I meet patients daily who claim cannabis helps them with their anxiety. However, many physicians will claim that cannabis actually worsens anxiety. So which group is correct, patients or doctors?
Well it appears to be that both are correct.
Anxiety is an extremely common medical issue. About 25% of Canadians at some point will suffer from an anxiety disorder (Stats Can). Anxiety is a state where one feels constant worry that is greater than what an average person would experience. Anxiety can be protective at times. Think about when you’ve had anxiety before an exam or big game. In these moments, anxiety can help motivate us to better prepare. Chronic anxiety or high levels of anxiety over a long period of time however, cause impairment in our day-to-day functioning. It can lead to isolation and avoidance. It causes many people to call in sick to work or to avoid activities and social events. There are many types of anxiety disorders. The most common ones include: Generalized Anxiety Disorder (GAD), Obsessive Compulsive Disorder (OCD), Post-traumatic Stress Disorder (PTSD), Social Anxiety Disorder or Phobias (fear of specific things such as spiders or heights). Risk factors for anxiety include: family history (genetics), environmental factors, chronic stress and chronic disease.
During anxious moments, or a chronic state of anxiety, the brain is undergoing neurotransmitter changes that involve dopamine, serotonin, GABA and noradrenaline. This leads to a state of arousal physically and can lead to panic symptoms which include chest pain, chills/hot flushes, fear of losing control, light-headedness, a racing heart, numbness/tingling, trembling or sweating. What is interesting to the field of cannabinoid medicine is that recent research has demonstrated that the endocannabinoid system is also directly involved in stress and anxiety (Tulane University).
Based on the research done at Tulane University, and published in the Journal of Neuroscience, when our bodies feel stress they produce cannabinoids (see here to learn the basics on cannabinoids) which acts on the emotional centers of our brain, the amygdala. This type of cannabinoid may actually lead to worsening stress based on the mechanism of action.
On the other hand, when we consume phytocannabinoids (plant based cannabinoids), particularly THC, the amygdala (the fear center of the brain) experiences a relaxation and calming of neurotransmitter release, or which we experience as reduced stress or anxiety. This is how THC can help anxiety. Interestingly, the phytocannabinoid ingredient CBD can also help anxiety given it works on serotonin pathways just like many of the antidepressants we used today (called SSRIs). So when patients state that using cannabis helps relieve their anxiety, there is a biochemical model that supports this subjective experience.
But why are doctors so worried about worsening anxiety with cannabis? How can they also be correct in stating that cannabis causes worsening anxiety? Well the answer lies in dosage. There is a saying that goes “a small tincture is medicine, too much is poison”. Researchers at the University of Illinois and Chicago, discovered that low dosages of THC leads to a reduction of stress in a public speaking task (see study here). When a higher dose was given and there was a reported “high” there was worsening anxiety. Today many experts in the field believe that the key to helping medical ailments with cannabis relies on microdosing. Using small amounts of THC has been very effective in alleviating symptoms for patients.
Based on my experience there is still a lot more to learn about cannabis and anxiety. Through my observations I have learned that sativa dominant strains likely worsen anxiety given they have specific terpene profiles that lead to increased energy. Anyone knows that given energy to an anxious person worsens their anxiety. In my experience, indica dominant strains with high myrecene levels, can lead to a reduction of anxiety. Putting all of this together the best medical advice I can give anxious patients is to use very low dosages of THC and stick to indica strains. Also always try to use CBD strains as this is likely going to be proven in the future to be better at controlling anxiety than THC. Too much THC will lead to worsening anxiety and a higher reliance on cannabis.
Future research will lead to better insight into specific strains, terpene profiles and dosages. Boosting your natural endocannabinoid system through running, yoga and meditation can also reduce anxiety and should always be used first prior to any medication.