Cannabis for Anxiety Disorders?

Until recently, the conventional wisdom in the medical community was that cannabis use could cause or exacerbate anxiety disorders (something we call weed-induced-anxiety), but current clinical research shows certain strains of whole cannabis and some cannabis derivatives can actually treat anxiety symptoms with fewer side effects and less addictive potential than current drugs on the market.

What are anxiety disorders?

An anxiety disorder is characterized by persistent fear of perceived future events. For anxiety to qualify as a disorder, the anxiety must persist for long periods (usually six months or more) and cause interference with the sufferer’s normal life and social functioning. The cause of the anxiety is typically irrational, or the response to rational causes of fear is irrationally inflated and consuming. This is according to the DSM-V, the psychiatry and psychology profession’s standard diagnostic text.

Diagnosing Anxiety according to the DSM-V

Differences among the disorders under the anxiety-disorder classification come down to differences in situations that cause anxiety and how the patient responds to that unhealthy level of anxiety they experience, according to the DSM-V.

Does cannabis cause anxiety?

Part of the misunderstanding about the role of weed in anxiety comes from the kind of studies used to make the connection. Because legal restrictions make pot is so difficult to obtain for research, most of the medical literature connecting marijuana to anxiety problems comes from the substance abuse treatment field.

These studies largely rely on study subjects’ self-reporting, with no controls on the strain, quality, dosage or method of administration for the cannabis involved. Furthermore, the vast majority of participants in substance abuse studies are using alcohol, tobacco and other drugs along with marijuana, making it nearly impossible to tease apart the co-variable effects.

Another problem with relying on studies on self-described addicts seeking treatment is a problem of correlation. It’s well known in the psychological community that people with anxiety, depression and other disorders tend to self-medicate with drugs and alcohol. Therefore, there’s no easy way to address whether the self-selected group of study participants in the substance recovery population already has a higher prevalence of generalized anxiety disorder and other anxiety-related conditions.

Does THC or cannabidiol treat anxiety symptoms?

Research has shown that the main psychoactive component of marijuana, the cannabinoid Delta-9 tetrahydrocannabinol (THC), can cause or exacerbate anxiety. This has been well documented in users of Marinol (dronabinol), which is a legal pharmaceutical distillate of pure THC. The Food and Drug Administration in their prescribing information lists anxiety as a serious potential side effect of the drug, now used to treat anorexia caused by AIDS and cancer chemotherapy.

However, it should be noted that taking THC in isolation is not a valid measure to make claims about cannabis; without the other cannabinoids and terpenes, cannabis does not get to express the “entourage effect“, which is the complex interaction of all these chemicals with the body’s endocannabinoid system.

The variety of cannabinoids and terpenes found in cannabis make a “bigger than the sum of its parts” impact on cannabis consumption compared to isolates.

Cannabidiol (CBD) and high-cannabidiol marijuana strains, however, seem to have the opposite effect, according to the clinical studies available on the subject. Cannabidiol is the other most potent cannabinoid in marijuana, but it is non-psychoactive. CBD has already seen some success in social anxiety disorder.

How can marijuana help anxiety?

A 2011 study in the Journal of Clinical Psychopharmacology showed the administration of cannabidiol in a double-blind, placebo-controlled study drastically reduced anxiety in patients with a generalized social anxiety disorder.

The sample size for this study was small, but highly valuable because results were measured through neuroimaging, rather than only self-reporting. In other words, scientists could watch on a functional MRI machine the regions of the brain responsible for anxiety calm down as the cannabidiol doses were administered.

CBD was more effective than placebo in curbing anxiety, as measured by public speaking stress. Figure from Bergamaschi et al. (2011)

The most current research is a meta-analysis looking at panic disorder published in 2017 in Current Neuropharmacology that takes into account results of dozens of human and animal trials. This study showed a strong anti-anxiety effect from cannabidiol.

Panic disorder is one of several disorders under the anxiety-disorder umbrella laid out in the DSM-V.

“CBD seems to be a promising drug for the treatment of (panic disorder),” according to the study authors. “However, novel clinical trials involving patients with the panic disorder diagnosis are clearly needed to clarify the specific mechanism of action of CBD and the safe and ideal therapeutic doses of this compound.”

Another promising avenue for research that scientists have yet to fully explore is the potential for cannabis to calm the anxiety symptoms related to post-traumatic stress disorder. This was a major theme of the most comprehensive meta-analysis of marijuana medical literature to-date, published in February, 2017 in the Journal of Clinical Psychology.