Cannabis and anxiety
Feeling anxious at times is natural. Your fight or flight response is critical to your survival. However, anxiety is the most common mental health issue in Australia. According to Beyond Blue, about 26% of individuals aged 16 to 85 have experienced and anxiety disorder at some stage in their lives.
Cannabis is becoming more popular as a treatment for anxiety. The question is: Does medical marijuana treat anxiety and anxiety disorders?
In this article Dr James Connell (Dr Jim), an RACGP accredited GP explains traditional treatments for anxiety, the benefits of cannabis for anxiety and what the clinical research says about cannabis as a treatment for anxiety. Here’s what the interview covers:
- What are some signs of anxiety or an anxiety disorder? | 0:24-3:09
- When should individuals seek a doctor’s help for anxiety? | 3:10-3:45
- How is an anxiety disorder diagnosed? | 3:46-4:28
- What are the traditional treatments for anxiety? | 4:29-6:36
- What are the side effects of traditional anxiety treatments? | 6:37-7:48
- Antidepressants | 6:40-7:20
- Tranquilisers | 7:21-7:48
- Can cannabis treat anxiety disorders? | 7:49-8:53
- Can marijuana be prescribed for anxiety in Australia? (not in video)
- How does THC help with anxiety? | 8:54-9:50
- How does CBD help with anxiety? | 9:51-11:06
- Can terpenes help with anxiety? | 11:07-12:15
- What are the best terpenes for anxiety? 11:29-12:15
- Does medical cannabis contain terpenes? (video only) | 12:16-12:49
- What are the side effects of cannabis for anxiety? | 12:50-14:07
- What cannabis medicine is prescribed for anxiety? | 14:08-15:19
- What is the typical dosage of cannabis for anxiety? | 15:20-16:19
- What does the research say about cannabis for anxiety? | 16:20-17:28
What are some signs of anxiety or an anxiety disorder?
It’s important to note that anxiety itself isn’t a disorder. Anxiety in short bursts helps you switch on and prepare for experiences. We often think of anxiety as something that happens prior to an exam, presentation or maybe even a big moment like your birthday party or wedding.
Anxiety becomes a problem when it’s there all the time. It’s broken up into different categories.
- Generalised Anxiety
- Obsessive Compulsive Disorder (OCD)
- Phobia Disorder (or Social Phobia Disorder)
- Panic Disorders
- Post Traumatic Stress Disorder (PTSD)
General anxiety is when an individual worries about things constantly and nothing seems to be triggering it. OCD is when an individual has repetitive obsessive thoughts or behaviours.
Phobia or Social Phobia disorders relate to something specific. Phobias can be fear of spiders and social phobias can be overwhelming anxiety in normal everyday situations.
Finally, PTSD often develops after a traumatic event where grave physical harm or the threat of harm occurred. We often think of PTSD relating to veterans, however, there are many other scenarios where PTSD develops.
The main emotional features of anxiety disorders can be:
- Panic attacks
- Excessive worry or anxiety
- Negative thought spirals that become all consuming
- Irritability, agitation and anger
- Mind blanks
The main physiological features of an anxiety disorder can be:
- Muscle tension
- Neck and shoulder pain
- Tremulousness (churning stomach, heart racing, palpitations)
- Sleep disturbance
- Panick attacks
It’s important to remember that some of these symptoms may be normal if they occur on occasion or in very small amounts.
When should individuals seek a doctor’s help for anxiety?
Seek a doctor’s help when anxiety or any of the symptoms mentioned become divisive or begin to infiltrate most aspects of your life. Part of the diagnosis of chronic anxiety is when you experience anxiety for most days over a period greater than six months.
If anxiety starts impacting your quality of life or stops you from doing the things you want to be doing, or it’s stopping you from doing other health promoting activities that give you a sense of wellbeing or joy, it’s time to seek a doctor’s advice.
How is an anxiety disorder diagnosed?
Anxiety disorder is a clinical diagnosis and is usually given by a doctor or psychiatrist. Your healthcare professional will talk to you about your anxiety and go through a questionnaire which is part of the DMS-5, a physician’s guide to diagnosing mental health disorders.
Anxiety becomes a clinical diagnosis when your symptoms have been occurring more days than not for at least 6 months. It must be affecting a number of events or activities and it must not be better explained by another medical condition like thyroid dysfunction, endocrine disorders or other chronic diseases.
What are the traditional treatments for anxiety?
There are two main kinds of traditional treatments:
- Non-pharmacological treatments
These treatments aren’t necessarily prescribed by a doctor. They are a good place to start when you notice anxiety and are good in the long run. Whether or not you have anxiety, these practices are good to incorporate into your routine.
- Sleep hygiene
- Good nutrition
The challenge with these treatments is that they require a lot of motivation and drive and when people are suffering with anxiety it can be difficult to maintain these practices. These natural practices are important to maintain even if your doctor prescribes medication.
There are also natural supplements like St John’s Wort, Sam-e and Kava, but there’s less clinical evidence in regards to these supplements. It’s important to note that these supplements should not be used with conventional antidepressants due to a risk of serotonin toxicity.
Pharmacological treatments are what most people think of as anxiety treatment. They can be lifesaving treatments for many people. While they can be excellent, they don’t work for everyone and can be associated with serious side effects, particularly in the long run.
Antidepressants are the most commonly used medications for anxiety disorders. Antidepressants can be real life savers for those who are experiencing severe anxiety. People often think of SSRIs (selective serotonin reuptake inhibitors ), SNRIs (serotonin and norepinephrine reuptake inhibitors) and tricyclic antidepressants as this class of medication.
Doctors may also prescribe monoamine oxidase inhibitors but they have their own side effect profiles. There are also newer medications like reboxetine, agamilitant, agomelatine and mirtazapine.
Tranquilisers are often prescribed for symptoms of panic and stress. Things like benzodiazepines can have an initial calming effect and may even be sedating. The challenge with tranquilisers is that in the long term, they can actually make things worse for some patients.
What are the side effects of traditional anxiety treatments?
While antidepressants can work very well for some they also can have nasty side effects for others. These side effects include:
- Weight gain
- Sleep disturbance
- Changes in sexual function
- Loss of feeling full range of emotions
- Agitation tremor
- Increased falls risk
- Serotonin syndrome (this is mainly for monamine oxidase inhibitors which are rarely used)
Long term use side effects can include:
- Loss of memory
- Impaired learning
- Increased depression
- Increased risk of death (due to the impact on respiratory drive in brain stem)
- Increased risk of dementia
Warning: It’s important to note that when taking antidepressants or tranquilisers, combining with alcohol can be a deadly combination.
Can cannabis treat anxiety disorders?
Anxiety occurs when there’s an imbalance in the body. Certain parts of the cannabis plant, for example THC, act upon the endocannabinoid system (ECS). The ECS is responsible for the body’s homeostasis, or balance. CBD, another chemical in cannabis, not only has anti-anxiety effects, but it also acts on different biological systems which help optimise internal processes.
Cannabis’s chemical properties and interactions with the body are how cannabis helps treat anxiety.
You will find conflicting information about cannabis and anxiety. Cannabis is prescribed for anxiety but there are warnings not to use cannabis if you have anxiety or depression. People often think cannabis can cause anxiety but it’s not that simple.
Cannabis’s impact on anxiety has to do with a number of factors which are discussed in our ‘does cannabis cause anxiety” article.
Cannabis’s impact on anxiety has to do with a number of factors which are discussed in our ‘does cannabis cause anxiety” article.
Can marijuana be prescribed for anxiety in Australia?
Yes. Medical cannabis is prescribed for anxiety in Australia. In order to be eligible for medical marijuana, you must meet the following conditions:
- Firstly, you must be clinically diagnosed with an anxiety disorder.
- Secondly you must have tried traditional treatments for your condition.
- Finally, your doctor must explain why those traditional methods have not been able to successfully treat your anxiety disorder.
If you meet those conditions your GP or specialist can create a cannabis treatment plan for you and apply to the TGA to prescribe you medical cannabis. Medical cannabis access often takes up to two weeks from seeing your doctor if you are eligible.
How does THC help with anxiety?
THC is the more controversial of the major cannabinoids when it comes to treating anxiety disorders. There are studies that show THC as promising in the treatment anxiety. THC can be anxiolytic, which means it reduces anxiety. It can also be anxiogenic, which means that it can increase anxiety.
The reason it can have both effects is because it directly acts upon the endocannabinoid system (ECS). THC directly stimulates the body’s cannabinoid receptors (CB1 and CB2). Because the ECS is responsible for maintaining balance, having the right dose can help create balance, the incorrect dose can cause an imbalance, thus causing anxiety.
THC administered within your therapeutic range, or the correct amount for your body, can provide good improvements in mood, sleep, relaxation, can help stop ruminating thoughts and can even help people forget traumatic memories.
How does CBD help with anxiety?
CBD acts on about 60 different receptors, enzymatic pathways and neurotransmitters. Because CBD doesn’t directly stimulate the endocannabinoid system it doesn’t have that same risk of causing or worsening anxiety.CBD works in different ways. CBD can activate certain biological receptors and pathways like our adenosine pathways and serotonin receptors. At another level, it can slow and reduce the uptake of beneficial chemicals like serotonin, dopamine and GABA. This means that our bodies can use these naturally produced chemicals for a sustained period of time.CBD can also modulate the activity of THC at CB1 receptors therefore reducing its anxiety provoking effects.Finally, CBD can also reduce the FAAH, which is the main enzyme that breaks down the body’s own anandamide. Anandamide is the chemical that is produced when we think of the ‘runner’s high’.So, CBD has multiple mechanisms by which it can alleviate anxiety, but as with all medication, it’s dose dependent.
Can terpenes help with anxiety?
Yes, terpenes can help with anxiety. Terpenes are the essential oils within the cannabis plant. Terpenes are also present in many other plants and throughout nature. They are what give certain plants their smell or aroma.
Terpenes alone have a lot of therapeutic benefit.
What are the best terpenes for anxiety?
The main terpenes that can be beneficial for anxiety are Limonene, Pinene, Linalool and Myrcene.Limonene is the same essential oil that comes from the lemon. It can give people a feeling of being energised or feeling uplifted. Limonene has a good anxiolytic effect.Pinene is similar to the pine tree. It can make people feel clear-headed and help with memory.Linalool comes from lavender. It is known to help with relaxation and can be mildly sedating.Myrcene is a very common terpene that’s common in many cannabis strains. Myrcene can be quite sedating and can help with relaxation, sleep and can help slow the mental processes.Aside from cannabis, having these smells close by when your anxious may help reduce anxiety.
Are there side effects specific to cannabis and anxiety disorders?
The known side effects of cannabis are generally mild and for most cannabinoid medicines are well tolerated.
THC has the potential to cause or worsen anxiety. THC can also worsen fatigue and reduce your mental processing.
Some people are extremely sensitive to THC. For some, even tiny doses of THC will worsen anxiety. If you do find that you’re having side effects from THC, then you either need to lower your dosage or maybe remove it from your regime.
CBD has less of a concern increasing anxiety. While CBD has been found to be relatively safe at higher doses than THC, it’s the administration at very high doses where the risk of side effects occurs.
Very high doses of CBD can cause irritability, hyper arousal, stomach aches and even sleep disturbance.
What type of cannabis is normally prescribed for anxiety?
Most doctors who prescribe cannabis will treat you slightly differently because cannabis is not your traditional one size fits all medication. Some doctors are very wary of using THC for anxiety disorders. Doctors who have practiced cannabis medicine a bit longer have the experience to use THC.
While cannabis medicine is unique to each patient, Dr Jim said that a rough approach to start with patients is as follows.
Start with a morning and afternoon dose of CBD oil. If the patient had sleep disturbances then there’s potential to use a THC based formulation at night time.
In terms of administration method, the CBD and THC would likely be in an oil form.
If a patient has acute breakthrough symptoms throughout the day then a dose of flower, most likely administered via vaporisation may be prescribed. This method offers rapid onset relief for anxiety, but again needs to be used cautiously because of THC’s potential to increase anxiety. For individuals hypersensitive to THC, high dose CBD flower may be prescribed.
Having a base of CBD can help reduce the impairing and anxiety provoking effects of the THC.
In conclusion, using CBD and THC in combination can often be very beneficial for patients with anxiety.
Is there a typical dosage of cannabis for treating anxiety?
Cannabis is really a personalised medicine. Because of this, there is really no set dosage. What doctors aim for is the lowest effective dose to treat the patient’s symptoms.
Doctors always recommend starting low and going slow. They will create a plan for their patients asking them to titrate up with intention and reflection. The patient is responsible, along with the doctor, to understand how they are responding to the cannabis.
What’s the best CBD dosage for anxiety?
There is no ‘best’ dosage of CBD for anxiety. We often find that higher doses are more effective. That being said, there are some studies that show that CBD has good effectiveness at around 25mg to 30mg of CBD a day.
What’s the best THC dosage for anxiety?
There is no ‘best’ dosage of THC for anxiety. THC it’s a much more potent medication than CBD and often only small doses are required. Because a low and slow approach is taken, no more than 5mg to 10mg are recommended at a time.
What does the research say about cannabis and anxiety?
When talking about research we often mean clinical evidence. There is limited clinical evidence specific to cannabis and anxiety.
There are studies that have shown that people with anxiety have low levels of circulating anandamide. Scientists believe that low anandamide indicates a deficiency in endocannabinoid function thus being a cause of anxiety.
There has also been a study showing that low dose use of CBD can be very effective for treating anxiety, and reducing anxiety symptoms of up to 80%. Another study shows that CBD can be an effective moderator of anxiety in things like public speaking.
A trial of Sativex, a THC based medicine, showed positive increases in the well being scales of patients. And, there are case studies from cannabis clinicians across the globe showing improvement in their patients anxiety when using cannabis.
With all this said, there is a lack of good quality randomised controlled, double blind, placebo trials that show CBD’s effectiveness in treating anxiety. We need more research to be able to say definitively, from a traditional scientific perspective, that cannabis can treat anxiety.
Staci Gruber, “High Anxiety? Examining the impact of four weeks of treatment with a novel high cannabidiol product.”