Medical Marijuana for Anxiety

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.

• Apply for a medical marijuana card

Potential side effects of cannabis use

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.