The Endocannabinoid System
Could cannabis be helpful for your anxiety? While research on this topic is ongoing, it’s clear that cannabis does have the ability to shift stress levels.
This is primarily because of how cannabis interacts with your body’s natural endocannabinoid system. This important system in the human body is made up of three main parts, endocannabinoids, receptors and enzymes. The endocannabinoids are molecules very similar to cannabinoids (some of the active chemicals in cannabis), but these are produced naturally in our own body. Endocannabinoids bond with endocannabinoid receptors (known as CB1 and CB2 receptors), which are found throughout the body on the surface of cells. This activates a chain response that maintains our body’s internal homeostasis (or balance) and stimulates many of our bodies most important functions, such as:
- stress response
- memory building
- muscle control
- and pain
Then, enzymes serve the important role of breaking down endocannabinoids and clearing them from our system.
While the endocannabinoid system should work on its own in healthy individuals, with receptors being stimulated by our natural endocannabinoids, cannabinoids (some of cannabis’s active ingredients) can also stimulate CB1 and CB2 receptors to activate their effects. This is how cannabis provides so many medicinal and psychoactive effects in humans and other mammals.
When it comes to anxiety, activating these receptors could be particularly helpful since the endocannabinoid system signaling regulates our stress and anxiety levels. One study found that endocannabinoid signaling determines how frightening we will find fear-evoking stimuli, and what we will see as an appropriate behavioral response. So, somewhat unsurprisingly, researchers have noticed that when endocannabinoid function is impaired or dysregulated, it can lead to the development of anxiety disorders. Theoretically, it makes a lot of sense why cannabis could help those with anxiety conditions. By adding cannabinoids to stimulate the endocannabinoid system, patients may be able to relieve their anxiety.
It makes a lot of theoretical sense that cannabis might help with anxiety, and notably, anxiety is one of the most common conditions that people treat with cannabis. In North America, for example, it is in the top five symptoms people report using cannabis for. Still, it’s important to look at the research as well, to see whether using cannabis is actually helping those with anxiety disorders.
One thing researchers have found is that cannabis intake can cause blunted stress reactions for those undergoing stressful stimuli. In one study, scientists administered stress tests, like doing math in a public performance or plunging hands into ice water, with subjects who either used cannabis or did not. Cannabis users reported lower stress levels during the test than non-users. Even more interesting, the test results showed that cannabis users had less cortisol in their system (a hormone that indicates stress) than those who didn’t use cannabis.
In a similar study, scientists had participants with generalized social anxiety disorder take part in a public speaking stress test. Some were given a placebo beforehand while others were given a 600mg dose of CBD (a cannabinoid in the cannabis plant). Those who had CBD beforehand had greater improvement on subjective and physiological anxiety measures than those using the placebo.
Other studies have shown patients with chronic pain may see greater short term relief from anxiety symptoms when taking cannabis rather than a placebo. Unfortunately, many of these studies have methodological issues that leave scientists taking them with a grain of salt. Meta-reviews of the literature admits there is some evidence that medical marijuana can help with anxiety but caution that it is limited.
And there are studies showing results in the opposite direction as well.
While cannabis can relieve anxiety, studies show that it can also cause it. Cannabis users have known this for a long time. While cannabis sometimes seems to produce relaxation, at other times it seems to induce anxiety and a sense of paranoia. In some cases, this has been associated with dosage. The same cannabinoids that relieve anxiety in low doses, may increase it at higher doses. For both major cannabinoids, THC, and CBD, studies have shown what are called biphasic effects. In other words, cannabis can produce opposite effects at different doses. The dose you take may be the difference between an anxiety-inducing or an anxiety-relieving experience.
In addition to these immediate effects, cannabis may have on anxiety, there is some evidence to suggest that using cannabis may worsen anxiety symptoms over time. The 2017 National Academy of Sciences report described one study which followed respondents who reported cannabis use for a three-year period. They didn’t find correlations between cannabis use and most anxiety disorders, but they did note a statistically significant tie between cannabis use in older adults and developing a social anxiety disorder. This did not hold for younger populations so it is unclear whether this might be due to physiological differences from age, or social factors related to cannabis stigma that might lead older users to withdraw from social settings. Either way, the NAS reported moderate evidence that using cannabis could result in social anxiety disorders in older adults, and limited evidence it could lead to developing another kind of disorder.
The research on anxiety has been limited and somewhat inconclusive in large part because of cannabis’ unpredictable effects on anxiety. With some studies showing positive results and others showing negative results, researchers and patients alike are left wondering what factors will produce positive results regularly. While one factor is clearly dosage, cannabis is also an extremely diverse plant and medical marijuana products can contain a wide variety of different active chemical components. Depending on the particular blend of cannabinoids, and other active ingredients like terpenes and flavonoids (the other medicinally active chemicals in cannabis), you might experience very different effects from your cannabis.
To confirm this theory, and hone in on the best chemotypes for treating anxiety, researchers at Whistler Therapeutics in Canada created a study testing which strains were most and least effective at relieving anxiety. This was the first (and only) study of its kind — looking at differences in anxiety-related effects amongst different cannabis strains.
To pull this off, they worked exclusively with one company that grows and sells its own cannabis, tracking each strain’s chemical composition. The researchers included 25 strains and surveyed 442 patients about these specific strains. Respondents were asked to rate the most and least effective strains for reducing their anxiety. Then researchers compared these survey results to two sets of independent lab tests showing the chemical composition of the reviewed strains.
Of the strains tested (and keep in mind this list is limited to those 25 strains) the best-rated strains for relieving anxiety were Kush varieties of cannabis, with a blend containing high levels of the terpenes trans-nerolidol, b-Caryophyllene, and D-limonene in all three strains. In addition, the statistical analysis found that the strongest correlation with a strain helping with anxiety was high THC and high levels of the terpene trans-nerolidol.
The analysis of the least effective strain suggests that the terpene terpinolene may be particularly unhelpful for anxiety and to a lesser degree the terpenes guaiol, eucalyptol, g-terpinene, a-phellandrene, 3-carene, and sabinene hydrate.
While this study was limited, it points to the fact that anxiety may be affected differently depending on the chemical profile of the cannabis product.
Based on the research, using cannabis for your anxiety could be helpful or harmful, either relieving symptoms of anxiety or potentially causing or worsening them. So for those seeking to use cannabis for anxiety, it’s best to consult a medical doctor or with expertise in cannabinoid science. These medical professionals can help you to determine if cannabis is the right treatment for you, and what types of cannabis might be best suited to your needs.
You should also make sure that cannabis is legal as a treatment for anxiety where you live, before beginning cannabis use.
Currently, patients with some types of anxiety and a doctor’s recommendation or prescription are able to use cannabis in the following countries:
- Puerto Rico
- And Uruguay
You can also use cannabis if you have certain kinds of anxiety disorders and a doctor’s recommendation in these US states:
- District of Columbia
- New Jersey
- New Mexico
- New York
- North Dakota
- West Virginia
Everyone has times in their lives when they might feel anxious, like before taking an important test or going into a job interview; but people with an anxiety disorder experience anxiety more frequently and more intensely. When you have an anxiety disorder, you feel anxiety that is more severe, lasts for longer, and/or occurs more often than regular bouts of anxiety.
There are several types of anxiety disorders and other conditions where anxiety is the main symptom. These include:
- Phobias – This is when your symptoms are triggered by particular circumstances. Some of the most common phobias include seeing a spider (arachnaphobia), being surrounded by too many people in a wide open space (agoraphobia), feeling trapped in a narrow, enclosed space (claustrophobia), or being in social situations (social anxiety phobia).
- Medically-induced anxiety disorders – This is when your feelings of anxiety, fear, or danger are caused by a different physical health problem.
- General anxiety disorder (GAD) – This is a very common type of anxiety disorder that affects 3.1% of the US population. Unlike a phobia, there’s no specific trigger that causes you to feel the symptoms of anxiety. You feel them during ordinary, regular daily experiences. GAD often comes along with mental health disorders like depression.
- Panic disorder – If you have a panic disorder, you’ll typically experience panic attacks—short but intense feelings of terror, doom, and danger, along with chest pain, shortness of breath, and/or heart palpitations. Sometimes, once you’ve had a panic attack, worrying about experiencing it again can be enough to bring one on.
- Post-traumatic stress disorder (PTSD) – This is an anxiety disorder that’s caused by a specific, extremely terrifying or traumatic event.
- Separation anxiety disorder – This disorder affects children, and is diagnosed when a child is more upset than normal about being separated from their parents or people in a parental role.
- Substance-induced anxiety disorder – This is anxiety or fear that’s caused by drug abuse, exposure to a toxic substance, or certain medications.
There are also other anxiety disorders and conditions which don’t fit any of the types mentioned above, but where you still experience anxiety-related symptoms that disrupt your life and cause you distress.
When you have an anxiety disorder, you could feel both physical and/or psychological symptoms. These symptoms could begin in childhood, or develop later in life. Some people who have anxiety develop the symptoms just after a particular, upsetting or traumatic event, but symptoms can also develop some years afterwards.
Psychological symptoms of anxiety include:
- Feeling restless, nervous, or stressed
- Struggling to concentrate, because your anxiety is filling your mind
- A sense of impending doom, dread, or panic
- A strong desire to avoid those situations that trigger anxiety
Physical symptoms of anxiety include:
- A raised heart rate, palpitations
- Breathing much faster than normal (hyperventilation)
- Shaking or trembling
- A dry mouth
- Nausea, a stomach ache, or sickness
- Pins and needles and/or achy and sore muscles
If you have GAD, you might feel some of these symptoms on a low level most or all the time, as a kind of background to your daily life. People who have GAD might find it hard to remember the last time they felt relaxed. It’s possible to have had general anxiety for a very long time, without realizing it, because you’re so used to feeling that way.
Other people might feel these symptoms very intensely and severely, but for short periods of time. For example, panic attacks are attacks of extreme anxiety that can reach a peak within just a few minutes. If you have a panic attack, you might feel your heart rate rising, find it difficult to breathe, feel dizzy, trembling, and sweaty, and feel convinced that something terrible is about to happen. At times, people may mistake a panic attack for a heart attack, especially if they’ve never felt any symptoms of anxiety before, because it can develop so suddenly and so intensely.
It’s important to remember that symptoms of anxiety can vary from one person to the next. You might not experience all or even most of these symptoms. Anxiety often occurs together with another mental or physical health disorder, which can make it more difficult to spot symptoms of anxiety.
When to see a doctor
Sometimes it can be difficult to know when to go to the doctor because of your symptoms, so here’s a brief guide.
- You’re worrying so much that it’s taking over your life
- Your anxiety is interfering with your work, your relationships, or your daily life
- You’re avoiding certain situations, places, or people because of it
- You feel depressed, you’re struggling with alcohol or substance abuse, or you have other mental health concerns as well as anxiety
- If you feel suicidal, you should seek emergency help immediately
If you have anxiety and you don’t seek any help, it could get worse over time and lead to complications like depression, social isolation, drug or alcohol abuse, chronic insomnia, and severe headaches. Like many disorders, you’ll be able to treat your anxiety more effectively if you deal with it early.
In general, anxiety disorders can be treated. It depends very much on what type of anxiety disorder you experience and how early you seek treatment for it. The sooner you get help for your anxiety, the better your chances of reducing it or eliminating it entirely.
If your anxiety is caused by a medical condition, or as a side effect of certain medications, then treating the underlying condition and/or stopping taking that drug should also deal with your anxiety. Even learning how to live with that condition is a step forward. But sometimes, the anxiety disorder has already become a habit, and it can continue even after the medical cause has been addressed
There are some medications that work to treat anxiety. Some of them take longer to work than others. Medication for anxiety includes:
- SSRIs (selective serotonin reuptake inhibitors) – These antidepressants increase the level of serotonin in your brain, helping you feel more relaxed. SSRIs can take several weeks to start working, but they are safe to take for many, many years. SSRIs include sertraline, escitalopram, and paroxetine.
- SNRIs (serotonin and noradrenaline reuptake inhibitors) – This is another type of antidepressant that raises your levels of serotonin and noradrenaline to help soothe your anxiety. SNRIs can also take a few weeks to begin working, and they can have unpleasant side effects during the first couple of weeks. SNRIs include venlafaxine and duloxetine.
- Benzodiazepines – These are sedatives that relieve symptoms of anxiety very quickly, in as little as half an hour. However, they can’t be taken for long periods of time because they’re very addictive, and also get less effective the longer you use them. If you’re prescribed a benzodiazepine, it will be for a maximum of 4 weeks. The most common benzodiazepine is diazepam.
- Therapy – For some people, psychological therapies work very well for the treatment of anxiety disorders. Guided meditation, applied relaxation, cognitive behavioral therapy (CBT), and group therapies can all be effective for anxiety. You’ll generally need to learn these techniques from a trained therapist, but once you’ve mastered them you can apply them on your own, whenever you need to.
- Alternative therapies – Some alternative therapies, like hypnotherapy, can be effective for treating anxiety disorders.
- Lifestyle changes – Many people find that making some lifestyle changes can help treat their anxiety. Getting exercise, avoiding alcohol and drugs, and taking part in activities that you enjoy can all help reduce the symptoms of anxiety.