Using Cannabis for Anxiety

An excerpt from the Cannabis Health Index

Anxiety is a normal reaction to the subjective experience of stress, such as in “performance anxiety.” It can occur when anticipation of future events is associated in one’s mind with thoughts and feelings not rooted in the present moment. While anxieties can be considered a normal part of life, chronic or constant anxiety can be debilitating to one’s quality of life. In fact, such interference can produce very real physiological changes in the short and long term. It is estimated that almost two out of ten people in the U.S. suffer from anxiety disorder.

Western medicine considers anxiety disorders mood disorders and defines five basic types: generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), and social anxiety disorder (social phobias).

Doctors often prescribe pharmaceuticals (e.g., anti-anxiety drugs, antidepressants) or psychological intervention to treat anxiety, particularly when underlying physical causes are absent. Adverse effects of pharmaceutical anti-anxiety medication range from mild to fatal. A thorough risk-versus-benefit analysis is advisable before committing to such a regimen.

The Science Behind Cannabis & Anxiety

Even though the combination of cannabis use and anxiety has been subject to extensive scientific scrutiny in the pre-clinical and clinical setting, the current state of the science of cannabis-based therapeutics in treatment of anxiety disorders is in its pre-clinical phase, yielding mostly negative, inconclusive, mixed, or contradictory results. This is presumably due to researcher bias and/or concerns about working with THC—its potential for inducing adverse effects when administered in inappropriate dosages or forms, the relatively low but present addiction potential, or its risk to various more vulnerable cohorts such as adolescents, pregnant women, or patients with a vulnerability toward developing psychosis, for example. The same, however, is not true for the use of CBD-based drugs or for the utilization of an essential oil of cannabis, where several clinical trials present us with more practical guidance. Here we review only the currently available randomized clinical trials that have directly examined the effects of modulating components of the endocannabinoid system (ECS) in the treatment of anxiety.

Double-Blind Placebo-Controlled Trials

A team of researchers from Brazil (2004) enlisted 10 healthy volunteers to test the effects of oral administration of a single dose of 400 mg of CBD or placebo during a typical anxiety-inducing neural imaging procedure. Resulting data suggest that CBD has anxiolytic properties. The authors posit that these CBD-induced therapeutic effects were mediated by affecting limbic and paralimbic brain areas.

Another, similar trial design from Brazil (2011) utilized 10 test subjects. This time instead of healthy volunteers, 10 patients diagnosed with generalized social anxiety disorder (SAD) were given a single dose of 400 mg of CBD or placebo during a typical anxiety-inducing neural imaging procedure. In this setting too, and relative to placebo, CBD was associated with significantly decreased experience of anxiety.

In yet another experiment from Brazil (2011), 24 patients (divided into two groups) with generalized social anxiety disorder were given a single oral dose of 600 mg CBD one and a half hours before a simulated public-speaking test. The placebo group had higher anxiety, cognitive impairment, discomfort, and alert levels. In direct contrast, the group using CBD had significantly reduced anxiety, cognitive impairment, and discomfort in their speech performance, as well as decreased alert levels in their anticipatory speech.

The previous test results were confirmed by collaborative data published by a group from Israel and Brazil (2018), who enlisted 57 healthy males (divided into four groups) to receive oral pharmaceutical forms of CBD at doses of 150 mg, 300 mg, 600 mg, or placebo before a simulated public-speaking test. Researchers measured data on a subjective Mood Scale as well as obtained physiological measures, i.e., blood pressure and heart rate. Results showed that pretreatment with 300 mg of CBD significantly reduced anxiety during the speech. The inverted U-shape indicating 300 mg (rather than 150 or 600 mg) as the most effective approach in this setting suggests a specific narrow dose-dependent therapeutic window.

A group of scientists from Italy (2018) tested the effects of essential oil (EO) of cannabis (with a main terpene content of myrcene and β-caryophyllene) by measuring autonomic nervous system (ANS) parameters (i.e., blood pressure, heart rate, respiratory rate, skin temperature), mood states, and electroencephalography results (alpha, beta 1 & 2, theta and delta waves) before, during, and after inhalation of the EO. Results suggest that the EO of cannabis reduced diastolic blood pressure rates, increased heart rate, and significantly increased skin temperature; patients’ subjective findings were reported as: “…more calm, relaxed, and energetic, were in a good mood, and had increased feeling of hunger and the subject with headache had no more pain.” In addition, there were noticeable changes of band power, amplitude, and relative power in alpha, theta, delta, and beta waves, which were like those noted in people practicing meditation, yoga, Qigong, and mindfulness, for example.

A team from Japan (2019) tested a single dose of 300 mg CBD in the treatment of 37 teenagers with social anxiety disorders. Results demonstrated that CBD significantly decreased anxiety and as such may represent a useful option to treat social anxieties.

The right type of cannabis, matched to meet the needs (or preferences) of each individual and given in the appropriate form and dosage, produces a deep sense of relaxation and homeostasis. In doing so, cannabis can bring about a state of mind that makes it easier for challenging emotional material to come to the surface without the usual triggering of strong reactions. 

Cannabis is famous for its capacity to diminish chronic negative affect (fear, anxieties, or anger) and replace it with a gentle attitude, an easy smile, and more optimistic outlook, all of which have proven to support our natural self-healing abilities.

Excerpted from The Cannabis Health Index

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