This research illuminates why some patients develop anxiety disorders after stress exposure while others remain resilient, potentially informing personalized treatment approaches. Understanding the brain-immune-endocannabinoid interactions in stress response could guide targeted interventions for vulnerable patients.

This review examines individual variability in stress responses, focusing on the interplay between the HPA axis, immune function, and endocannabinoid signaling in anxiety disorder development. The authors explore how chronic stress leads to sustained HPA activation, amygdala hyperreactivity, and immune dysfunction, while discussing potential biomarkers including amygdala reactivity, cortisol levels, and sleep disturbances as predictors of stress vulnerability. The study emphasizes the endocannabinoid system’s role in modulating stress resilience through its effects on HPA axis regulation and immune responses.

“While this framework elegantly connects stress neurobiology to clinical anxiety presentations, I remain cautious about biomarker-driven treatment selection until we have validated clinical tools. The endocannabinoid system’s central role here reinforces what I observe clinically—that cannabis medicine often helps patients with stress-related anxiety, likely through these same regulatory pathways.”

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