Anxiety and Depression

Cannabis has been used to treat anxiety and depression for thousands of years. A recent survey of patients seeking care in medical cannabis clinics in California reported that 38% (51% female, 33% male) of patients found relief from anxiety and 26% (35% female, 23% male) found relief from depression with cannabis use.¹

Although research on the effectiveness of cannabis treatment of anxiety and depression in humans is limited, there is evidence of endocannabinoid system dysfunction in these patients.

• Women with major depression were found to have significantly decreased levels of the endocannabinoid 2-AG when compared to women without major depression, suggesting an endocannabinoid deficiency in these patients.²
• The same study found that levels of the endocannabinoid anandamide were low in women who had reported anxiety, again suggesting an endocannabinoid deficiency disorder.³
• A significant increase in Type I cannabinoid receptors was found in brains of individuals with a diagnosis of major depression who had committed suicide, compared to brain tissue of individuals who died of other causes, suggesting an endocannabinoid system abnormality in those that suffer with severe depression.⁴

The phytocannabinoids are well known to have anti-anxiety and antidepressant properties. THC, although very relaxing and mood enhancing for most people, can cause paranoia, anxiety and depressive episodes in some. Although there are many variables that can account for this paradox, three stand out.

• The first variable that can affect what type of response an individual patient may have depends on the potencies of THC and CBD in the cannabis product that is being used.
• The second variable is the dose and frequency of use, for instance, too much THC can give an undesired result.
• The third variable is the individual genetic factors that may affect a patient’s anxiety response.

Many patients report less anxiety overall with intermittent use of low dose THC-rich cannabis. This approach can help the endocannabinoid system to run more smoothly and enhance endocannabinoid function. Large doses of THC taken on a frequent basis can cause increased anxiety and panic attacks in some people – this may happen suddenly or over time. CBD has anti-anxiety properties in both low and moderate high doses.⁵

I have treated thousands of patients who suffer with anxiety and depression. Some patients prefer THC-rich cannabis, some prefer CBD-rich cannabis and some prefer a combination approach. Many have been able to stop using prescription medications and are using only cannabis to treat their condition. Others continue to use conventional treatment but they are able to keep the doses of these other medications low, which helps them to minimize the negative side effects well known to occur with these types of medications, such as sedation or dependence. Certain chemovars of cannabis may have more anti-anxiety effects, such as those that contain the terpenoid linalool, and others may have more anti-depressant effects, such as those containing limonene.

Patients sometimes report that they experienced anxiety and paranoia when they used cannabis recreationally when they were younger. Many of these patients are now finding good results with CBD-rich cannabis. I have also found that CBD can “antidote” THC-induced anxiety and paranoia if someone unintentionally takes too much THC.

Dosing is very important when using any cannabis containing THC. Starting at a low dose and titrating up slowly helps in minimizing any chance of unwanted side effects.

If you suffer with anxiety and/or panic, do not over medicate with THC-rich cannabis. Lower doses taken intermittently will work much better for you and will allow your endocannabinoid system to find balance. If you take large doses frequently, you will down-regulate (decrease) your cannabinoid receptors, which will result in loss of effectiveness of THC. My recommendation to my patients is to be very thoughtful about their use of THC-rich cannabis and to take breaks (from a few days up to a week) from cannabis when they are feeling well to minimize down-regulation of the receptors.

Sources

[←1]

^{Nunberg, H., et al. An Analysis of Applicants Presenting to a Medical Marijuana Specialty Practice in California. Journal of Drug Policy Analysis (2011) 4}

[←2]

^{Hill, Matthew N., et al. “Serum endocannabinoid content is altered in females with depressive disorders: a preliminary report.” Pharmacopsychiatry 41.2 (2008): 48.}

[←3]

^Ibid.

[←4]

^{Hungund, B. L., et al. “Upregulation of CB1 receptors and agonist-stimulated [35S]GTPS binding in the prefrontal cortex of depressed suicide victims.” Molecular psychiatry 9.2 (2004): 184-190.}

[←5]

^{Zuardi, A., et al. Action of cannabidiol on the anxiety and other effects produced by Δ 9-THC in normal subjects. Psychopharmacology (1982) 76: 245-50}