In this article, we answer a question that was asked by a honahlee community member named Chloe. Here’s Chloe’s question
“I’ve been reading through the info on your website (which has been extremely helpful by the way – so thank you so much for it). However, I’ve come across a discrepancy I would like some further info on.
Mainly on the use of cannabis for anxiety, it says on your Medical Conditions Treated by Cannabis (And Side Effects) that the TGA has approved use of medical cannabis for anxiety (and anxiety disorders) in the past. But then further down in the next subheading (Who should not be using cannabis) it states that people with anxiety disorders shouldn’t be using it.
Basically I’m just looking for clarification on whether it is advised to use medical cannabis for anxiety and anxiety disorders. I have found this same conflicting information on a few different sites, while also hearing anecdotal evidence that it has helped alleviate anxiety symptoms for individuals. Any information you could provide to me would be greatly appreciated.”
Cannabis causes and relieves anxiety – a contradiction
Mental health is one of the most commonly TGA approved areas for medical cannabis. These conditions include:
To understand if it’s safe to use cannabis for anxiety, you need to understand cannabis and the chemical compounds CBD and THC, a bit more deeply. Once you understand CBD and THC at a high level, (no pun intended), and the concept of a ‘therapeutic window’, you’ll see how cannabinoids, one’s therapeutic window and dosing all work together.
Without an understanding of these three concepts, it’s easy to understand why these contradictory statements are often made.
CBD is useful and ‘safer’
There are multiple types of medical cannabis products prescribed for anxiety. Cannabidiol (CBD) predominant treatments are very safe and quite effective for anxiety. And, it’s rare that CBD actually induces any further anxiety in patients. Occasionally at very high doses, it can cause irritability and hyperactivity. But, this is more common with CBD isolates.
So, when we talk about cannabis medicine and anxiety, CBD isn’t something that you generally need to worry about.
THC is useful but needs more vigilance
THC is also prescribed to help with anxiety disorders. It can help with relaxation, sleep, and it can help with traumatic memories and changing the nature of the way that we remember certain events. THC can also provide an alternative perspective on certain situations and helps distance people from the stress of their situations.
But THC is something that directly stimulates the cannabinoid receptors and the endocannabinoid system (ECS). It has a stronger impact on parts of the system that regulate anxiety. In some cases, more often than CBD, too high a dose of THC may provoke cannabis-induced anxiety.
The ECS’s purpose is to maintain homeostasis and balance within systems around the body. This means that the endocannabinoid system needs to be able to upregulate and downregulate certain neurotransmitters within the systems that are being activated. Because the goal of cannabinoid medicine is to help the body find and maintain homeostasis again, when THC is used in too high a dose, it can actually start inducing the symptoms that you’re trying to alleviate.
The therapeutic window
A therapeutic window is the drug dose needed to maintain the benefits and exposure of the medicine that’s effective but avoids any adverse events (AEs). In this case, an AE would be increasing anxiety rather than lowering it.
Everyone has their own therapeutic window where THC is effective. Some people have a very narrow therapeutic window and this means that they’re more prone to getting unwanted side effects with a lower dosage. Some people have a really large therapeutic window. So this means that they could use higher doses of THC and not get an increase in paranoia or any anxiety.
Dosages and your therapeutic window
Even if you have a narrow therapeutic window, THC may still be beneficial in treating your mental health related condition or their anxiety. It just means that when initiating treatment with a THC formulation, you need to start at extremely small. Dr. Jim says:
“We need to start extremely small, pretty much micro doses. And, the treatment needs to be done in a very intentional sort of manner. So people need to be very aware of how the THC is making them feel.
In the early phase of using a THC formulation, it’s really beneficial to do a sensitization protocol. This sensitization protocol involves using very small, barely perceptible doses for the first four days. What this often does is, instead of overwhelming the endocannabinoid system, it stimulates the endocannabinoid system and it often broadens the therapeutic window for that person.
The result is that the individual may have a broader range of dosing where THC and cannabis medicines are effective for treating their conditions.”
Without taking a low and slow approach in the early stages of treatment with cannabis medicines, you may get a worsening of symptoms. Too high a dose can cause paranoia, agitation, restlessness, and actually make you feel a lot worse. This can and does put people off using cannabis medicines. This can also happen with other medications, however formalised dosages make it less likely to happen.
Dr. Jim also makes the important observation that, “It’s important to have proper guidance when using such a powerful medicine because of the potential for it to have such wide-ranging effects, and because it’s tapping into a really powerful system within the body that is so important for maintaining balance and homeostasis. Cannabis can affect a lot of different body systems.”
So, does medical cannabis cause anxiety?
Medical cannabis may cause anxiety if not administered properly. Cannabidiol (CBD) is relatively safe for anxiety, however, at very high doses it may increase anxiety.
Tetrahydrocannabinol (THC) is more likely to give you anxiety at a lower dosage and therefore must be monitored very carefully when first starting treatment. Microdosing and a low and slow approach reduce the likelihood of increased anxiety from cannabis medicines.
CBD is a very safe and potentially effective cannabinoid for anxiety. THC can also be used by people with anxiety and it can improve symptoms.
THC however, needs to be used with a lot of caution. It needs to be done in a very intentional, individualised and slow titration to get to that right dose. Otherwise, cannabis can increase anxiety rather than lower it.
CBD oil and all other forms of cannabis are only legal with a prescription in Australia. If you’re interested in buying cannabis for anxiety speak to your GP or a cannabis specialist.
We hope you found this helpful. If you have cannabis questions, please don’t hesitate to ask us a question. If you know someone that this might help, please feel free to share this article. Thanks to Dr. Jim for taking the time to share his wealth of knowledge with the honahlee community.