Updated: Oct 15, 2021
Can Medical Marijuana Help?
By Jodi L. Levy, D.O.
Updated: October 2021
If you have anxiety, you are not alone!
Anxiety is one of the most common psychological conditions in our society. According to epidemiological studies, up to ONE THIRD of the population in the U.S. is affected by an anxiety disorder during their lifetime. Anxiety is more common among women, and is most prevalent during midlife. Despite its prevalence, it is often under-diagnosed.
Some level of anxiety or “stress” affects all of us, such as worrying about money, job stress, health issues, relationships, our children, politics, COVID, etc., but it can become a disorder when it affects your daily life in a negative manner. At times anxiety may feel like something you cannot control. Don’t blame yourself!
There is a difference between the normal "stress" of daily life which can make most of us feel anxious once in a while, and an anxiety disorder:
What is Anxiety?
ANXIETY VS. ANXIETY DISORDER
Anxiety may be a normal reaction to stress or difficult life situations.
It usually has a start and end.
It can be helpful in some cases, and is sometimes known as the ‘fight or flight reflex,’ which refers to the fact that when we are faced with a stressful situation, such as being chased by a lion, we have an increase in cortisol, which can help us run away faster. That same reflex can kick in when we are stressed, but it manifests a bit differently.
Anxiety is usually manageable with relaxation techniques and emotional support from family and friends.
May interfere with your daily life or your ability to enjoy your life
May feel unmanageable or overwhelming, as if there is no end in sight, and it is out of your control
May be triggered by a specific stimulus
May sometimes feel like it comes out of nowhere
May have physical symptoms such as racing heart, sweating, tremor, lightheadedness, insomnia, constant worry or feelings of impending doom, irrationatiol thinking or confusion
Many people recognize their own anxiety symptoms, but others are worried that they are having a heart attack, or a brain tumor, or just feel that they cannot stop worrying. Many have seen multiple doctors with extensive workups that reveal no medical problem to explain their symptoms. This can be quite frustrating for the patient because they KNOW something is wrong, but they don’t know what it is, and the doctor isn’t always able to figure it out.
Once you know it’s anxiety, it’s best to find a therapist who can help sort out what type of anxiety you have. You might have a diagnosis of generalized anxiety disorder, panic attacks, social anxiety, phobias, or other types of anxiety
TYPES of ANXIETY
Generalized anxiety disorder
PTSD (post-traumatic stress disorder)
CAUSES of ANXIETY
It is not always clear what causes anxiety but some possible explanations are:
Genetics - anxiety has been shown to run in families
Brain chemistry - up-regulated cortisol system?
Life events - Major life changes such as marriage, divorce, death in the family, illness of oneself or a loved one, moving, job changes, financial issues, COVID-19, political divisiveness, the economy, taking care of elderly family members, etc.
COMMON SYMPTOMS OF ANXIETY
Racing or pounding heart
Continuous thoughts of worry
Headaches or other body aches
Sense of impending doom
Shortness of breath
“Brain fog” or difficulty concentrating or focusing
Abdominal pain, upset stomach, indigestion
Muscle aches and tension
Changes in appetite or eating habits
Dizziness or lightheadedness
SYMPTOMS OF GENERAL ANXIETY DISORDER
Excessive anxiety and worry
Muscle aches or soreness
COVID-19 HAS INCREASED ANXIETY LEVELS FOR ALL OF US!
And for those who are already struggling with anxiety, the pandemic has exacerbated it.
Changes in our social interactions - missing seeing family and friends
Changes in work
Changes in activities we enjoy - restaurants, concerts, sporting events, family get-togethers, etc.
Changes in our children’s lives - worrying that they are struggling with school and/or lack of social interaction, more screen time than we’d like
CURRENT TREATMENTS FOR ANXIETY
Benzodiazepines - This class of drugs includes medications such as Xanax, Klonopin, Valium, Librium, Ativan
These drugs have been around for a long time. They work by interacting with a neurotransmitter in the brain called GABA.
Anti-depressants - SSRIs, SNRIs - This class of drugs includes Prozac and Zoloft and are sometimes used to help prevent or mitigate anxious feelings.
These can be very effective, but they do have side effects. Benzodiazepines also have addiction potential.
Also, many people “self-medicate” with alcohol, which can lead to numerous other health problems.
MOST COMMON SIDE EFFECTS OF BENZODIAZEPINES
unsteadiness (especially in older people, who may fall and experience injuries)
nausea (feeling sick)
LESS COMMON SIDE EFFECTS OF BENZOS
low blood pressure
increased saliva production
sight problems, such as double vision
changes in sexual desire
incontinence (loss of bladder control)
NON-MEDICINAL TREATMENTS FOR ANXIETY
Cognitive behavioral therapy (CBT)
Talk therapy - with a therapist and/or friends or family
A combination of all of these treatments is probably the most effective way to approach and treat anxiety.
CAN CANNABIS HELP WITH ANXIETY?
Research is limited because marijuana is still labeled as a Schedule I drug by the federal government. In 1970, the federal government declared marijuana more dangerous than cocaine, methamphetamines, oxycodone and fentanyl. There is no evidence to prove that marijuana has caused injury or death.
This designation will hopefully change soon. We need more studies!
Anecdotal evidence does suggest that cannabis can be a very effective treatment for anxiety.
Marijuana has been used by humans for hundreds of years!
Medical marijuana can serve as a natural alternative to existing pharmaceutical approaches to treating anxiety.
HOW CAN CANNABIS HELP?
May affect the GABA neurotransmitter receptors
May lower cortisol levels, and thus decrease stress
In addition to relieving the feelings of unease associated with anxiety, cannabis may help with the following anxiety symptoms:
Insomnia: Certain types of medical marijuana have relaxing, sleep-inducing properties.
Fatigue: Other kinds of cannabis medicine have an energizing effect that counteracts fatigue.
Concentration difficulties: Specific strains and formulas can also help with focus and concentration
WHICH MEDICAL MARIJUANA TREATMENT WORKS BEST FOR ANXIETY?
The right marijuana consumption method and strain for you depends on your symptoms, diagnosis and how you react to cannabis. You have many options to choose from, and each method impacts how your medicine affects you. There are many ways you can use medical marijuana:
Smoking: This is the most popular way to use cannabis for both recreational and medical users. But it may not live up to the hype for you — in fact, it can harm your health. Like smoking tobacco, smoking marijuana produces tar and toxins you inhale along with the cannabis.
Vaping: If you absolutely must inhale your marijuana, you can try vaping. When you vape correctly using a high-quality vaporizer, you can reduce the toxins generated. However, it will still release a small amount of those chemicals, no matter how you vape it.
Edibles: As long as you don’t have any dietary issues or restrictions preventing you from eating edible marijuana products, they can provide an extended and milder effect. If you don’t mind feeling the effects later than you would with inhalation, edibles could take the edge off any side effects marijuana gives you.
Tinctures: Tinctures are liquid, cannabis-infused products made with alcohol and they come in glass bottles with droppers. A tincture can vary in effect depending on if it is used sublingually (under the tongue), orally or used to infuse in food. Sublingual is usually the fastest acting but all tinctures are faster acting than other edibles.
Topicals: Most topicals, such as lotions and balms, help patients dealing with localized But, there are also patches available in certain states that let the medicine directly enter your system. Patches can come in a 100 percent CBD formula that lets you avoid the paranoia resulting from tetrahydrocannabinol (THC).
Pure CBD: A treatment method growing in popularity is pure CBD. CBD oils and pills are taken similarly to pharmaceutical medicine but affect you the same way other CBD products do. CBD does not have THC, or has such a low amount (<0.3% by law) that you will not feel the "euphoria" or “high” that you might if you take THC.
So while you can consume your marijuana in just about any manner and feel relief, some products will work better than others, and each individual is different. Try out different products and stay in touch with your doctor so you can make adjustments as you go.
CANNABIS STRAINS - INDICA VS. SATIVA
Many say that indica strains are more relaxing and better for helping you sleep, while sativa strains are better for a more uplifting effect. There is not as much research as we’d like to prove that different strains really address the different types of disorders specifically. These distinctions are more anecdotal.
Some individuals do still use these distinctions, and claim they get much better effects from one than the other. If it works, stick with it!
SIDE EFFECTS OF MARIJUANA
While it has numerous benefits, medical marijuana can also have side effects for some patients. Due to marijuana’s versatility, a negative side effect for one patient can serve as a benefit for another, such as indica strains’ tendency to make the user sleepy. So when you consider the pros and cons of marijuana, you must look at it holistically and understand all its nuances.
If you do experience side effects, there are ways to reduce them and this is one of the reasons that working with a knowledgeable physician is so important. Some side effects of medical marijuana include:
Hunger: All jokes about “the munchies” aside, constant hunger can cause you to eat more unhealthy food. Since the only solution to a cannabis-induced appetite is eating, we recommended keeping healthy food around so you don’t snack on junk food when you feel hungry.
Red eyes: Eye redness doesn’t harm you. But it can make you feel self-conscious, especially if you worry about the judgment some medical marijuana users face. To get rid of your eye redness, you can use some over-the-counter eye drops.
Respiratory issues: Only marijuana smokers and vapers need to worry about their medicine causing respiratory issues. If your marijuana use starts to damage your lungs, switch to another means of taking your medicine. Vaping does appear to be safer than smoking the flower directly.
Drowsiness: In addition to calming you down, indica strains and other strains high in CBD can make you feel sleepy. If you have difficulty sleeping due to your anxiety, you might consider this a benefit. On the other hand, if your sleepiness gets in the way of daily functioning, time your dosage so the sleepiness hits you around bedtime.
Dry mouth or thirst: “Cotton mouth” isn’t limited to pharmaceutical medicine alone. To keep from constantly feeling thirsty, drink plenty of fluids and chew xylitol gum. To avoid extra sugar, drink water or other healthy drinks instead of soda or juice.
Short-term memory loss: You may feel a bit forgetful when your medicine kicks in. If this happens during work or school, try changing the time you take your medicine so the memory issues won’t affect you when you need the extra brain power.
Insomnia: Insomnia may occur in patients who use sativa strains high in THC. If your medication makes it hard to get to sleep, take it at a time that allows it to wear off before bed.
Everyone has a slightly different experience with medical marijuana. With the guidance of a trained medical professional, you can minimize side effects and maximize the benefits.
RESEARCH ABOUT MEDICAL MARIJUANA AND ANXIETY DISORDERS
As marijuana laws change, we’ll have more opportunities for research that can tell us when and how to use marijuana for anxiety properly. We recommend working closely with your doctor so you can figure out whether or not it works for you, and how to use it most effectively.
Journal of Affective Disorders, Volume 235, August 1, 2018, pages 198-205
Tracked nearly 12,000 “sessions”
Found that cannabis was perceived to have significantly reduced stress and anxiety (58% reduction in stress and anxiety)
2 puffs seemed to be the most effective, and using too much cannabis might exacerbate depression or anxiety
TREATING ANXIETY - IT'S COMPLICATED, BUT WE CAN HELP!
Some patients have difficulty finding the right treatment for their anxiety. Since we all have unique brain chemistry and react differently to anxiety medicine, the same treatment won’t affect every patient in the same way. In addition to this, finding the right therapist may sometimes be a challenge.
Be patient, and open to trying different strains and doses until you find what works best for you. If you choose to work with a therapist, make sure you develop a dialogue that makes you feel understood and cared for. If you find that a therapist isn’t the right fit for your personality, find another therapist!
DOSING and GENERAL GUIDELINES
Start low and go slow!
Effect and dosing varies by individual, especially by age, and previous use of cannabis.
Low doses seem to be more effective in treating anxiety than high doses. In fact, high doses may make anxiety worse!
Wait for the effect to start (this can take up to one hour for edibles!)
More anxiety does not necessarily mean you should increase the dosage.
Work with your physician to help guide you to find the right dose and frequency for YOU. An individualized regimen will give you the best results.
WHAT DO DOCTORS RECOMMEND FOR TREATING OR MANAGING ANXIETY?
There is strong evidence to support that cannabis or marijuana can help with anxiety.
The form of ingestion, strain, and dosage really depends on the patient and might take some trial and adjustment of your regimen.
Dosing of medical marijuana is patient-dependent. There is no one recommended dose for all.
Stay in touch with your prescribing doctor so they can help you with dosing, form, and timing of your ingestion. We can help to customize the treatment plan for your specific needs, but keep in mind that this can take time.
If marijuana makes your anxiety worse, then it might not be for you. It is not the answer for everyone.
MULTIMODAL APPROACH IS THE MOST EFFECTIVE WAY TO TREAT AND MANAGE ANXIETY
Spending time with friends and family, and engaging in activities you enjoy
Improving sleep patterns
Listening to music
Other relaxation techniques
OTHER RESOURCES THAT MAY BE HELPFUL:
ANXIETY AND DEPRESSION ASSOCIATION OF AMERICA
PLEASE CONTACT INTEGRATIVE HEALTHCARE TODAY IF YOU WOULD LIKE HELP MANAGING YOUR ANXIETY!