Cannabis & Anxiety

By Dr. Kimless, MD

“What, me? Worry?” This iconic signature phrase was on the front cover of MAD magazine, emblazoned under the face of Alfred E. Newman. Anxiety, and the associated psychological and physical symptoms, is the most prevalent mental illness in the US—affecting approximately 18% of the population. Anxiety manifests differently in each person and it originates from a variety of risk factors including life events, genetics, and personality. And although the “What, me? Worry?” attitude is attributed to male archetypes like Alfred E. Newman, it is women who primarily suffer from anxiety disorder, twice as frequently as men.

There are traditional therapies that are used to treat anxiety and its co-associated disorders. The treatment protocols and success rates vary, just like the anxiety presentation itself varies from patient to patient. Patients respond differently to different treatment options, and some may do well with a combination of techniques such as cognitive behavioral therapy, meditation, other complementary treatments, and a pharmaceutical medication. This multi-modal approach is wellaccepted by traditional medical practitioners even though it has varied success rates.

So how does cannabis fit? It depends. Some physicians and other health care providers are suspicious of cannabis, believing it will cause more harm than good—and in truth, that is a possibility. The over consumption of cannabis products containing high concentrations of THC, the intoxicating molecule in cannabis, may actually mimic a panic attack. Patients who do not consume cannabis regularly, overconsume cannabis with high concentrations of THC, or who are completely new to consuming cannabis may be sensitive to some of THC’s effects. THC may cause a rapid heart rate, dry mouth, and an overwhelming feeling of fear or anxiety—which is similar to many of the symptoms experienced with a panic attack!

However, there are many patients who use cannabis to help treat their anxiety disorders. How can this be if the effects of THC imitate a panic attack? Well, the answer is that not all cannabis is alike. Cannabis is like an entire pharmacy in a plant. Different cultivars and cannabis products contain varied amounts of THC and the non-intoxicating CBD (the second most predominant cannabinoid), as well as other constituents. The different combinations of chemicals can be used to discover which mix helps reduce anxiety for each individual patient. If you are considering using cannabis to see if it works for your anxiety, you may want to start with a cannabis product that contains all or mostly CBD. CBD is a non-intoxicating chemical that carries no risk of causing panic attack-like effects, as it works differently in the body than THC does. There are also animal studies which report that CBD does work on serotonin receptors—and these are the very same receptors that pharmaceutical drugs known as SSRIs target to treat anxiety.

Another animal study showed that CBD helped increase the number of hippocampal nerve cells in the brain. (Hippo-what?) The hippocampus is a structure in our brain that is in charge of many things, such as regulating memory and emotions. This includes anxiety. Brain scans of people who suffer with anxiety show that they have a smaller hippocampus than people who do not have anxiety. Both CBD and SSRIs may help to regrow the hippocampal nerve cells to increase the hippocampus size and possibly reduce anxiety. What about terpenes? As we know, cannabis is more than just cannabinoids. There are over 400 constituents in the cannabis plant. Terpenes are some of the chemicals that give cannabis its scent and taste. They also have therapeutic effects. Cannabis products that contain the terpenes myrcene and limonene, for example, may create a sense of relaxation and may lessen the feeling of anxiety. Cannabis products that contain a lot of the terpene pinene may create an energized and focused feeling in some, but may make other people feel anxious. The upshot? Is THC the evil demon? Not necessarily. There are patients who require some amount of THC in combination with CBD to effectively treat their anxiety. It is just prudent to start at a very low concentration of THC or start with no THC and slowly add THC and titrate to higher concentrations of THC if needed. The panic-like feeling dissipates with continued cannabis use. There is no one cure for every person, whether it is conventional medical therapy, medical cannabis, or a combination. Risks and benefits of every treatment need to be weighed before starting any treatment. Consult your recommending physician and be willing to try different combinations, as every person responds differently.