Author: Drew H Lesser
Anxiety and fear are natural adaptive responses to threats in our environment, however when they become excessive, the outcome can lead to a myriad of anxiety related disorders from, general anxiety disorder, panic disorder, social anxiety disorder, obsessive compulsive disorder and PTSD [1]. Anxiety and stress are two of the primary reasons people choose medical cannabis after pain [2].
Current pharmacological treatments include serotonin–norepinephrine reuptake inhibitors, benzodiazepines, monoamine oxidase inhibitors and tricyclic antidepressant drugs, many with side effects which lead to intolerability and poor adherence [3].
Cannabis has been used for literally thousands of years to treat anxiety, the oral use of cannabis as a medicine to treat anxiety appears in the Atharvaveda, a core Vedic text dating to around 2000 BCE.6 [4].
Cannabidiol (CBD) has been found to be an effective treatment for a range of anxiety related disorders. The benefit of CBD is that it is NON psychotropic and has no hallucinatory side effects so you can drive and operate machinery. CBD has been found to reduce anxiety and fear of individuals showing comparable efficacy to drugs such as diazepam in a target group [6;7].
The inclusion of THC increases the efficacy of the treatment, but careful titration (dosage) is essential because cannabis can reduce or increase anxiety depending on the strain of the plant, chemistry of the medicine, and THC CBD ratios and dosage. Cannabis is a drug that operates bidirectionally, providing either calm or chaos (anxiety). When using CBD with THC, the correct dosage is critical, where lower dosages relieve anxiety and higher dosages can exacerbate it.
A study testing the effects of CBD on generalised social anxiety disorder was carried out measuring subjective anxiety in patients with the disorder using functional neuroimaging. The results suggest that CBD has anxiolytic (anti-anxiety) effects on the activity in the limbic system (behavioural and emotional brain regions) [8].
Biological evidence that the endocannabinoid system regulates anxiety is implicit in the fact that the there is a high density of the CB1 cannabinoid receptors in the brain’s amygdala, hippocampus, and anterior cingulate cortex; structures which regulate anxiety and related conditions [9].
Anecdotal evidence offers the greatest resource for patients with anxiety and anxiety related disorders. The treatments measured by self report, demonstrate strong evidence in support of Medical cannabis and CBD as a treatment for generalised anxiety, social anxiety disorder, panic disorder, obsessive Compulsive Disorder, Post Traumatic Stress Disorder and Separation Anxiety Disorder.
Whilst the research available to make informed decisions regarding use of medicinal cannabis to treat anxiety is still in its formative stages; it is important to educate and inspire decisions based on available data.
For any patient who has grappled with anxiety overtime and attempted multiple conservative medical treatments; it is the patient’s informed right to explore solutions that may have minimal side effects and have greater efficacy.
Anxiety can be crippling; traditional treatments and medications can lead to long term unpleasant medical side effects such as weight gain and further complications.There are many anecdotal stories of success in treating anxiety with medicinal cannabis; however the anecdotal evidence falls outside of the existing research literature available for the most part.
References
1. Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow
2. Walsh, Z., Callaway, R., Belle-Isle, L., Capler, R., Kay, R., Lucas, P., & Holtzman, S. (2013). Cannabis for therapeutic purposes: patient characteristics, access, and reasons for use. The International journal on drug policy, 24(6), 511–516. https://doi.org/10.1016/j.drugpo.2013.08.010
3. Dyussenova, L., Pivina, L., Semenova, Y., Bjørklund, G., Glushkova, N., Chirumbolo, S., & Belikhina, T. (2018). Associations between depression, anxiety and medication adherence among patients with arterial hypertension: Comparison between persons exposed and non-exposed to radiation from the Semipalatinsk Nuclear Test Site. Journal of environmental radioactivity, 195, 33-39.
4. Morgan CJA, Schafer G, Freeman TP, Curran HV. Impact of cannabidiol on the acute memory and psychotomimetic effects of smoked cannabis: Naturalistic study. Br J Psychiatry. 2010;197(4):285–90.
5. Englund A, Morrison PD, Nottage J, Hague D, Kane F, Bonaccorso S, et al. Cannabidiol inhibits THC-elicited paranoid symptoms and hippocampal- dependent memory impairment. J Psychopharmacol. 2013;27(1):19–27.
6. Zuardi AW, Shirakawa I, Finkelfarb E, Karniol IG. Action of cannabidiol on the anxiety and other effects produced by delta 9-THC in normal subjects. Psychopharmacology (Berl) 1982;76: 245-250.
7. Bergamaschi MM, Queiroz RH, Chagas MH, et al. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naive social phobia patients. Neuropsychopharmacology 2011;36:1219-1226.
8. Crippa, J. A., Derenusson, G. N., Ferrari, T. B., Wichert-Ana, L., Duran, F. L., Martin-Santos, R., Simões, M. V., Bhattacharyya, S., Fusar-Poli, P., Atakan, Z., Santos Filho, A., Freitas-Ferrari, M. C., McGuire, P. K., Zuardi, A. W., Busatto, G. F., & Hallak, J. E. (2011). Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report. Journal of psychopharmacology (Oxford, England), 25(1), 121–130. https://doi.org/10.1177/0269881110379283
9. Crippa, J. A., Zuardi, A. W., Garrido, G. E., Wichert-Ana, L., Guarnieri, R., Ferrari, L., Azevedo-Marques, P. M., Hallak, J. E., McGuire, P. K., & Filho Busatto, G. (2004). Effects of cannabidiol (CBD) on regional cerebral blood flow. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 29(2), 417–426. https://doi.org/10.1038/sj.npp.1300340
Disclaimer:
This information is not intended to be a substitute for professional medical advice and is provided for educational purposes only. It should not be relied on as health or personal advice. The author is NOT a Doctor. Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding your health or a medical condition.