Anxiety, Panic Disorders

Medical Cannabis and Anxiety, Panic Disorders

Definition

Medical cannabis could be beneficial for managing anxiety and panic disorders and other mental health conditions often associated with anxiety-like post-traumatic stress disorder (PTSD). Much like chronic pain, anxiety is often a symptom of other health problems.

Medical cannabis flower and CBD-rich products that contain low-to-moderate THC levels may be a more effective treatment for managing anxiety disorders than those with high THC levels.

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What is Anxiety and Panic Disorder?

“Anxiety” is an umbrella term for many different conditions. There are several subtypes of anxiety, including generalized anxiety disorder (GAD), social anxiety disorder (SAD), and obsessive-compulsive disorder (OCD). Some mental health manuals also list post-traumatic stress disorder (PTSD) as an anxiety disorder.

Panic disorder is an anxiety disorder where a person has sudden, acute attacks of panic or fear when there is no threat of danger. Panic disorder is not always a part of other anxiety disorders. Still, the feeling of panic is a common feature in many of them, enough, so that panic disorder is a subset of other anxiety disorders. Phobias (an uncontrollable, irrational, and lasting fear of a particular object, situation, or activity) are also often anxiety-related but not necessarily a feature of panic disorder.

Anxiety disorders are one of the most common forms of mental illness in the United States, affecting 40 million adults annually in the U.S. aged 18 and older. Almost one-fifth of the U.S. population will likely develop an anxiety-related disorder.

Download Guide to Anxiety and Medical Cannabis

Brief Summary of Current Treatments

Current treatment methods for anxiety and anxiety-related disorders include:

• Various modes of therapy, including cognitive-behavioral therapy (CBT), psychoanalysis and psychodynamic therapies, behavior therapy, humanistic therapy, and integrative or holistic therapy.
• Exercise, improving diet and regulating sleep patterns.
• Antidepressants, including SSRIs (selective serotonin reuptake inhibitors) such as escitalopram (Cipralex, Lexapro), paroxetine (Paxil, Seroxat), or sertraline (Zoloft); SNRIs (serotonin-norepinephrine reuptake inhibitors) such as desvenlafaxine (Pristiq), duloxetine (Cymbalta), levomilnacipran (Fetzima); and tricyclic antidepressants like amitriptyline (Elavil), doxepin (Sinequan, Quitaxon) and imipramine (Tofranil).
• Benzodiazepines, which have sedative effects.
• Some people utilize herbal remedies such as chamomile, valerian root, and St. John’s Wort.

How Might Medical Cannabis Help?

Due to anxiety’s effect on serotonin receptors, selective serotonin reuptake inhibitors (SSRIs) are most often prescribed. In some instances, drugs such as valium, lorazepam, and others in the benzodiazepine class are prescribed. Sadly, these have problems of addiction and many other adverse side effects. Moreover, for some forms of anxiety disorders (especially PTSD, if considered an anxiety disorder), benzodiazepines can make the condition worse.

Alternatives are sorely needed, and cannabinoids may be of particular use. Many cannabinoids and terpenoids, including THC, CBD, pinene, and limonene, have anxiolytic effects. However, too much THC may prompt an anxiety attack, so microdosing is critical.

Anxiety is often comorbid with depression, so always look at any other conditions a person is suffering from before deciding on a particular cannabinoid ratio or chemotype (strain/cultivar). Cannabis seems to be a potent anxiolytic, modulating anxiety-related behavior and neurotransmitter release in otherwise stressful situations.

Medical cannabis may also help with anxiety-related health problems, such as chronic pain, insomnia, nausea/vomiting, irritable bowel syndrome (IBS), and headaches/migraine. The multi-pronged effect of cannabinoids, terpenes, and flavonoids means that medical cannabis could help improve the quality of life (QOL) among many patients with generalized anxiety disorder (GAD), panic disorder, and other anxiety-related disorders. Medical cannabis could also help reduce prescription pill intake.

Cannabinoids

Cannabinoids that could be useful for managing anxiety include:

• Tetrahydrocannabinol (THC): low-to-moderate doses
• Cannabidiol (CBD) and cannabidiolic acid (CBDA/CBDa): moderate-to-high doses
• Cannabichromene (CBC): has antidepressant and anti-anxiety (anxiolytic) effects that could be greater than that of CBD
• Cannabinol (CBN): has sedative effects
• Cannabigerol (CBG): has anxiolytic effects

Cannabinoid Ratios

Anecdotal reports suggest that the following THC:CBD ratios could be useful:

• 1:20
• 1:3
• 1:2
• 1:1

It is worth bearing in mind that several product lines label their products CBD:THC. Usually, if a product is THC-rich, it is given as THC:CBD. If a product is CBD-rich, it is often given as CBD:THC. The lack of regularity can be confusing when it comes to products sold at dispensaries or other licensed medical cannabis outlets, which can cause problems for patients. We will consistently maintain THC:CBD to avoid confusion.

Terpenes and Terpenoids

Many terpenes have stress-busting and anxiolytic effects. Some notable ones in cannabis include:

• Limonene: has uplifting and relaxing effects
• Myrcene: has relaxing and sedative effects
• Linalool: has relaxing effects
• Pinene: has refreshing, uplifting, and relaxing effects
• Beta-caryophyllene: has stress-busting and anxiolytic effects

Flavonoids

Flavonoids also have potential anti-anxiety and antidepressant effects. Several flavonoids found in cannabis could have anti-anxiety effects, including naringin, luteolin, kaempferol, and apigenin.

Effective Ways of Taking Medical Cannabis for Anxiety, Panic Disorders

Routes of Administration

The following routes of administration may be ideal for medical cannabis consumption targeting anxiety disorders:

• Inhalation
• Tinctures

Special Formulations

Cannabis flower and products containing low-to-moderate amounts of THC, CBD, CBC, CBN, linalool, pinene, myrcene, and limonene may be of particular interest to those with anxiety.

Cultivars (often referred to as “strains”) that could be useful for anxiety include Blue Dream, Lavender, Cannatonic, Harlequin, and Sour Tsunami, but no definitive scientific evidence supports this.

Dosing Methods

For sudden anxiety and panic attacks, inhalation of cannabinoids and terpenes may be required for immediate effects.

Tinctures may be ideal for their longer-lasting effects.

Microdosing edibles may also be useful, but care must be taken when eating cannabis, as THC is more potent when ingested and passed through the liver (second pass metabolization). This is because the liver metabolizes THC into the more potent metabolite, 11-OH-THC.

Some people may find cannabis-infused bathing products (e.g., bath bombs, soaps) effective, but no evidence suggests cannabinoids are metabolized this way.

Potential Adverse Effects

• Cannabis may prompt anxiety, paranoia, or panic attacks in some, especially if high amounts of THC are consumed: this could be called cannabis-induced anxiety disorder.
• Increased heart rate and blood pressure during the initial stages of cannabis intoxication, followed by a drop
• Dizziness
• Dry mouth
• Dry eyes

What are the Pros and Cons of Taking Medical Cannabis for Anxiety and Panic Disorders?

As with any over-the-counter (OTC) or prescription medication, medical cannabis has its pros and cons for utilizing it for anxiety.

Potential Pros

• Cannabis contains several anxiolytic terpenes that serve as stress busters. Linalool, beta-caryophyllene, and borneol are just a few of them.
• Cannabidiol (CBD) could improve regional cerebral blood flow (rCBF) in the brain, which helps reduce anxiety.
• Pinene could help prevent hyperventilation during anxiety/panic attacks, which can cause chest pains and further anxiety.
• Beta-caryophyllene targets CB2 receptors, helping reduce anxiety.
• Low doses of THC can help reduce anxiety to some extent.
• Medical cannabis and CBD can modulate glutamate-GABA systems, which in turn can act as a sedative to an anxiety-ridden mind.
• Moderate to high doses of CBD can have sedative effects that can help reduce anxiety.

Potential Cons

• Due to cannabis’ biphasic effects, a low dose of THC may act as an anxiolytic, while a higher dose may make a person more anxious.
• Can cause an initial increase in heart rate, which can potentially lead to a panic reaction in some
• Can cause depersonalization, especially with high doses of THC
• Set and setting can make a huge difference: A relaxed environment may be conducive to the relaxing effects of some cannabinoids.
• Low doses of CBD may induce a “wired,” stimulated, or uplifting effect in some, making sleeping more difficult. Higher doses of CBD are needed for anti-anxiety effects, but this may be sedative for some.

Useful Anecdotal Information

• Project CBD’s Sarah Russo Explains How CBD-Rich Cannabis Affects Her
• Medical cannabis and anxiety with Dr. Dani Gordon

Scientific Data Overview and Studies

• Total Studies = 162
• Positive Studies = 122
• Inconclusive Studies = 29
• Negative Studies = 11
• 90 Meta-Analyses (58 positive, 22 inconclusive, 10 negative); 46 Animal Studies (41 positive, 4 inconclusive, 1 negative); 16 Double-Blind Human Trials (15 positive, 1 inconclusive); 8 Human Trials (6 positive, 2 inconclusive); 2 Lab Studies (all positive)
• 56 studies include CBD (48 positive, 8 inconclusive); 20 studies include THC (14 positive, 5 inconclusive, 1 negative); 1 study includes CBG (positive); 2 studies include CBDA (all positive)
• No. of Leafwell Patients (2021) = 16,594
• Possible Overall Efficacy: Moderate to High

Quotes from Studies

“The final sample consisted of 72 adults presenting with primary concerns of anxiety (n = 47) or poor sleep (n = 25). Anxiety scores decreased within the first month in 57 patients (79.2%) and remained decreased during the study duration. Sleep scores improved within the first month in 48 patients (66.7%) but fluctuated over time. In this chart review, CBD was well tolerated in all but 3 patients.” Source: Shannon, Scott, et al. ‘Cannabidiol in Anxiety and Sleep: A Large Case Series‘ The Permanente journal vol. 23 (2019): 18-041. doi:10.7812/TPP/18-041

“Overall, users experienced a symptom intensity reduction in 95.51% of sessions, no change in symptom intensity in 2.16% of sessions, and increases in symptom intensity in 2.32% of sessions.” Source: Stith, Sarah S. et al. ‘The effectiveness of inhaled Cannabis flower for the treatment of agitation/irritability, anxiety, and common stress’ Journal of Cannabis Research 2, Article number 47 (2020)

“Evidence from human studies strongly supports the potential for CBD as a treatment for anxiety disorders: at oral doses ranging from 300 to 600 mg, CBD reduces experimentally induced anxiety in healthy controls, without affecting baseline anxiety levels, and reduces anxiety in patients with SAD [social anxiety disorder].” Source: M. Blessing, Esther, et al., ‘Cannabidiol as a Potential Treatment for Anxiety Disorders’ Neurotherapeutics 2015 Oct; 12(4): 825–836. Published online 2015 Sep 4. doi: 10.1007/s13311-015-0387-1

Conclusion

There is some good evidence to suggest that medical cannabis, particularly low-to-moderate THC and CBD-rich chemotypes, could be very useful for managing anxiety and panic disorders. However, higher doses of THC (tolerance depending, but usually over 10-15 mg per day) may cause cannabis-induced anxiety. Balancing the THC with CBD, CBC, CBG, and terpenes like linalool, myrcene, pinene, limonene, and beta-caryophyllene may be necessary for medical cannabis to be therapeutic.

Related Articles

• Can Medical Marijuana Really Treat Anxiety?
• Anxiety, Insomnia, and Chronic Pain: How Medical Cannabis & Telehealth Helped People During the Pandemic
• 4 Best CBD Products to Ease Anxiety in 2022
• Cannabis, Stress, and Inflammation: Targeting the ECS for a Range of Health Problems

Note that the information in this article does not constitute medical advice.

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