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Anxiety and Medical Cannabis

Definition

“Anxiety” is an umbrella term for a number of different conditions. There are several subtypes of anxiety, including generalized anxiety disorder (GAD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD). Some mental health manuals also list post-traumatic stress disorder (PTSD) as an anxiety disorder.

Potential Efficacy / Quality of Evidence (Low, Average, High) of Medical Marijuana for Anxiety

Average to high.

Cannabinoids, Terpenes/Terpenoids, Strains and Ratios that May Help

Small amounts of THC; CBD; linalool, limonene.

CBD:THC 20:1; CBD:THC 3:1; CBD:THC 1:1.

Medical Cannabis Pros

Cannabis contains a number of anxiolytic terpenes that serve to act as stress busters. Linalool, beta-caryophyllene and borneol are just a few of them.

Cannabidiol (CBD) could improve regional cerebral blood flow (rCBF) in the brain, which helps reduce anxiety.

Pinene could possibly help prevent hyperventilation during anxiety/panic attacks, which can cause chest pains and further anxiety.

Beta-caryophyllene targets CB2 receptors, helping reduce anxiety.

Low doses of THC can help reduce anxiety to some extent.

Medical Cannabis Cons

Due to cannabis’ biphasic effects, a low dose of THC may act as an anxiolytic, whilst a higher dose may make a person more anxious.

Can cause an initial increase in heart rate, which can potentially lead to a panic reaction in some.

Can cause depersonalization, especially high doses of THC.

Set and setting can make a huge difference – a relaxed environment may be conducive to the relaxing effects of some cannabinoids.

Too high a dose of CBD may induce a “wiry” effect in some, which can make sleeping more difficult.

More About the Condition

Anxiety disorders are one of the most common forms of mental illness in the United States, affecting 40 million adults in the US aged 18 and over every year. Almost one-fifth of the US population will likely develop some sort of anxiety-related disorder.

Due to anxiety’s effect on serotonin receptors, selective serotonin reuptake inhibitors (SSRIs) are most often prescribed. In some instances, drugs such as valium, lorazepam and others in the benzodiazepine class are prescribed. Sadly, these have the problems of addiction, as well as many other negative side-effects. Moreover, for some forms of anxiety disorder (especially PTSD, if considered an anxiety disorder), benzodiazepines can make the condition worse.

Alternatives are sorely needed, and cannabinoids may be of particular use. Many cannabinoids and terpenoids, including THC, CBD, pinene and limonene, have anxiolytic effects. However, too much THC may prompt an anxiety attack, so microdosing is key.

Anxiety is often comorbid with depression, so always look at any other conditions a person is suffering from before deciding on a particular cannabinoid ratio or strain. Cannabis seems to be a very powerful anxiolytic, modulating anxiety-related behaviour and neurotransmitter release in otherwise stressful situations.

Quotes from Experts

“The final sample consisted of 72 adults presenting with primary concerns of anxiety (n = 47) or poor sleep (n = 25). Anxiety scores decreased within the first month in 57 patients (79.2%) and remained decreased during the study duration. Sleep scores improved within the first month in 48 patients (66.7%) but fluctuated over time. In this chart review, CBD was well tolerated in all but 3 patients.” Source: Shannon, Scott et al. ‘Cannabidiol in Anxiety and Sleep: A Large Case Series‘ The Permanente journal vol. 23 (2019): 18-041. doi:10.7812/TPP/18-041

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Case Studies – Patient Stories

Project CBD’s Sarah Russo Explains How CBD-Rich Cannabis Affects Her