Medical Cannabis as a Treatment for Stress & Anxiety which are common types of mental disorders that can have a major impact on daily life for those affected. In 2013, an estimated 3 million Canadians (11.6%) aged 18 years or older reported they had a mood and/or anxiety disorder.
Anxiety disorders are characterized by strong and long-lasting feelings of apprehension, worry and fear. There are six main anxiety disorders: generalized anxiety disorder (GAD), panic disorder, specific phobias (such as fear of spiders, flying, enclosed spaces, etc.), agoraphobia (fear of open spaces), social phobia (or social anxiety disorder [SAD]), and post-traumatic stress disorder (PTSD).
For sufferers, treatment often includes therapy and medication. The most common prescriptions for anxiety are sedatives and anti-depressants. Because these drugs can cause unwanted side effects, many individuals look for alternative treatments.
Stress relief and relaxation are common reasons for cannabis use but there is limited scientific evidence about exactly how cannabis effects anxiety disorders.
Although there is some evidence that cannabis can reduce anxiety, there also evidence that shows it can cause unpleasant mental symptoms, including increased anxiety, panic attacks, and psychotic episodes. These side-effects are generally associated with smoking and consuming whole plant extracts3, which include many active compounds, such as THC (the main psychoactive component of cannabis), CBD (the main non-psychoactive component), and hundreds of other cannabinoids and terpenes. In contrast, CBD-only extracts or high-CBD blends don’t seem to cause these problems. Also, it was not clear whether cannabis use caused anxiety in these cases, or if sufferers were using cannabis because they already had anxiety.
Patients should be cautious about using whole plant cannabis to treat anxiety. The majority of current research is based on synthetic cannabinoids, such as nabilone (a THC mimic), and pure THC and CBD, rather than whole plant cannabis.
There is a growing body of evidence in animal trials that suggests the CBD component of cannabis has anxiolytic (anti-anxiety) properties. A recent review identified several studies where CBD reduced signs of anxiety in a range of animals under certain conditions6. It was noted that CBD appears to have anti-anxiety effects at moderate doses, but not at higher doses.
In limited human studies, it was found that high levels of THC caused or increased anxiety in subjects, but the addition of CBD seemed to block the anxiety effects caused by THC7. CBD treatment also relieved anxiety in experiments where healthy volunteers were stimulated to become anxious by other means. CBD also seemed to reduce anxiety in patients with social anxiety.
A more recent double-blind trial involving 12 healthy volunteers and 24 patients with generalized SAD showed that pre-treatment with CBD prior to a stressful experience (a simulated public speaking test), was able to significantly reduce anxiety in participants compared with those that received a placebo8.
Studies that look at the brain areas which are involved with anxiety have also shown effects of CBD. 10 patients with social anxiety disorder received CBD or placebo in a double-blind procedure. Relative to placebo, the CBD subjects showed less anxiety and had changes in activity in areas of the brain that process anxiety9.
The anti-anxiety effect of THC is less clear. Early studies with the synthetic THC drug, nabilone, showed mixed results. A double-blind study involving 20 patients demonstrated showed anxiety symptoms improved with patients who received nabilone compared to a placebo. However, in another study involving volunteers with generalized anxiety disorder (GAD), only some subjects showed reduced anxiety after receiving nabilone1.
Additional studies on THC found that it can both increase and decrease levels of anxiety in healthy volunteers. At low doses, THC exerts anti-anxiety effects, but at higher doses, THC can induce anxiety.
Post-Traumatic Stress Disorder
There is growing interest in the use of cannabis to treat individuals with post-traumatic stress disorder (PTSD). While there are many anecdotal reports of PTSD patients using cannabis to treat symptoms, controlled clinical trials are limited1.
Our body’s natural endocannabinoid system (ECS) is involved when we acquire a new fear, which is a central process to PTSD. Imaging studies in the brain of PTSD patients studied two parts of the ECS system: the CB1 receptor (the part of the system that gets activated to respond to stress) and anandamide (the molecule that signals CB1 receptors to trigger a coping response). The study found that PTSD patients had more available (unstimulated) CB1 receptors, and less anandamide to stimulate the coping response1. This evidence suggests that developing therapies that target CB1 receptors (possibly with cannabinoids) could help treat PTSD.
In a single trial with 10 Canadian male military personnel who had PTSD, nabilone helped control their nightmares and improve their general well-being better than a placebo. Also, in a small pilot study, Canadian patients with PTSD who weren’t responding to conventional drug treatments reported significantly less intense nightmares and better sleep when taking nabilone. In a similar pilot study, 10 patients with chronic PTSD were given 5 mg of THC. They showed a significant improvement in the severity of their nightmares, with 2 of the 10 patients also reporting their nightmares were completely gone after 3 weeks1. Medical Cannabis as a Treatment for Stress & Anxiety.
Although there has been quite a bit of research on isolated or synthetic cannabinoids, there have not been many well-controlled studies using whole plant marijuana. This means the medical community can’t come to a conclusion yet about whether whole marijuana is a safe or effective treatment for PTSD2.
Another area where medical cannabis shows promise is as a substitute medication. This means patients who currently take anti-anxiety medicate can add cannabis to their therapy and either decrease or replace their current drug. This is a benefit when traditional drugs cause unpleasant side effects. In a recent study, 71.8% of survey respondents reported they were using less of their anti-anxiety medications after starting medical cannabis2. Further studies are required, however, to learn exactly how cannabis should be used as a substitute medication.Medical Cannabis as a Treatment for Stress & Anxiety.
Anxiety-related disorders are common mental disorders with a significant impact on the daily lives of sufferers. Many people view cannabis as an alternative therapy for anxiety and stress, and believe it may work better or produce fewer side effects than conventional drugs. While there isn’t enough evidence to promote whole plant extracts as a treatment for anxiety-related disorders, limited clinical studies show promising results for pure extracts of THC and CBD, as well as the synthetic cannabinoid, nabilone. On-going clinical trials will hopefully provide more evidence on the effects of cannabis and cannabinoids as a treatment for anxiety-related disorders in the future.