Medical marijuana for anxiety
Sep 23, 2019
Can marijuana help with anxiety?
Can cannabis be a helpful remedy for anxiety? While research on this topic is ongoing, it’s clear that cannabis is very popular — both recreationally and medicinally — for its ability to elevate the mood and make simple everyday experiences more enjoyable, or just less stressful. Along with sleep, anxiety is one of the most common reasons people use cannabis therapeutically.
Cannabis also interacts with the body’s endocannabinoid system, which plays an important role in modulating functions ranging from sleep to mood, energy, and pain.
It’s worth noting though, that like with many medications, there isn’t a single set dose that works for everybody. The active ingredients in cannabis can produce two opposite effects, depending on the dose taken. In the case of anxiety, low doses can ease anxiety whereas higher doses can exacerbate it. As such, using cannabis to ease anxiety can take some trial and error, and a medical professional should be consulted.
Medical research on anxiety and cannabis
Anxiety is one of the most common conditions that cannabis is used to treat — one of the top five in North America. Let’s take a look at what the research says, to better understand if and how cannabis actually helps people with anxiety disorders.
The research on anxiety has been limited and somewhat inconclusive, in large part because of cannabis’s unpredictable effects on anxiety. While one factor is clearly dosage, cannabis is also an extremely diverse plant and cannabis products can contain a wide variety of different active chemical components — producing very different effects.
- In 2018, researchers at Whistler Therapeutics in Canada published a study that tested which strains were most and least effective at relieving anxiety. While the study was limited, it provided evidence that anxiety may have different effects depending on the chemical profile of the cannabis product used.
- A systematic review published in 2015 also found some evidence that cannabinoid treatment can help with anxiety, but caution that it’s limited due to those unpredictable effects on the condition.
- A study from 2018 found that pure THC “appears to cause more anxiety than whole plant cannabis,” and that further investigations are needed to determine which chemotypes are anxiolytic (relieves anxiety) and which are anxiogenic (causes anxiety). This also supports evidence that CBD can counteract the anxiety producing effects of just THC.
- A 2017 National Academy of Sciences study 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.
CBD and anxiety
Cannabidiol (CBD) is one of more than 140 identified cannabinoids, and because it does not have the intoxicating effects of THC, it is often widely available in places where medical marijuana has not been legalized. There is some research that seems to indicate CBD can be helpful for treating anxiety.
- In a 2019 study that tracked 72 patients with anxiety or poor sleep treated with CBD, anxiety scores decreased within the first month in 57 patients, and sleep scores improved within the first month for 48 patients.
- In a 2011 study, researchers 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 dose of CBD. Those who had CBD beforehand had greater improvement on subjective and physiological anxiety measures than those who took the placebo.
How cannabis works on anxiety
The endocannabinoid system (ECS) exists in all vertebrates and helps regulate crucial functions such as sleep, pain, mood and appetite. The human body produces its own cannabinoids, which modulate and activate its various functions, but as its name suggests, the endocannabinoid system can also be modulated and activated by cannabinoids found in the cannabis plant. Because the entire system was only discovered in the past 30 years, scientists still have much to learn about the myriad ways cannabis affects the human body.
When it comes to anxiety, the fact that cannabis interacts with the ECS indicates why it is a promising treatment for anxiety. This is because the ECS regulates stress and anxiety levels, and when endocannabinoid function is impaired or dysregulated, it can lead to the development of anxiety disorders. By adding cannabinoids to stimulate the endocannabinoid system, patients may be able to relieve their anxiety.
Research carried out in 2015 found that the ECS is key to the body’s shift from active to passive fear response and plays a role “in guarding against fear, anxiety, and stress.” In addition, a 2005 study carried out on mice found that the ECS has “a pivotal role in the regulation of emotional states and may constitute a novel pharmacological target for anti-anxiety therapy.”
Additional studies have shown some promising results:
- A study from 2015 found that the ECS determines how frightening we will find fear-evoking stimuli, and what we will see as an appropriate response. Researchers noticed that an impaired or dysregulated endocannabinoid system can lead to the development of anxiety disorders.
- A 2011 study found that there is support for the hypothesis that endocannabinoid signaling “regulates anxiety in humans” and suggests that activation of cannabinoid receptors by endocannabinoids “could produce anxiolytic (anxiety reducing) effects.” That said, the researchers also noted that while its use as for relaxation and tension reduction is very common, “paradoxically, the most commonly cited reasons for discontinuation of cannabis are increased anxiety and panic reactions.”
- Researchers have also found that cannabis intake can blunt stress reactions for those undergoing stressful stimuli. The study, published in 2017, asserted that cannabis users “demonstrated blunted stress reactivity; specifically, they showed no increase in cortisol and a significantly smaller increase in subjective stress ratings.” Cortisol is the body’s main stress hormone.
Using cannabis for anxiety
When using cannabis for anxiety, patients need to be aware of how much the dose itself can play a central role. For many patients, the difference between cannabis providing relief from their anxiety — or making it worse — can come down solely to the amount taken and/or the potency of the cannabis in question.
There is growing interest in “microdosing” with marijuana, which is taking such a small dose that the psychotropic effects are imperceptible. This can potentially provide the benefits of marijuana without the intoxicating effect, and should also be less likely to cause anxiety or paranoia.
The effects of microdosing could be explained by what is known as the biphasic effect. When we say a substance (like THC) has a biphasic effect, it means that it can produce two opposite effects — depending on the dose of the substance taken. Studies have shown that with THC this can be most glaring in the way that low doses can ease anxiety whereas higher doses can spike it, even causing paranoia or panic attacks in some cases.
Biphasic responses have also been found for CBD with effects like pain, sedation, nausea and vomiting relief, and immune responses.
While countless patients sing the praises of cannabis for its ability to relieve stress and anxiety, or simply to take the edge off at the end of a work day, it is far from being a one-size-fits-all medication. The same dose of cannabis that relieves anxiety for one person could potentially trigger anxiety and paranoia in someone else. For someone already dealing with anxiety, this could have the potential to make matters worse.
In addition, cannabis can have strong intoxicating effects that can cause temporary cognitive impairment and interfere with your ability to perform your job or operate heavy machinery.
Smoking cannabis can present the same respiratory and cardiovascular health issues as any form of smoking. It can also be habit forming, and patients must use it responsibly.
The Cannigma content is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Always consult with an experienced medical professional with a background in cannabis before beginning treatment.
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.