, THC, and so on than it is in isolation. The terms “full-spectrum” and “whole-plant” are alluding to this concept. Biologically, a person gets high by having THC bind to CB1 receptors in the brain. CBD also binds to CB1 receptors in the brain and has been shown to actually counteract some of the effects of getting high by blocking the activation of THC in CB1 receptors. CBD changes the shape of the receptor so that there is less room for THC to bind to. CBD has even been shown to decrease the heightened heart rate that you feel from getting high. Therefore CBD can even have an impact on the anxiety that comes from the psychoactive effects of THC.

There are thousands of unique varieties of hemp. The cultivars used for CBD oil contain significantly higher concentrations of CBD than others. Using these uniquely potent plants, it is possible to extract cannabis oil that contains significant levels of cannabidiol, as well as essential vitamins, minerals, fatty acids, terpenes, flavonoids, and other non-psychoactive cannabinoids.
de Mello Schier, A. R., de Oliveira Ribeiro, N. P., Coutinho, D. S., Machado, S., Arias-Carrión, O., Crippa, J. A., . . . Silva, A. C. (2014). Antidepressant-like and anxiolytic-like effects of cannabidiol: A chemical compound of cannabis sativa [Abstract]. CNS & Neurological Disorders - Drug Targets, 13(6), 953-960. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24923339
Critics contend that the Realm of Caring parents are using their kids as guinea pigs, that not enough studies have been done, that many, if not most, of the claims can be dismissed as the result of the placebo effect. “It’s true, we don’t know the long-term effects of CBD, and we should study it,” Meagan says. “But I can tell you this. Without it, our Addy would be a sack of potatoes.” No one asks, she notes, about the long-term effects of a widely used pharmaceutical that has been routinely prescribed for her two-year-old. “Our insurance pays for it, no questions asked,” she says. “But it’s highly addictive, highly toxic, turns you into a zombie, and can actually kill you. And yet it’s perfectly legal.”
Hemp Bombs is slightly different from all the companies we have listed in our compilation because it uses a pure CBD isolate instead of full-spectrum extracts to make CBD oil. Hemp Bombs sources their CBD from European Hemp producers who are known for cultivating the top-notch quality industrial hemp. The company is actually proud to have developed such good business relationships with leading European hemp companies. But the most interesting part about Hemp Bombs’ products contain literally ZERO THC – that’s what the company claims and that’s what is written in the third-party lab testing it provides.
Given the current state of evidence, it is important to avoid assuming CBD is a sustainable long-term intervention for anxiety disorders.  As further research is conducted with larger-scale, longer-term, robustly designed trials – we will better understand the anxiolytic capacity of CBD.  Those with refractory cases of anxiety in search of an alternative pharmacological intervention may want to discuss the feasibility of “as-needed” CBD administration with a medical professional.
As with a fermented food like kombucha, slight natural variations are normal and to be expected in a product such as CBD oil because it is made from living plants. Changes in the weather, soil, and water can all impact the biology of the source material. While we verify Certificates of Analysis (and take many other criteria into consideration during our review process), even the most reputable five-star companies have no way to control for every variable in this organic process.
I couldn’t really tell when the effect of the CBD tapered off, but I had a relatively nice, mellow afternoon.  I noticed slight changes in perception after taking the BioCBD+ to the extent that I knew the formulation had “kicked-in.”  Whether these perceptual changes were a direct result of cannabidiol, the other herbal additives in the product, or a combination of both – isn’t clear.
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Overall, existing preclinical evidence strongly supports the potential of CBD as a treatment for anxiety disorders. CBD exhibits a broad range of actions, relevant to multiple symptom domains, including anxiolytic, panicolytic, and anticompulsive actions, as well as a decrease in autonomic arousal, a decrease in conditioned fear expression, enhancement of fear extinction, reconsolidation blockade, and prevention of the long-term anxiogenic effects of stress. Activation of 5-HT1ARs appears to mediate anxiolytic and panicolytic effects, in addition to reducing conditioned fear expression, although CB1R activation may play a limited role. By contrast, CB1R activation appears to mediate CBD’s anticompulsive effects, enhancement of fear extinction, reconsolidation blockade, and capacity to prevent the long-term anxiogenic consequences of stress, with involvement of hippocampal neurogenesis.

Kat’s Naturals offers five non-THC tinctures of varying concentrations: Heal and Naked (1,500mg), Balance (750mg), Metabolize (500mg), and Relax (300mg). All five tinctures are available in 5mL to 30mL containers, which can sustain users anywhere from five days to four weeks, depending on their dosage. Kat’s Naturals tinctures are derived from 99% pure fat soluble CBD isolate and pose no risk for yielding positive results on drug tests. For best results, Kat’s Naturals recommends ingesting three to five drops under the tongue and holding them in place for 60 seconds.
The seizures started in May 2013 when she was six months old. Infantile spasms, they were called. It looked like a startle reflex—her arms rigid at her side, her face a frozen mask of fear, her eyes fluttering from side to side. Addelyn Patrick’s little brain raced and surged, as though an electromagnetic storm were sweeping through it. “It’s your worst possible nightmare,” her mother, Meagan, says. “Just awful, awful, awful to watch your child in pain, in fear, and there’s nothing you can do to stop it.”

Whether the claim of 10-fold bioavailability of nano-engineered CBD can be scientifically verified isn’t known, however, preliminary testing from the company suggests that 10 mg of their product is equivalent to 100 mg of others.  Assuming the nano-engineering is effectively increasing bioavailability by 10-fold, each BioCBD+ capsule I’ve taken (with 10 mg CBD) is delivering the equivalent of 100 mg standard CBD.
One of the most experienced practitioners in this field is Los Angeles physician Bonni Goldstein, who has used the compound to treat dozens of children with intractable epilepsy. She says about half of these patients have seen a significant drop in the number of seizures. “Used in the right way, with the right patient, CBD is extremely powerful,” she says.
If you just don’t have the time or inclination to take supplements every day, but you still want to experience the potential benefits of CBD, this Hemp Oil CBD Patch from Pure Ratios could be just what you’re looking for. With little fuss or need for specialist know-how or equipment, simply apply a patch to the target area and enjoy a slow-release 40-mg serving of CBD that will last for up to 96 hours.
Lidicker added that people’s responses have a lot to do with how they personally process the product, and how cannabinoid receptors are distributed throughout the body. This is why it’s also difficult to standardize dosing recommendations for CBD. I was administering 0.5 ml of CBD oil under the tongue about half an hour before bed every night (that was the amount recommended on the bottle), but it’s worth noting that the concentration of cannabidiol may vary by product and that some people require more or less to feel the effects.

Cannabis sativa, a species of the Cannabis genus of flowering plants, is one of the most frequently used illicit recreational substances in Western culture. The 2 major phyto- cannabinoid constituents with central nervous system activity are THC, responsible for the euphoric and mind-altering effects, and CBD, which lacks these psychoactive effects. Preclinical and clinical studies show CBD possesses a wide range of therapeutic properties, including antipsychotic, analgesic, neuroprotective, anticonvulsant, antiemetic, antioxidant, anti-inflammatory, antiarthritic, and antineoplastic properties (see [11, 12, 16–19] for reviews). A review of potential side effects in humans found that CBD was well tolerated across a wide dose range, up to 1500 mg/day (orally), with no reported psychomotor slowing, negative mood effects, or vital sign abnormalities noted [20].
Opioid receptor modulator: Another possible mechanism by which CBD may alleviate symptoms of anxiety is through allosteric modulation of mu-opioid receptor (MOR) and delta-opioid receptor (DOR) sites.  Though it is known that allosteric modulation of the MOR and DOR is capable of reducing anxiety, it isn’t fully understood how.  Some speculate that MOR and DOR sites affect GABAergic and dopaminergic neurotransmission.
Can’t sleep? Cannabis oil also works for people with insomnia. The calming effects of the oil help people to sleep calmly, relieving issues of anxiety and restlessness. A 2015 scientific review published in the American Journal of Health-System Pharmacy found that cannabis treatment is effective for military veterans with post-traumatic stress disorder (PTSD). Research suggests that cannabinoids, the psychoactive components of unrefined cannabis, regulates neurotransmitter release and produces a wide range of central nervous system effects, including increased pleasure and alteration of memory processes.
While CBD predominantly has acute anxiolytic effects, some species discrepancies are apparent. In addition, effects may be contingent on prior stress and vary according to brain region. A notable contrast between CBD and other agents that target the eCB system, including THC, direct CB1R agonists and FAAH inhibitors, is a lack of anxiogenic effects at a higher dose. Further receptor-specific studies may elucidate the receptor specific basis of this distinct dose response profile. Further studies are also required to establish the efficacy of CBD when administered in chronic dosing, as relatively few relevant studies exist, with mixed results, including both anxiolytic and anxiogenic outcomes.
Although nearly all of the published studies found CBD effective for the attenuation of anxiety, there are some notable limitations associated with the research.  Perhaps the most notable limitation is the fact that most CBD studies investigate the effect of acute, single-dose administration.  The problem with this is that it remains unclear as to whether chronic or long-term CBD ingestion maintains therapeutic efficacy.
de Mello Schier, A. R., de Oliveira Ribeiro, N. P., Coutinho, D. S., Machado, S., Arias-Carrión, O., Crippa, J. A., . . . Silva, A. C. (2014). Antidepressant-like and anxiolytic-like effects of cannabidiol: A chemical compound of cannabis sativa [Abstract]. CNS & Neurological Disorders - Drug Targets, 13(6), 953-960. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24923339

One study comparing the effects of THC and CBD even found that, while THC increased anxiety by activating the neurotransmitters involved in the "fight or flight" response, CBD actually repressed autonomic arousal—or the nervous system response associated with sudden increases in heart rate or respiration. In other words, CBD is ideal for people looking to relax and unwind—not get out of their minds.
Hemp Bombs is slightly different from all the companies we have listed in our compilation because it uses a pure CBD isolate instead of full-spectrum extracts to make CBD oil. Hemp Bombs sources their CBD from European Hemp producers who are known for cultivating the top-notch quality industrial hemp. The company is actually proud to have developed such good business relationships with leading European hemp companies. But the most interesting part about Hemp Bombs’ products contain literally ZERO THC – that’s what the company claims and that’s what is written in the third-party lab testing it provides.
Buying CBD OIL has never been easier.  Since CBD Oil from the Hemp plant does not contain unlawful measures of THC, it is legitimate in every one of the 50 states. This is imperative to individuals everywhere throughout the US who need CBD however can’t get it locally. What’s more, legitimate CBD is accessible for home conveyance in every one of the 50 states meaning numerous individuals don’t need to move to a state with sanctioned Medical Marijuana. Additionally, in states where medicinal weed is lawful, buyers utilizing this hemp plant type of CBD don’t need to obtain a medical marijuana card.
Hi Dr. Kevin. Thanks for your question. I have seen people react differently to CBD. For some, yes it can help them relax and sleep. For others, it can make them feel more energetic. And yes, unfortunately for some it may increase their anxiety. For those people, CBD would not be a good fit. You made a good observation about the possibility this has to do with the terpenes involved. There are some theories about that but I have no definitive knowledge on that being the cause.
Many who take prescription medication for insomnia or other sleep-related issues complain of feeling lethargic, nauseated, distracted, and unable to focus - and that’s just some of the side-effects. Many of those who take prescription medication are also unable to operate vehicles or machinery, which can mean the loss of mobility and even the loss of income. But how do you find something that helps you maintain a decent sleep without all the horrible side-effects of prescription medication?
Preclinical evidence conclusively demonstrates CBD’s efficacy in reducing anxiety behaviors relevant to multiple disorders, including PTSD, GAD, PD, OCD, and SAD, with a notable lack of anxiogenic effects. CBD’s anxiolytic actions appear to depend upon CB1Rs and 5-HT1ARs in several brain regions; however, investigation of additional receptor actions may reveal further mechanisms. Human experimental findings support preclinical findings, and also suggest a lack of anxiogenic effects, minimal sedative effects, and an excellent safety profile. Current preclinical and human findings mostly involve acute CBD dosing in healthy subjects, so further studies are required to establish whether chronic dosing of CBD has similar effects in relevant clinical populations. Overall, this review emphasizes the potential value and need for further study of CBD in the treatment of anxiety disorders.
Talansky says that his sleep improved almost immediately when he started taking CBD daily. Soon after, he was also less anxious about transitioning from pro cycling to his new sport, felt that he recovered more quickly from hard training, and had fewer flare-ups of his old cycling injuries. Now he encourages other athletes to try CBD, in part “to get rid of the association with smoking weed,” he says. “It’s completely different.”
Further testing found what the world now knows: This compound is the plant’s principal active ingredient, its mind-altering essence—the stuff that makes you high. Mechoulam, along with a colleague, had discovered tetrahydrocannabinol (THC). He and his team also elucidated the chemical structure of cannabidiol (CBD), another key ingredient in marijuana, one that has many potential medical uses but no psychoactive effect on humans.
Cannabidiol can be taken into the body in multiple different ways, including by inhalation of cannabis smoke or vapor, as an aerosol spray into the cheek, and by mouth. It may be supplied as an oil containing only CBD as the active ingredient (no added THC or terpenes), a full-plant CBD-dominant hemp extract oil, capsules, dried cannabis, or as a prescription liquid solution.[1][3]
Cannabidiol also works with anxiety by boosting our own endocannabinoid levels, meaning that we can naturally produce more of the things inside of us that put us in a good mood without needing extra things like CBD. Another interesting side effect of CBD with anxiety is that CBD actually boosts our own natural production of endocannabinoids such as anandamide.
The vape would be very easy to carry around, but I don’t really enjoy having to inhale something, as it reminds me of when I had a problem with drugs back in the day.  You’d also have to use it more often.  This could be a great method for you, however, the brand I used was probably low quality and I have no idea if using a better brand would change my opinion on using a vape.

The truth is that no one knows precisely what any of these molecules are doing to us. It is a case of finding the effects first and working backwards to understand the mechanisms. “There are a number of possible transmitter systems that CBD could act on,” says McGuire. “And it’s not 100% clear which ones are critical for anxiety, or psychosis or schizophrenia. But [the antipsychotic effect] is a different mechanism from existing treatments, which is a big deal because existing treatments aren’t working.”
Results indicated that CBD significantly reduced subjective measures of anxiety as evidenced by changes in VAMS scores.  Neuroimaging data revealed decreased ECD-tracer uptake when participants received the CBD compared to when they took the placebo.  Particularly, activity in the left amygdala-hippocampal complex and the left posterior cingulate gyrus decreased following CBD administration.
Cannabidiol (CBD) is a component of Cannabis sativa that has a broad spectrum of potential therapeutic effects in neuropsychiatric and other disorders. However, few studies have investigated the possible interference of CBD on the sleep-wake cycle. The aim of the present study was to evaluate the effect of a clinically anxiolytic dose of CBD on the sleep-wake cycle of healthy subjects in a crossover, double-blind design. Twenty-seven healthy volunteers that fulfilled the eligibility criteria were selected and allocated to receive either CBD (300 mg) or placebo in the first night in a double-blind randomized design (one volunteer withdrew from the study). In the second night, the same procedure was performed using the substance that had not been administered in the previous occasion. CBD or placebo were administered 30 min before the start of polysomnography recordings that lasted 8 h. Cognitive and subjective measures were performed immediately after polysomnography to assess possible residual effects of CBD. The drug did not induce any significant effect (p > 0.05). Different from anxiolytic and antidepressant drugs such as benzodiazepines and selective serotonin reuptake inhibitors, acute administration of an anxiolytic dose of CBD does not seem to interfere with the sleep cycle of healthy volunteers. The present findings support the proposal that CBD do not alter normal sleep architecture. Future studies should address the effects of CBD on the sleep-wake cycle of patient populations as well as in clinical trials with larger samples and chronic use of different doses of CBD. Such studies are desirable and opportune.

Oil method or Carrier Oil Extraction – a popular method based on extraction by a carrier oil, usually olive oil. It is save and there is no unwanted, harmful residue in the extracted oil. There’s just one downside to this method: carrier oils have a short shelf life. Therefore, CBD hemp oil made in this way should be stored in smaller amounts and ingested orally.
Endocannabinoids (ECS), a group of endogenous cannabinoid receptors that play a key role in memory, mood, brain reward systems, drug addiction, and energy balance. They are also known as »the body’s own cannabinoid system«. Research shows the benefits of the ECS system in fighting depression, anxiety, increasing appetite, and creating feelings of well-being. CBD naturally acts on the ECS system’s signals to increase receptor function and flow. CBD, along with 2-Arachidonoylglycerol(2-AG), is involved in the regulation of appetite, immune system functions and pain management.
Is it possible that some types or “strains” of hemp extracts used for CBD tinctures/capsules could actually increase a persons anxiety and insomnia? I’m a chiropractor and I personally use and sell CBD products in my office. I sell a few different brands. I have had several patients complain about a new higher dosage (50mg per serving) brand saying it actually increased their anxiety, increased their heart rate and prevented them from sleeping well. I have a few other patients that say that this same brand has been very useful in pain relief. Does this have more to do with the terpene profile that the amount of CBD?
It's the Wild West out there. Without any federal regulatory body checking labels, consumers have very little way of knowing what they're buying when they purchase CBD oil. Bonn-Miller co-authored a study that found that 26 percent of CBD products on the market contained less CBD than their label claimed. So the amount you need for an effective dose could vary drastically, not just from product to product, but from bottle to bottle of the same product.
Hi. I really do believe it depends on the mg & ratio of the CBD to THC. My first try at high CBD : low THC tincture oil was with Humboldt Anthropology 16:1. I started off with 2 drops twice a day after 3 days I went to 4 drops twice a day. After a few daysof that I went up to 6 drops and then 8 drops and then 10 drops twice a day. 10 drops twice a day was a perfect dosage for me. FINALLY no pondering worries or fears from all the “what if’s”. If I didn’t want to think about something I had control over not thinking about it. It was an amazing feeling. It was complete FREEDOM. Sadly the dispensary I use no longer has the Humboldt Anthropology 16:1 tincture. Last week I moved on to my first trial with a different brand. They recommend Jayden Juice 28:1 tincture 2 to 3 drops twice a day. Very 1st dose tried 4 drops(because I was up to 10 with my other tincture) and felt weird. Kinda spaced or like a head change. Not sure if it was my tincture or the fear (my anxiety) of trying something different. Didn’t like that feeling one bit. My second dose for the day I took 2 drops. With that said I took 2 drops twice a day for a couple of days. I could feel the anxiety stirring around within me. That warm tingling feeling in my chest and arms. All the “what if” thoughts are far off in the back ground of my mind. Crazy thing because I haven’t felt that feeling in over a year while taking Humboldt Anthropology 16:1 even after the passing of our son this past Aug. As of yesterday I started 3 drops twice a day with the Jayden Juice 28:1 that I currently have. Praying that I can make this work for me. $80 for .05 oz is a tad pricey, “what if” it doesn’t work for me.

Hi. I really do believe it depends on the mg & ratio of the CBD to THC. My first try at high CBD : low THC tincture oil was with Humboldt Anthropology 16:1. I started off with 2 drops twice a day after 3 days I went to 4 drops twice a day. After a few daysof that I went up to 6 drops and then 8 drops and then 10 drops twice a day. 10 drops twice a day was a perfect dosage for me. FINALLY no pondering worries or fears from all the “what if’s”. If I didn’t want to think about something I had control over not thinking about it. It was an amazing feeling. It was complete FREEDOM. Sadly the dispensary I use no longer has the Humboldt Anthropology 16:1 tincture. Last week I moved on to my first trial with a different brand. They recommend Jayden Juice 28:1 tincture 2 to 3 drops twice a day. Very 1st dose tried 4 drops(because I was up to 10 with my other tincture) and felt weird. Kinda spaced or like a head change. Not sure if it was my tincture or the fear (my anxiety) of trying something different. Didn’t like that feeling one bit. My second dose for the day I took 2 drops. With that said I took 2 drops twice a day for a couple of days. I could feel the anxiety stirring around within me. That warm tingling feeling in my chest and arms. All the “what if” thoughts are far off in the back ground of my mind. Crazy thing because I haven’t felt that feeling in over a year while taking Humboldt Anthropology 16:1 even after the passing of our son this past Aug. As of yesterday I started 3 drops twice a day with the Jayden Juice 28:1 that I currently have. Praying that I can make this work for me. $80 for .05 oz is a tad pricey, “what if” it doesn’t work for me.
In an initial experiment, the male Wistar rats received injections of CBD and were exposed to 60 minutes of restraint stress – with cardiovascular responses recorded.  In a second experiment designed to determine effects of CBD on the 5-HT1A receptor, researchers administered a 5-HT1A antagonist prior to the CBD.  Precisely 24 hours after CBD administration, the Wistar rats were tested in an elevated plus-maze to gauge anxiety.
107. Hindocha C, Freeman TP, Schafer G, et al. Acute effects of delta-9-tetrahydrocannabinol, cannabidiol and their combination on facial emotion recognition: a randomised, double-blind, placebo-controlled study in cannabis users. Eur Neuropsychopharmacol. 2015;25:325–334. doi: 10.1016/j.euroneuro.2014.11.014. [PMC free article] [PubMed] [Cross Ref]
Anyone who wants a safe, natural health supplement can use CBD. Some people take it just to boost their body’s systems and balance their general health. Others take it to treat specific ailments, such as anxiety, pain, inflammation, and even epilepsy and some nerve and muscle afflictions. While the FDA hasn’t’ approved CBD oil and it shouldn’t be considered a medicine, an increasing number of people all over the world have discovered the healing properties of high CBD liquid. Everyone wonders what the future may hold. We will soon find out.
I’ve been struggling with sleep for almost a decade. I started with over-the-counter pills for sleep, then moved to Xanax for sleep. The Xanax works like magic to help me sleep. I’d take three 0.5mg and in 30 mins I’d be in a deeep sleep. However, I would like to wing off pills to sleep for my poor liver and just within the last 2 days have came across this CBD alternative. Given how long I’ve been using a sleep aid and amount I take to sleep, what mg would you recommend taking to sleep? I wanna buy the pen. Also, is there different brands, or strains or whatever like there is with THC “regular weed” or is it all pretty much the same and only separated by MG amount? If there is a different strain of these oils which one is best for pain and for insomnia?
Grant says this may lead to a “dampening” or mellowing of some neurochemical processes, including those linked to pain. “CBD may also react with other receptors, like those for serotonin, and it may have actions that reduce the inflammatory molecules produced whenever there is tissue damage or bacteria coming in,” he says. “But we really don’t know the mechanisms.”
An animal study involving male Wistar rats conducted by Resstel et al. (2009) examined the effect of CBD on restraint stress (RS).  Previous research had demonstrated that the phytocannabinoid cannabidiol (CBD) yielded anxiolytic and antipsychotic properties in animal models.  For this reason, they investigated whether CBD facilitates adaptation to scenarios of inescapable stress and whether this response is mediated by 5-HT1A receptors.
Cross-sectional studies have found a direct correlation between more severe PTSD symptomatology and increased motivation to use cannabis for coping purposes, especially among patients with difficulties in emotional regulation or stress tolerance. When using cannabis treatment, military veterans with PTSD reported reduced anxiety and insomnia and improved coping ability. (5)
My trouble falling asleep has never been a major problem. But when I recently learned that nearly 60 percent of people taking cannabidiol—better known as CBD, one of the over 80 compounds found in the marijuana plant—are doing it to help with sleep, I was intrigued. (That stat's according to a survey conducted by Brightfield Group and HelloMD, an online community that brings doctors and cannabis patients together.)
Summary: Early research has found that CBD oil has the potential to reduce chronic pain, anxiety, depression and acne, and may help those overcoming addiction. Its anti-inflammatory properties may also play a role in lowering the risk of diabetes and cardiovascular disease. It has even shown anti-tumor effects and could be effective in inhibiting the progression of cancer and its related symptoms.

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