Anxiety is a state of fear or worry in the face of a perceived threat of danger. It is an emotional dis-ease or uneasiness, in which the anxious individual describes feeling tense, nervous, or disturbed. Within the medical community this condition of fear is known as anxiety neurosis, and it affects twice as many women as men. Someone with anxiety manifesting as IBS might feel worried sick, with their “stomach in knots.” Nearly all people with chronic pain also have anxiety.
There is probably no one who has not experienced at least some degree of anxiety. Like depression (see below), it covers a spectrum of emotional discomfort that ranges from mild appropriate concern to being overwhelmed by an excessive continuous state of worry. In fact, anxiety often accompanies depression, as well as obsessive compulsive disorders and posttraumatic stress disorder (PTSD). When taken to the extreme, anxiety manifests as acute panic attacks and phobias.Generalized anxiety disorder is characterized by excessive or unwarranted worry (usually over work, finances, relationships, and health) that occurs chronically for at least six months. The degree of fear is often unrelated to any obvious cause. But in today’s world, global and financial instability, terrorism, governmental dysfunction, and the divisiveness that presently permeates our society have provided an abundance of obvious contributors to our current epidemic of anxiety and its offspring, insomnia.
Anxiety and fear trigger the “fight-or-flight” response, which causes excess adrenaline to be produced by the adrenal glands along with other hormones called catecholamines, and the body prepares itself for action. When no action is taken and nervous energy is not discharged, there is physiological confusion. This could be described as an anxiety or panic attack, manifested by many of the symptoms in the following list:
• Restlessness, irritability, feeling keyed up or on edge/a sense of urgency
• Insomnia (difficulty falling or staying asleep, nightmares)
• Heart palpitations (rapid or irregular heartbeat)
• Muscle tension, especially in the neck, shoulders, and chest
• Easily fatigued
• Difficulty concentrating or mind going blank
• Rapid and shallow breathing, or feeling short of breath (hyperventilation)
• Trembling or feeling shaky
• Dry mouth
• Generalized sweating, or sweaty palms
• Headaches
• Abdominal pain and/or diarrhea
• Loss of appetite
• Occasional panic attacks
Conventional medical treatment for anxiety consists primarily of antianxiety medications, called benzodiazepines. These include Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam), and Valium (diazepam). Although these drugs act rapidly and effectively and relieve panic attacks and general anxiety, they can be addictive, impair memory, and increase fatigue. Similar to opioids for treating physical pain, these medications can be quite helpful when used for a short time. Daily, long-term use, however, can be a problem, especially with addiction and deaths from overdose. According to the Centers for Disease Control and Prevention, benzodiazepines were involved in about 30 percent of prescription drug overdose deaths in 2013, second only to opioids, which were involved in 70 percent.
Among my patient population, relief from anxiety is the third-most sought therapeutic benefit from MMJ, behind pain and insomnia. But unlike the top two symptoms, I advise patients suffering with anxiety to avoid significant amounts of THC, unless their anxiety is accompanied by physical pain, which is often the case. This poses somewhat of a challenge to find an effective balance, which must be determined by each individual.
The problem is that anxiety, pain, and insomnia are closely connected. With increased anxiety, your pain is likely to be worse, which can then result in greater difficulty obtaining a good night’s sleep. And those who are sleep-deprived are invariably more anxious. This is a miserable cycle, one that I briefly experienced during the height of my bout with shingles, until I discovered the right combination of MMJ products.
As I’ve previously mentioned, some THC is needed for optimal pain relief, but in someone who has a predisposition toward higher levels of anxiety, too much THC can increase it. What is too much? Individuals must determine that for themselves. A minimal amount of THC—for example, the strongest indica strains (80:20/I:S)—are invariably helpful before bed for inducing sleep and decreasing anxiety. However, many patients with high anxiety also use these same strong indica strains or a 70:30/I:S during the day without feeling the least bit sleepy. In fact they function quite well, and often describe the effect as “it levels me out, and helps me feel more grounded.”
Depending on one’s level of anxiety, vaporizing the indica-dominant strains, 80:20, 70:30, or 60:40, is recommended for patients with anxiety accompanied by some degree of physical pain. Indica edibles, Stratos Sleep (indica) tablets, or Med-a-mints indica sublingual tablets are other indica options that work well for both anxiety and sleep, depending on the time of day they are taken. But as with the majority of MMJ products, you’ll have to experiment and see what works best for you.
For those patients with anxiety and no pain, the high-CBD tinctures with little or no THC are preferred over indica-THC products. Examples of high-CBD tinctures include Charlotte’s Web or Restorative Botanicals, both of which are derived from hemp oil.
Other high-CBD products derived from marijuana include 20:1/CBD:THC tincture, or vaporizing a high-CBD strain of marijuana flower. Also effective are the Stratos tablets, 15:1/CBD:THC; CBD capsules, 25 or 50 mg; or high-CBD edibles.
As a rule with high-CBD products, the lower the percentage of THC, the less effective the product is as an analgesic. However, it will still retain its anxiety-lowering effect. The CBD products derived from hemp oil with less than 1 percent THC are legal and they are the preferred choice for those who do not want to feel even the slightest psychoactive effect. Studies have shown that they are most effective for relieving anxiety, rather than reducing pain or helping with sleep. It is important to note that many people find that a mild psychoactive effect is often helpful in relieving anxiety.
The causes of anxiety include:
• Fear—relationships and situations that contribute to insecurity
• Chronic pain or prolonged illness/inflammation
• Excess caffeine
• Excess sugar, chocolate, NutraSweet
• Excess of highly acidic foods—tomatoes, eggplants, peppers
• Stimulants—decongestants, NoDoz, tobacco, and asthma and corticosteroid medications
• Hyperthyroidism
• Hyperadrenalism
• Hypoglycemia
• Nutritional deficiencies of B vitamins and magnesium
• History of trauma: physical, sexual, or emotional abuse
• Abnormal levels of stress hormones and/or neurotransmitters
Holistic and Functional Medicine practitioners can now accurately measure your chemistry of stress:
Levels of neurotransmitters, such as serotonin, GABA, dopamine, glutamate, norepinephrine, epinephrine, and PEA, can be measured with a simple urine test. If it is determined that you have an abnormal level, there are support therapies that can either help to reduce excess stimulatory neurotransmitters that might be causing or aggravating anxiety, or boost relaxation chemicals like serotonin and GABA. With this testing your practitioner can help to personalize your holistic treatment program. For the past decade this approach has proven to be highly successful for significantly reducing or eliminating anxiety. The neurotransmitter test can be performed by NeuroScience Pharmasan Labs.
The adrenal stress hormones cortisol and DHEA can be measured with a saliva test. These stress hormones are associated with the body’s “fight-or-flight” system. Many people with anxiety and/or sleep disorders have elevated cortisol, which is stimulating, and depressed or elevated DHEA. Labs performing this test include Genova, NeuroScience Pharmasan Labs, and Diagnos-Techs, among others (see Resources for URLs).
The recommended diet for treating anxiety includes complex carbohydrates (whole grains—especially brown rice, barley, millet, non-GMO corn, and original wheat [that has not been hybridized]), vegetables, seaweed, and foods containing L-tryptophan (sunflower seeds, bananas, milk [unless you are dairy sensitive]). These foods support serotonin production. The diet is moderate in protein, fat (30 percent of calories), and strong spices. Caffeine, chocolate, alcohol, sugar, and highly acidic foods should be avoided.
• Gamma-amino butyric acid (GABA): a nonessential amino acid in the brain that the body uses to calm anxiety naturally. Most tranquilizers (Xanax, Ativan, Valium, etc.) create a calming effect by stimulating the natural GABA receptors. But unlike tranquilizers, the common oral form of GABA from the health food store cannot pass the blood-brain barrier and is believed to be ineffective in calming the brain. However, it is very helpful in relieving anxiety symptoms originating in the digestive tract and adjacent organs—for example, diarrhea, “stomach butterflies,” heart palpitations, and hyperventilation. This is due to its effect on what some scientists refer to as the second, or GI, brain (see Chapter 10). It may take several weeks to appreciate the full benefit of GABA. There is a form of it called pharmaGABA that is well absorbed and readily available in most health food stores. The recommended dosage for daytime relaxation is up to 750 mg two times daily. For sleep, take 500–1,500 mg before bed. There is a form of GABA called Phenibut that does cross the blood-brain barrier, and is contained in some NeuroScience products.
• RelaxMax (Xymogen): a tasty powder containing L-theanine, an amino acid that helps potentiate GABA in the nervous system. Theanine will begin having an effect within twenty minutes. It also contains myo-inositol, a supplement well documented to reduce anxiety, as well as super-absorbable magnesium and taurine. The recommended dosage is 1–2 scoops one to three times daily in cool water between meals.
• 5-HTP or 5-hydroxytryptophan is often quite effective for dealing with anxiety. This amino acid is readily converted into serotonin, which is a calming neurotransmitter as well as an antidepressant. It is best taken on an empty stomach for absorption and conversion. The recommended dosage for anxiety of 100–200 mg twice a day between meals is often sufficient. As a sleep aid, take 50–200 mg before bedtime. I recommend Xymogen’s 5-HTP CR. It is time-released and works slowly and steadily.
• Vitamin C: Take at least 1,000 mg three times daily.
• Vitamin B complex or B Activ (Xymogen): Take 1 capsule at breakfast and lunch daily. This is a scientifically formulated B complex with methylated B vitamins that are essential for the production of anti-stress neurotransmitters, and for balancing adrenal hormones.
NOTE: A very small percentage of people will have increased anxiety with vitamin B complex.
• Essential fatty acids (EFAs)/OmegaGenics EPA/DHA 720 (Metagenics): a high-dose, pharmaceutical-grade fish oil. (Fish oil has been shown to lower anxiety.) The recommended dosage is 1–3 capsules daily with meals.
• Kava kava (Piper methysticum): an herb that has been successfully used by herbalists since the discovery of its use in Polynesia by Captain James Cook. It is used for treating anxiety and promoting sleep. Kava kava is one of the best-studied herbs with proven effectiveness, as well as being one of the best known and utilized. Kava kava is available in both liquid and capsule form. Use the standardized extract of its active ingredient, kavalactone. For daytime relief of anxiety, take 250 mg (one capsule or one-half dropperful) three times daily with meals. One can take four to six capsules for sleep (up to 1,500 mg). As with all other medications and nutrients, each individual has a biochemical individuality and needs to take responsibility for finding his or her own unique level. Kava kava should not be taken continuously for a prolonged period of time (more than four months).
• Valerian: the treatment of choice for over two hundred years throughout the world for anxiety and insomnia. Although it is quite safe to take for short periods of time, its long-term effects are not known. For daytime anxiety, the recommended dosage is 150 mg (standardized extract of 0.8 percent valeric acid) three times daily. For difficulty with sleep, start with 150 mg, forty-five minutes before bed. If that dose is insufficient, gradually increase to 600 mg.
• Other herbs that can be used for treating anxiety include chamomile, passionflower, lemon balm, and skullcap. The latter two are best for acute anxiety.
If the above herbs are not helping, there are stronger herbal formulas that holistic practitioners can recommend.
Longer, low-intensity aerobic exercise requiring greater endurance, such as jogging, swimming, and hiking, is best for relieving anxiety. Tai chi, yoga, and qigong are also excellent.
The following therapies can all be effective in treating anxiety: acupuncture (especially five-element style) and traditional Chinese medicine (TCM), Ayurvedic medicine, biofeedback training, bodywork (especially Rolfing), breathwork, chiropractic, environmental medicine (including detoxification therapy), homeopathy, mind-body medicine (guided imagery, meditation, hypnotherapy, neurolinguistic programming), naturopathic medicine, psychotherapy, and professional counseling (especially cognitive therapy).
Each of the following can be helpful in treating both anxiety and depression:
• Meditation: a technique for calming the mind. A sound or mantra can be used as an “object of meditation.” Transcendental meditation uses a repetitive phrase to focus one’s attention. Another method is to focus attention on the breath or other body sensations, a technique used in Vipassana and Zen meditation. Raja yoga is an integrative transpersonal approach that elicits responses of intuition and creativity. Whatever the specific method, the goal is to build confidence, increase focus and concentration, and reduce anxiety and depression. Thus, the feedback loop—consisting of depressive thinking, anxiety, hopeless feelings, more depressive thinking—is diminished.
• Relaxation training: teaches you to relax the body by progressively tensing and relaxing various muscle groups. Variations include tensing your fists while rolling your eyes upward and holding your breath. You then sequentially relax the eyes, exhale, and release the tension in your fists. This produces a “letting go” effect that can then be enhanced by focusing on counting down from five to one, picturing each number in a different color. Unlike meditation, this method emphasizes physical relaxation. Since you can’t think depressing thoughts while physically relaxing, this method is effective for relaxing the mind as well.
• Breath techniques: include several breathing methods derived from yoga and various forms of meditation. More recently, these practices have been used with good effect by patients of psychotherapy to calm the mind and body. Sometimes called breath therapy, the techniques include quickly paced, connected (no pause between inhalation and exhalation) mouth breathing (to evoke emotions). Breath therapy allows repressed emotions to surface and be released. Alternating mouth-nose breathing is good for centering, and alternating nostril breathing can enhance creativity. Some of these breathing techniques can be enhanced with imagery and music. Each breathing method has its own intention and rationale and can be quite helpful in treating anxiety and depression. To get started, work with a qualified breath therapist. These methods are quite easy to learn and highly effective.
• Biofeedback training: a systematized approach for learning relaxation that provides feedback evidence of reaching a calmer level of brain-wave activity and physiological response. By allowing you to refocus energy in a self-empowering way, it gives you a greater feeling of control over your autonomic (“involuntary”) nervous system reactions (heart rate, blood pressure), including those triggered by stress. With the help of a biofeedback technician, you are hooked up to an apparatus that measures your responses (heart rate, muscle tension, skin temperature, brain waves) while you focus on a sensory cue to help you relax. If you need technical confirmation that something is happening, this method is for you. During the past decade, breath feedback using capnometry (measures CO2) has been highly effective in helping to relieve anxiety, pain, and depression.
• Journaling: a technique for recording your emotions and understanding patterns of action based on your feelings. To begin to focus on positive experiences, try keeping a gratitude journal. This consists of writing each day about something for which you can be grateful. By making a gratitude entry each evening before bed, you neutralize the mind-set that focuses on what’s wrong in your life—the depression cycle—and you begin to appreciate what’s right.
• Hypnosis (hypnotherapy): a form of treatment that can be quite effective with milder types of anxiety and depression. Hypnosis produces an altered state of consciousness (ASC) in which certain senses are heightened and others seem to fade into the background. It is not a state of sleep. While in a hypnotic trance, you become more aware of words and suggested images, and they grow more intense.
Bodily sensations and time are often distorted. You do not need a deep trance to receive the benefits of hypnosis; a light trance is often adequate. Images of calm, relaxing scenes are often suggested for clients with anxiety. Although the visual imagery is quite effective, much of the benefit from hypnosis is obtained by the simple act of learning to relax. It is often a revelation to learn that you can relax.
Depression is often a pattern of seeing yourself and your life with a bleak sense of entrapment. Hypnotherapy can be used to imagine, while in a heightened state of suggestibility, more hopeful options and better methods of dealing with painful issues. While in a hypnotic state, one can visually rehearse newer ways of perceiving oneself.
• Self-hypnosis: which can easily be learned from a skilled therapist (and even from books), provides simple and effective methods for training yourself to enter a hypnotic state. Audiotapes are also an excellent source of training in self-hypnosis and learning strategies to relax and reprogram habits of the mind.
• Emotional Freedom Techniques (EFT): an energy psychology technique that can be quite helpful in treating anxiety, depression, and insomnia. Utilizing acupressure, EFT’s central premise is that the cause of all painful emotions is a disruption in the body’s energy system. Although it can be an effective self-care technique with practice, it is best to learn it from a trained practitioner. Also known as “Tapping,” there are several websites (e.g., thetappingsolution.com) with a wealth of information on EFT.
• Progressive muscle relaxation: another form of hypnotherapy that is effective for anxiety. The client is instructed to start by tensing, then relaxing, the muscles of the feet, then repeating this process with each muscle group in succession, moving all the way up the body to the face and forehead (similar to relaxation training, described above).
• Self-talk: re-scripting self-dialogue from self-defeating to positive encouragement. This is done through the use of affirmations or changing phrases from “if only” to “I am!”
• NLP (neuro-linguistic programming): has proven extremely successful with intractable phobias and certain forms of anxiety. It utilizes transformational imagery to modify behavior and help reshape emotional patterns.
• Spending consistent time immersed in creative activities such as painting or playing a musical instrument can help with anxiety and depression. The same holds true for daily and weekly scheduled time for play and/or relaxation, as well as periodic vacations.
The mental and emotional health techniques most effective for anxiety include psychotherapy; stress-reduction techniques—meditation, relaxation training, breath therapy, and biofeedback training; journaling; energy medicine—Healing and Therapeutic Touch, Reiki, qigong, along with working on the specific emotional issues associated with your condition; hypnosis; bodywork therapies; planned retreats and vacations—even long weekends away from home are helpful; creative activities—art, music.
Holistic medicine is based on the belief that unconditional love is life’s most powerful healer. Love and fear are inversely proportional—i.e., the greater one’s capacity for love, the less one’s fear. Spiritual psychotherapy is focused on expanding one’s capacity for self-love. Since fear is the primary cause of anxiety, those spiritual practices that are most beneficial for reducing fear are also the most helpful for lessening anxiety. These include prayer, psalms (especially Psalms 23 [before bed], 91 [after work], and 121 [early morning, facing east), meditation, and altruism (volunteering).
Richard U. is a sixty-three-year-old trial attorney who, since his divorce twelve years ago, had been taking Ativan (2 mg) two to three times daily to relieve his anxiety. He also had moderate pain in both knees from osteoarthritis.
He began using MMJ approximately one year ago, and although his job is no less stressful and he’s not been in counseling as I had recommended, he’s been able to wean himself off the Ativan and now uses it no more than once or twice a week. He typically vaporizes the stronger indica strains of MMJ (some with high-CBD content), either 70:30 or 80:20/I:S, and functions quite well during the day, without the least bit of drowsiness. According to Richard, “it levels me out.” In the evening or after work, he tends to do the heaviest indica strains, which he says help him to relax.
He will also occasionally use indica edibles early in the day. He finds that he’s able to obtain some relief from his arthritic pain with the indica flower and edibles, in addition to the topical cream Apothecanna Extra Strength.
Richard’s case of anxiety is somewhat unusual in that it did not respond at all to CBD tincture (with no THC), or any of the anti-anxiety supplements that I recommended. This may be indicative of an especially severe case of anxiety, or possibly not being patient long enough to determine the appropriate dose of the CBD tincture or the supplements.
However, he seems satisfied with the results he’s obtained from the indica and has been able to nearly stop the Ativan entirely, which was his original objective.
Just as the incidence of anxiety has increased dramatically during the past two decades, so too has insomnia. Insomnia is our most common type of sleep disorder, defined as a lack of sleep due to insufficient quality or quantity and typically involves difficulty falling asleep or staying asleep. Most cases of insomnia are caused by varying degrees of anxiety. Insomnia also occurs as a result of medical conditions (especially chronic pain, heart disease, and cancer), depression, medications, and environmental factors (e.g., temperature extremes, noise, light), changes in sleep habits, and lack of exercise.
Sleep apnea is one of the less common but potentially most serious types of secondary insomnia. It is a disorder in which there is intermittent cessation of breathing during sleep, which forces the individual to repeatedly wake up to take breaths. It affects predominantly men between thirty and sixty.
The most common symptoms accompanying insomnia are fatigue, immune deficiencies (increased susceptibility to illness), headaches, weight gain, irritability, depression, slowed reaction time, diminished short-term memory, decreased libido, poor job performance, and increased substance abuse.
Why do we need to sleep, and why does sleep have such a profound impact on our physical well-being? Science has been seriously exploring the physiology of sleep since the early 1970s, but it still remains largely a mystery. Although many prominent people (JFK, President Clinton, Martha Stewart, Jay Leno) have claimed they need only three to four hours of sleep, the evidence supports the fact that while sleep requirements are highly individualized, most people require seven to eight hours to function optimally. Even as the quality of sleep diminishes with age, the need for sleep does not.
There are two distinct physiological states of sleep: non–rapid eye movement (NREM—deep sleep), with four stages defined by specific electroencephalogram (EEG) features, and REM sleep, characterized by episodic bursts of rapid eye movements, muscle relaxation, and dream activity. The two types of sleep alternate throughout the night, in three to six ninety-minute NREM-REM cycles.
The functional purposes of NREM and REM sleep states are not definitively known. However, most sleep researchers accept the idea that the purpose of NREM sleep is at least in part restorative—i.e., replenishing immune cells; restoring organs, bones, and tissue; and circulating a rejuvenating supply of growth hormone, making us less vulnerable to the diseases of aging. Studies show that when deprived of sleep, the brain prioritizes deep sleep over REM sleep. Although the function of REM sleep remains a matter of considerable controversy, some studies indicate that it is crucial for proper functioning of the brain and psyche. While more research is needed, it’s possible that the ability of marijuana to increase deep sleep, even at the expense of REM sleep, might turn out to be a good thing.
Numerous studies have shown that using marijuana before bed reduces REM sleep and lengthens the time the brain spends in deep sleep (NREM). Most of these studies on marijuana and sleep have looked primarily at the effects of THC, and do not reflect the predominance of strong indicas (with relatively small amounts of THC) currently used by the vast majority of MMJ patients for sleep. I continue to hear repeatedly from my patients that the greatest benefit they derive from MMJ is better quality sleep, with pain relief and decreased anxiety a close second and third. As I’ve explained in the “Anxiety” section above, these three symptoms are very closely connected.
Researchers believe that marijuana users report fewer dreams because THC reduces REM sleep. Using THC or marijuana before bed also appears to reduce the density of rapid eye movements during REM sleep. Interestingly, less REM density has been linked to more restful sleep.
Although the science of marijuana and its effect on sleep remains unclear, there is nothing ambiguous about the clinical reports I receive from patients on a daily basis as to its tremendous benefits for sleep. And in the majority of cases, marijuana, as indica, has allowed them to stop using their prescription sleep medications.
Remember that all indica strains have some THC, and even though they are an excellent choice for promoting sleep as well as reducing pain, it’s easy to take too high a dose. This is especially true with edibles and tinctures, which is why it’s best to start out with a minimal dose and gradually increase. Otherwise you might get too high to fall asleep, and if you take too much of an edible or tincture, you can be up for several hours, precisely the opposite effect that you were hoping for. If this occurs, don’t worry. If nothing else, it will only last for a few hours before the effect dissipates, and you will have learned a valuable lesson about dosage.
• Vaporizing a strong (80:20/I:S) indica strain a few minutes before getting into bed—every dispensary has several options from which to choose. Purchase smaller amounts (e.g., one-eighth ounce) of three or four strains and rotate these strains every two or three days. If you use the same strain every night, you’ll develop a tolerance and the effect will gradually weaken. Start with two or three inhalations from a vaporizer (or one or two hits of smoke) at most.
• High-CBD hash oil in a vaporizer pen works well.
• High-CBD tincture—forty to sixty minutes before going to bed. You’ll have to experiment to determine the optimum number of drops or sprays for you. Start with three to five drops or sprays of tincture. Best taken on an empty stomach.
• High-CBD hash oil—ingest a 6:1, 12:1, or 20:1 oil in an amount approximately the size of one grain of rice.
• Tinctures or capsules combining CBN/CBD/THC are very effective, especially Prana P4 Bio Medicinals, but at the present time are not readily available outside of California.
• Indica tablets (Stratos Sleep)—ingest between sixty and ninety minutes before bed, along with a fatty food (increases absorption), such as peanut butter, avocado, nuts, cheese. Start with one-half tablet.
• Sublingual indica tablets (MED-a-mints)—dissolve one under your tongue (try and keep it in your mouth for at least ten minutes after it has dissolved) thirty to fifty minutes before bed. Start with one-half tablet.
• CBN—either Mary’s Medicinals CBN capsules, transdermal CBN gel pen, or CBN transdermal patch work extremely well for both sleep and pain.
• Indica edibles—require a period of experimentation to determine the best dose. Ingest sixty to ninety minutes before bed and start with a very small piece, approximately one-quarter to one-half of the recommended dose. If there’s no effect within ninety minutes, then eat a little more.
• Dixie Elixirs Bath Soak and Mary Jane’s Medicinals Hash Bath are both effective for helping to fall asleep.
• The indica edibles (six to eight hours), tinctures (four to six hours), Stratos Sleep tablets (six to eight hours), MED-a-mint sublingual tablets (four to six hours), and especially the CBN patch (ten to twelve hours) might last long enough to help you to both fall asleep and stay asleep. This includes easily falling back to sleep if you awaken to urinate during the night.
• Vaporizing in the middle of the night can be an ideal solution for staying asleep as well as falling asleep. If your problem is only waking too early, but you fall asleep OK, then have your vaporizer loaded with a strong indica and set the correct temperature, which is approximately 375 degrees Fahrenheit (assuming you’re able to set the exact temperature, as is the case with a good quality vaporizer). Then turn the vaporizer off and set it on the nightstand or table next to your bed, and it will be ready to use if you need it during the night.
• Another option for “middle of the night use” is the Charlotte’s Web Disposable CBD Vape Pen.
• If you vaporized before bed to help fall asleep and you have a problem of awakening too early, then before turning the vaporizer off, set the temperature for 390–395 degrees Fahrenheit and place it on your nightstand. One of the advantages of vaporizers is that you can use the same strain a second time if you raise the temperature fifteen to twenty degrees. Although there’s more “smoke”—i.e., visible vapor at the higher temperature—this allows you to avoid turning on lights, grinding, and reloading the vaporizer, and in the process becoming more awake.
Regular users of cannabis experience an abnormal increase in REM sleep when use is stopped. This is called the REM rebound effect, which leads to longer and denser periods of REM sleep. The REM rebound explains why cannabis users often experience highly vivid dreaming when trying to quit.
The sleep disturbances that occur during cannabis withdrawal usually begin twenty-four to seventy-two hours after quitting and can persist for up to six to seven weeks.
The rebound effect appears to be the body’s way of coping with being deprived of certain stages of sleep.
• Age—sleep quality begins to diminish after age forty.
• Inflammation—If you are chronically inflamed, the inflammation will increase neurotransmitters that are stimulatory, such as glutamate, dopamine, epinephrine, PEA, and norepinephrine. This is part of the “fight-or-flight” mechanism. It can also disrupt sleep by increasing nighttime cortisol released from the adrenal glands.
• Lighted screens too late into the evening, such as computers, tablets, phones, and TVs—the lights can reduce melatonin production and keep cortisol levels high at night.
• Menopause—estrogen deficiency.
• PMS—progesterone insufficiency.
• Excess caffeine—in coffee, tea, soft drinks, chocolate, over-the-counter drugs (analgesics and diet pills).
• Drugs—decongestants, thyroid medications, oral contraceptives, beta blockers, marijuana (especially sativa and high-THC products), and overuse of sleep-inducing drugs.
• Stimulating herbs—ginseng, ephedra/ma huang, ginger, guarana, kola nut.
• Sugar (in some sensitive individuals).
• Nocturnal hypoglycemia.
• Allergies.
• Pain.
• Alcohol—initially sedating but lightens sleep as the night goes on.
• Environmental factors—noise, light, temperature, humidity, uncomfortable mattress.
• Insufficient exercise.
• Hypo- and hyperthyroidism; adrenal hyperactivity.
• Chemical hypersensitivity.
• Anxiety, especially the fear of not sleeping.
• Depression.
• Grief.
• Excitement/mania.
• Anticipation of confrontational situations.
• Work stress.
The underlying societal cause of this critical problem is that we are an overworked and overstimulated culture that is continually under pressure to accomplish more in less time. Insomnia is clearly a dis-ease of our modern age. As technology helps us to achieve our material goals, we are sacrificing our relationships, our health, and our happiness.
A neurotransmitter/adrenal cortisol/melatonin test, NeuroSLP, is now available through NeuroScience Pharmasan Labs. It is performed by collecting a urine and saliva sample during the night. With this test your holistic practitioner can determine your exact nighttime sleep chemistry.
Eliminate or reduce all caffeine in your diet, including coffee, tea, chocolate, and cola soft drinks. Also eliminate any other stimulants, such as cigarettes, over-the-counter drugs containing caffeine, hot spicy foods (especially cayenne), sugar, refined carbohydrates (they deplete B vitamins), alcohol (can lighten sleep), food additives, pork (bacon, ham, sausage), eggplant, spinach, and tomatoes. Some people with insomnia suffer from food sensitivities. The most common offending foods are dairy products, wheat and gluten grains, corn, and chocolate. Eliminate all of these foods for three to four weeks, then gradually reintroduce them, except chocolate. Avoid eating a heavy meal before bed, and establish a regular eating schedule.
Foods that enhance sleep have a high tryptophan-to-tyrosine (or phenylalanine) ratio (such as pumpkins, potatoes, bananas, onions, spinach, broccoli, cauliflower, eggs, fish, liver, milk, peanuts, cheddar cheese, whole grains [especially whole wheat, brown rice, and oats], cottage cheese, and beans). Eating tryptophan-rich foods for the evening meal or an evening snack may help induce sleep, including organic milk products from grass-fed cows, turkey, chicken, beef, soy products, nuts and nut butters, bananas, papayas, and figs. If you are hypoglycemic, follow a diet that stabilizes that condition.
Foods that are high in carbohydrates raise the level of serotonin in the brain, which has a sedating effect. Without overeating, you can try having some bean soup, half a baked sweet or Yukon gold potato, cooked root vegetables, or a piece of toast half an hour before bed. Fruits, especially mulberries and lemons, can calm the mind. Drinking an adequate amount of water during the day will prevent waking up at night thirsty. But avoid drinking large amounts before going to sleep.
• Vitamin B complex or B Activ (Xymogen): 1 capsule at breakfast and lunch
• Calcium and magnesium or Ossapan MD (Xymogen): within forty-five minutes of bedtime
• 5-Hydroxytryptophan or 5-HTP CR (Xymogen): 100 to 200 mg before bed
• Phosphatidylserine: up to 100–300 mg daily with dinner; an amino acid for those with insomnia due to elevated cortisol levels, usually induced by stress
• GABA: Either PharmaGABA, as mentioned above for anxiety, or a professional type of GABA that passes through the blood-brain barrier. This must be done with holistic medical supervision.
• Hormones: Melatonin is a normally occurring hormone manufactured and released by the pineal gland in response to darkness. It is most effective for the type of insomnia that manifests primarily as difficulty falling asleep, and its recommended dosage ranges from 1 to 4 mg, a half hour to one hour before bed. Melatonin can also be used for sleep maintenance with a sustained-release 1 mg preparation. There is also benefit with melatonin in treating jet lag. One of the best melatonin products is Melatonin CR (Xymogen). It has an initial quick release for falling asleep, then a sustained release after that for staying asleep. Take 1 tablet approximately twenty minutes prior to bedtime.
Natural progesterone has been used with good results for insomnia associated with menopause and PMS. Progesterone restores hormonal balance and has a calming effect. Only try this with holistic medical supervision. The majority of menopausal women need natural estrogen support to maintain healthy sleep.
• Benesom (Metagenics): a highly effective sleep aid with the following ingredients: calcium, magnesium, Chinese skullcap, passionflower, Melissa lemon balm, valerian, hops, and melatonin. The recommended dosage is 1–2 tablets one hour before sleep. NOTE: This product contains melatonin. Only add more melatonin under holistic medical supervision.
• Kava kava: useful for both anxiety and insomnia. The recommended dosage for sleep is 2 or 3 capsules (60 to 75 mg per capsule) an hour before bedtime.
• Chinese herbs (and acupuncture): often produce dramatic and long-lasting relief from insomnia, but you’ll need to find a qualified Chinese medicine practitioner or OMD (doctor of Oriental medicine).
Exercising during the afternoon or early evening, five to six hours before bedtime, and avoiding strenuous exercise in the evening is best. Outdoor exercise is preferable, since studies show that people who get adequate natural sunlight tend to sleep better. Exercise for at least twenty to thirty minutes—brisk walking, jogging, bicycling, hiking, swimming, or yoga.
Clinical research shows that about thirty minutes of exposure to bright light within two hours of waking can ameliorate sleep disorders, depression, and seasonal affective disorder. This can be from direct sunlight or from full-spectrum indoor lights.
While it’s best to take in light within two hours of waking up, there’s good news for those who work nights or just can’t stand to get up earlier: the important point is to get light before what is called the circadian nadir, which most people experience in the mid- to late afternoon. After that, your body begins its downswing toward sleep, and bright light will just throw things off. It can also be beneficial to take your lunch break outside or hold a midday meeting in the sunniest conference room.
Sunshine (or fake sunshine from full-spectrum lights) triggers a chemical message to the hypothalamus that tells the body it’s time to wake up and also shuts down the production of melatonin. In addition, exposure to light stimulates the production of serotonin. So morning sunlight helps you out in two major ways: it makes you feel alert and cheery now, and it promotes sleep later. Start the day with sun, and you’ll set the stage for a good night’s sleep.
Since sleep comes most easily when body temperature is falling, this process can be triggered by soaking in a warm bath or hot tub (below 105 degrees; if too hot, it can be stimulating) an hour to ninety minutes before getting into bed. Try keeping the bedroom temperature moderately cool (low sixties) to enhance the effect. To maximize the relaxation of tense muscles, you can add six to eight drops of lavender oil (used by aromatherapists for both anxiety and insomnia) and one cup of Epsom salt (consists primarily of magnesium, which relaxes muscles)to the bathwater. For maximum relaxation, a massage with lavender or chamomile oil following the bath is ideal.
• Make sure your bed is comfortable; most people do well with a medium-firm mattress that has a medium-soft top layer of padding.
• Restrict the bed to sleeping and sexual activity only; use other rooms for TV, reading, or conflict resolution.
• If you cannot fall asleep, or wake up and can’t go back to sleep, then get up and go into another room and do something boring, including housework, until you’re drowsy enough to go back to bed.
• Avoid taking naps.
• Go to sleep at the same time every night, at least eight hours before you have to get up, and set the alarm for the same time every morning; the best quality sleep can be found between 10 pm and 6 am.
• Create optimum bedroom conditions—avoid bright lights after 9 pm. If it’s noisy, buy a white noise generator or use foam earplugs; if it’s dry, use a warm mist humidifier.
• Avoid obsessing about sleep, and turn the face of the clock away from you.
• Create a relaxing ritual before bed—read, listen to soothing music, do breathing exercises to quiet your mind.
• Lovemaking before sleep will usually induce good quality deep sleep.
The following mental and emotional health options to help you relax and reduce anxiety are recommended just before bedtime:
• Meditation, with or without a mantra.
• Visualization, with or without audiotapes.
• Relaxing breathing exercises, with or without coordinating affirmations. (For example, repeat along with the breath: “I am sleeping soundly and peacefully.”)
• Journaling.
• Attitudinal adjustment to reduce fear of insomnia. (Remember that even a couple of hours of sleep is adequate for basic survival; the less anxiety about insomnia, the better you’ll sleep.)
• For night-awakening problems, affirm at bedtime that you will remember the thought of your unconscious mind as you awaken, and provide pen and paper on your bedside table. On awakening during the night, allow yourself to come to sufficiently full wakefulness to turn on the light and record a sentence or two about the first thoughts that come to mind. They will usually relate to the issue with which your unconscious mind has been struggling and stressing you into wakefulness. Several nights may be required to zero in on the topic. Once identified, the issue can be dealt with. Sleep is often dramatically better after using this technique.
Margaret B. is a sixty-five-year-old retired psychotherapist with intermittent neck and upper back pain, but her primary reason for using MMJ is for sleep. It has enabled her to stop the prescription sleep aids that she’d been taking for nearly fifteen years, since the onset of menopause.
She rotates several different marijuana products and has been quite pleased with the results. None of them have caused the unpleasant side effects (e.g., hangover effect) she experienced with both Ambien and Trazadone. She had also used Ativan for a brief period of time.
She recognizes that anxiety is a significant cause of her sleep problems, which can be both falling asleep and, more often, staying asleep. When she awakens to go to the bathroom in the middle of the night, she often has trouble falling back to sleep. She has successfully addressed the problem by using a variety of MMJ products.
She most often uses indica edibles (about an hour before bed), which last for six to eight hours, but during the past year she has also started using Stratos Sleep tablets (six to eight hours’ duration) with excellent results. Another option that has worked is to vaporize a strong indica just before bed. Rather than emptying the chamber, she increases the temperature setting by fifteen to twenty degrees before turning the vaporizer off, and then places it on the night table by her bed. If she awakens and can’t fall back to sleep, she turns on the vaporizer, and with the same leaves but at a twenty-degree higher temperature, she’s able to quickly fall back to sleep.
In recent months she’s added the MED-a-mints indica sublingual tablets to her rotation. Since these have a somewhat shorter duration than other products (four to six hours), she takes one-half tablet about a half hour before bed, and then if she awakens too early, she takes the other half.
She describes medical marijuana as a “life-changer”: “Having a good night’s sleep on a regular basis has made a huge difference in my life. I’m so much happier, and I have more energy and much less anxiety.”
Depression is an all-inclusive term covering the spectrum from major depression at one extreme, to adjustment problems, sadness, and the blues at the other. In the middle of the spectrum are the bulk of depressed people, with chronic, mild, or intermittent depression. Nearly all people with chronic pain are also suffering from some degree of chronic depression.
According to the DSM-5 (the handbook of the American Psychiatric Association), one needs to display at least five of the following nine symptoms for at least two weeks to be diagnosed with a major depressive disorder, and one of these five has to be either depressed mood or loss of interest or pleasure in activities.
• Depressed mood for most of the day
• Markedly diminished interest or pleasure in usual activities
• Insomnia or excessive sleep nearly every day
• Significant loss of weight or appetite when not dieting or weight gain
• Agitated or markedly slowed movements nearly every day
• Loss of energy or fatigue nearly every day
• Feelings of worthlessness or inappropriate guilt
• Diminished ability to think or concentrate, or indecisiveness nearly every day
• Recurrent thoughts of death (not just fear of dying), recurrent suicidal thoughts with or without a specific plan
Typically, if you’re depressed you have a significant loss of self-esteem, motivation, energy, sense of purpose, and sexual drive. Other typical symptoms include crying spells, self-loathing, irritability and short temper, extreme pessimism, and thoughts of death. Everything seems hopelessly futile.
When the symptoms of the milder and more common forms of depression (the blues) increase in frequency, intensity, and duration, they can become more disabling. Sufferers’ relationships, work, and general functioning become more impaired. At that point, when one’s symptoms and functioning are clearly perceived as distressing, one has a major depression, and treatment is required. At least 40 percent of people with depression are neither medically diagnosed nor undergo professional treatment, and are therefore not included in the official estimates of the incidence of depression in the United States.
Depression in its various forms currently afflicts about 25 million people in the United States (those who have been diagnosed and are being treated), but the actual number is estimated to be somewhere between 40 and 50 million. This disorder does not distinguish among age, race, culture, or occupation—it is pervasive in all echelons of society. More than twice as many women are being treated for depression than men, but it is not known whether this is because women are more likely to be depressed or because men tend to deny their depression. Suicide rates, especially for younger people, continue to rise. Some studies of high school students reveal that as many as 30 percent commonly think of suicide and feel hopeless. Depressed people are much more likely to develop cancer, die from a second heart attack, or die prematurely. The estimated yearly cost to this country of depression is $50 billion. According to the World Health Organization (WHO), depression is currently the fourth leading cause of disability in the world. Major depressions occur in the course of a lifetime for 10 to 20 percent of the world’s population. By the year 2020, WHO estimates that depression will be second only to heart disease as the world’s leading chronic disease.
Conventional treatment for depression consists of medication and psychotherapy. Although none of the antidepressant medications are addicting, they can become a psychological crutch, and there is also some evidence that they may speed the recurrence of depression. Multiple studies have also shown that for mild to moderate depression, treatment with antidepressant medication is no better than a placebo. In other words, the medication may have little or no therapeutic benefit.
The combination of medication and conventional psychotherapy alone, without treatment of the body and spirit, is often not effective for treating moderate to severe depression.
The majority of patients suffering with depression favor sativa strains of MMJ, since the THC improves mood, increases energy and appetite, and enhances their ability to focus on whatever activity they are engaged in. For those whose depression is accompanied by some degree of anxiety, which includes a large segment of the depressed population, hybrids are the preferred choice. They can be either 50:50 or 60:40/S:I. These should be vaporized (vape pen hybrid hash oil cartridges can also work well).
Other effective options for depression include:
• Hybrid or sativa (sativa is OK only if anxiety is not a significant factor)—tinctures, edibles, and tablets (e.g., Stratos Energy tablets—low-dose THC); remember to rotate three or four products if you’re taking something on a daily basis.
• 1:1/CBD:THC—tinctures and patches
In spite of the temporary improvement provided by MMJ, marijuana use on a daily basis has been found to contribute to depression. However, most people suffering with chronic pain have some degree of depression. If you focus on treating the underlying chronic pain condition, the depression should improve and the need for the daily use of MMJ will lessen.
Depression is not well understood. The following are believed to be the most significant risk factors contributing to it:
• Genetics—close to 50 percent of sufferers have a hereditary predisposition. Variants in the MTHFR gene, for example, could be a contributing factor.
• Candidiasis (yeast overgrowth).
• Inhalant and food allergies.
• Gut dysbiosis—an imbalance of gut bacteria that can impact mood, as 90 percent of serotonin is manufactured in the GI tract.
• Childbirth—postpartum depression.
• Female hormone dysfunction or insufficiency—PMS, perimenopause, menopause.
• Hypothyroidism.
• Hypoglycemia.
• Obesity.
• Folic acid/folate deficiency.
• Drugs and medications—Tagamet, Inderal, narcotics, benzodiazepines, birth control pills, sleeping pills, prednisone, alcohol, marijuana.
• Lack of exercise.
• Biochemical—low levels of the neurotransmitters serotonin and norepinephrine.
• Environmental toxicity—air pollution (decreased negative ions, increased positive ions, outgassing), heavy metal exposure (mercury, lead, cadmium).
• Decreased sunlight (seasonal affective disorder—SAD).
• Overcrowding.
• Lack of feeling grounded.
• Distorted thinking.
• Low self-esteem.
• Grief—feelings of loss following bereavement, divorce, or retirement.
• Feelings of failure.
• Lack of stimulation.
• Addiction to work.
• Sense of helplessness.
• Lack of self-expression.
• Sense of powerlessness.
• Emotional traumas as a child: history of abuse or violence, abandonment or neglect.
• Lack of purpose or meaning in life.
• Feelings of isolation; lack of compassion or a committed loving relationship.
• Lack of family or social connection.
• Feeling disconnected from God/spirit.
Spiritual issues are more prominent with severe depression.
Holistic treatment along with MMJ is most effective for mild to moderate depression. Severe depression will usually require antidepressant medication, but it can be combined with many of the following physical health recommendations to enhance the therapeutic result.
These factors can benefit both depression and anxiety:
• Clean air.
• Negative-ion–filled air. (Studies have shown mood benefits with levels above three thousand ions per cubic centimeter.) The highest negative-ion content air is found by seacoasts and waterfalls, on mountain tops, and in pine forests.
• Sunlight or daily exposure to full-spectrum lights.
• Beautiful natural settings—provide a sense of both grounding and relaxation.
The basic recommendation for treating depression is a diet high in complex carbohydrates such as whole grains (brown rice, barley, corn, millet, oats, and whole wheat), vegetables, beans, and fruits. These foods will boost serotonin and promote feelings of well-being. The diet should be high in protein—no less than 60 gm daily divided into three or four servings. This will help to maintain a stable blood sugar level throughout the day. In addition to food, you may want to use protein powder in diluted fruit juice or almond or soy milk, taken between meals as snacks, to meet your daily requirement.
The diet should also include red pepper, garlic, and ginger. One or two servings of cold-water fish, such as salmon or sardines, per week is recommended, as they contain high amounts of essential fatty acids (see below). Caffeine, alcohol, sugar, and refined carbohydrates (products made from white flour—bread, pasta) should be eliminated. A food-elimination diet to identify any food allergens can be very helpful.
In many cases, natural products can have an effect on mood that is greater than or equal to that of antidepressants. Although you should start out slowly and carefully consider your unique biochemical individuality, the following amino acids, vitamins, minerals, and essential fatty acids are usually effective in treating depression:
• Amino acids: DLPA (phenylalanine) is an amino acid found to be effective for treating depression. It is a precursor (directly on the formative pathway) to norepinephrine, one of the main neurotransmitters that govern mood. The recommended dosage is to begin with 500 mg (one capsule) two times daily, on an empty stomach with juice. This can gradually be increased by 500 mg per day to 2 or 3 capsules, three times daily. For maximum effect, it is best to take 50 mg of vitamin B6 at the same time, as well as niacin, 500 mg per day, and 1 gm of vitamin C. Vitamin B6 is particularly important in regulating the absorption, metabolism, and utilization of amino acids.
L-tyrosine is an amino acid formed from phenylalanine and is one step closer to norepinephrine. The recommended dosage is exactly the same as for DLPA.
NOTE: Glutamine is another “excitatory” amino acid that seems to combine quite well with L-tyrosine to improve its effectiveness. Some nutritional companies formulate both L-tyrosine and glutamine together. This combination capsule contains the correct ratio of both, and up to six capsules may be taken per day in divided doses on an empty stomach.
NOTE: With both DLPA and L-tyrosine, you need to be watchful for increased blood pressure, headaches, or insomnia. These side effects are indications that an excessive stimulation of the nervous system has occurred. DO NOT take these amino acids if you are currently taking standard antidepressant medications (the interaction between them is not well documented). Also avoid taking these amino acids with the following conditions: phenylketonuria (PKU), hepatic cirrhosis, and melanoma.
Like other essential amino acids, L-tryptophan cannot be manufactured by the body but must come directly from food or supplements. It is the building block for serotonin, the same neurotransmitter influenced by Prozac in the treatment of depression. When properly taken, tryptophan is extremely useful as a natural antidepressant as well as a sleep aid. The recommended dosage for depressive symptoms is to take 2 gm (2,000 mg) of tryptophan two or three times daily. It should be taken between meals, with fruit or juice (simple sugars) to improve its utilization. It should not be taken with a protein meal, because tryptophan competes poorly with other amino acids for absorption. To convert tryptophan to serotonin, the body must have adequate levels of folic acid, vitamin B6, magnesium, niacin, and glutamine.
The tryptophan metabolite 5-HTP, which is much stronger than L-tryptophan, is a proven antidepressant and is available in most health food stores. The recommended dosage is 100 to 200 mg twice daily between meals.
The amino acids DLPA, L-tyrosine, and L-tryptophan should be tried one at a time. If after six weeks at a high dosage there is no improvement, then you should take a different amino acid.
Other vitamins, minerals, and supplements include:
• B complex (containing all of the B vitamins) or B Activ (Xymogen): 1 capsule at breakfast and lunch daily. Postpartum depression may result from a deficiency of B6, B12, and folic acid.
• B12: 1,000 mcg daily, along with a weekly injection of B12, 1,000 mcg, combined with up to 5 mg of folic acid (especially for the elderly with cognitive dysfunction, or people with digestive disorders).
• Folate (5-methyltetrahydrofolate) or 5MTHFR (Xymogen): 5,000 mcg (5 mg) daily for one month, then reduce to 800 mcg daily.
• Niacinamide (vitamin B3): 500 mg two times daily.
• Vitamin C: 1,000 mg three times daily (as ascorbate or Ester-C).
• Vitamin E: 400 IU daily (as natural d-alpha tocopherol).
• Magnesium or Mag Glycinate (Metagenics): 1,000 mg daily; necessary for the production of neurotransmitters (as glycinate or aspartate).
• Calcium: 1,000 mg daily (as citrate).
• Zinc or Zinc Arginate (Metagenics): 30–40 mg daily.
• Essential fatty acids (EFAs) or EPA/DHA-720 (Metagenics): Take 1 capsule two times daily. (The nervous system is composed of 60 percent DHA, and this EFA is essential for normal function.) For omega-6 EFAs, take evening primrose oil, 1,000 mg three times daily.
• Phosphatidylserine (PS): Take 100 mg with breakfast and 200 mg with dinner (double-blind studies have proven its effectiveness with depression and insomnia).
The therapeutic benefits of herbs often require more time than standard drugs. An advantage, however, is the safety in long-term use and the absence of reported side effects.
• St. John’s Wort (Hypericum perforatum): Several clinical studies have shown this herb to be as effective as standard antidepressants (amitriptyline and imipramine). The herb also has far fewer side effects. The active ingredient in St. John’s wort is hypericin. The recommended dosage is 900 mg daily of 0.3 percent concentration—600 mg with breakfast and 300 mg with lunch. A trial period of one month is adequate to determine the herb’s potential benefits. Do not take St. John’s wort along with the DLPA and L-tyrosine if you’ve just started the treatment program. After four to six weeks on DLPA or L-tyrosine, you can then begin St. John’s wort. Likewise, do not take St. John’s wort with SSRI drugs (Prozac, Zoloft, Paxil), or with birth control pills. There is some evidence that it may accelerate the metabolism of oral contraceptives, rendering them ineffective.
• Ginkgo biloba: improves cerebral circulation, strengthening memory and often benefiting depression. Generally, ginkgo is not as effective as St. John’s wort for depression, but it can be taken along with other herbs and nutrients to bolster one’s overall mood. Ginkgo biloba should be in an extract that is standardized to contain 24 percent ginkgo flavone glycosides. The usual dose is 80–120 mg two times daily (breakfast and lunch).
• Yohimbine: comes from tree bark in West Africa and has been used for decades in treating male impotence or diminished libido. Recent research has indicated that yohimbine can also improve the overall effectiveness of standard antidepressant medications. In some cases, yohimbine can be used by itself to both stimulate sexual functioning and relieve mild depression in men. For mild depression and enhanced sexual functioning, take 5.4 mg of standardized yohimbine extract three times daily. A suggested trial period for this yohimbine regimen would be two to three weeks. Yohimbine can then be taken periodically as needed. NOTE: For some individuals, yohimbine can cause increased anxiety or uncomfortable cardiac stimulation. It should be taken under the supervision of a health professional.
• Siberian ginseng: Take 400 mg of a standardized extract three times daily.
• Rosemary shampoo: can be absorbed through the skin as well as provide aromatherapy for depression.
The beneficial effects of regular aerobic exercise in the treatment of depression are well documented. For many years an increasing number of psychotherapists have believed that aerobic exercise, through its powerful release of endorphins, may be the most effective as well as the most economical antidepressant. However, as I mentioned in Chapter 3, a recent German study concluded that it is the endocannabinoids released during aerobic exercise, rather than endorphins, that are responsible for “runner’s high.”
• Hormonal therapy: Desiccated thyroid can often elicit a dramatic improvement, especially in middle-aged women. This can be true even with normal thyroid function. Lethargy, sense of cold, and fatigue are often symptoms of low thyroid function. One-half to one grain daily is a good starting dosage. DHEA can also be effective in treating depression, but the dosage should be based on blood or saliva levels of DHEA sulfate. Your physician might also check your adrenal function via cortisol/DHEA testing. This can measure maladaptive responses to stress.
• Traditional Chinese medicine (acupuncture and Chinese herbs) and homeopathy can be helpful.
Although these mental and emotional health recommendations are the same as those suggested for anxiety, they are somewhat less effective for treating depression.
The holistic psychotherapist is concerned with the presenting psychological problems as well as the life force energy or spirit of each client. What are his or her purpose and unique talents, interests, dreams, and desires in life? Where does he or she perceive a loss of love? This orientation can also be described as spiritual psychotherapy.
Providing the encouragement and motivation to change are the hallmarks of a skilled therapist. This can only be done by evoking the assets and gifts in each person, as well as focusing on solutions to his or her current problems. Empowerment is the essence and goal of therapy—helping clients develop their own inner resources to be a catalyst for change. Being the source of your own choices and having the capability to reinterpret any painful experience as an opportunity for learning can provide you with the energy to transform your life and cure depression. If used with a clear intention, marijuana can be a profound asset in this process of empowerment, while heightening self-awareness.
Psychotherapy is most successful when the client establishes a comfortable therapeutic rapport with the therapist. Although this connection and trust are more important than the treatment model itself, there are several psychotherapeutic options in addition to conventional psychotherapy that are helpful in treating depression. They include:
• Cognitive/behavioral therapy (CBT)—multiple studies have demonstrated its effectiveness in treating depression. Affirmations and imagery are an integral part of this form of therapy.
• Mindfulness-based cognitive therapy—one large study has shown it to be as effective as antidepressant medication, and with no adverse effects.
• Psychosynthesis—a holistic type of spiritual psychotherapy.
• Hakomi therapy—a body-centered form of psychotherapy.
• Solution-focused/brief therapy—a goal-oriented form of psychotherapy.
• Spiritual psychotherapy—described above under “Anxiety.”
• Stress-reduction techniques—see above under “Anxiety.”
• Energy medicine—Eye Movement Desensitization and Reprocessing (EMDR—if depression is a result of trauma), EFT, and Neurofeedback can all be helpful for treating depression. Therapies such as Healing Touch, Therapeutic Touch, and Reiki are all hands-on techniques that are helpful for treating both depression and anxiety. You’ll need to find a qualified practitioner.
• Qigong is a moving meditation practiced by over 300 million Chinese on a daily basis that strengthens life force energy, or chi. It is relatively easy to learn and can be used to both treat and prevent depression and anxiety.
• Regular exposure to sunlight and filtered sun (twenty to thirty minutes daily) or full-spectrum lights that simulate sunshine can help treat depression, especially with people suffering from seasonal affective disorder. This condition is most prevalent in locations with little sunshine during the winter months.
• Soothing or stimulating music, or whatever sounds you resonate with, can also be helpful in treating depression.
A multitude of hands-on techniques can help to release deeply held or repressed emotions. Some of these methods are described as body-centered psychotherapy and often combine deep-tissue bodywork, such as Rolfing, with types of body movement, like yoga or Feldenkrais. Depression and anxiety are frequently more amenable to physical touch than to verbal therapies. These therapies are particularly important for people with a history of physical and sexual abuse or poor body image.
The most beneficial spiritual practices for treating depression are meditation, prayer, and altruism (volunteering).
Joining a support group or maintaining a connection to one is especially helpful for depressed people in strengthening their degree of social health. Working on your committed relationship with a spouse or partner can often mitigate depression.
Robert R. is a fifty-seven-year-old radiology technician with a long history of depression. He was originally diagnosed with bipolar disorder in his early thirties, shortly after a suicide attempt. He was prescribed strong antidepressants—which he said “ruined my energy, my sex life, and made me feel like a zombie” (with little or no emotion)—and Abilify.
After approximately five years on this pharmaceutical regimen, feeling hopeless and powerless, he decided to stop all of his medications and committed to healing himself. He found that smoking marijuana provided a lift, with more energy, optimism, and a greater sense of well-being. However, being prone to high levels of anxiety, he had to be careful not to smoke a strain containing too much THC. But this was prior to the legalization of medical marijuana, and detailed information about specific strains was not known.
In addition to marijuana, he modified his diet (mostly vegetarian), began taking supplements, started journaling, and did at least thirty to sixty minutes of aerobic exercise daily. He’s made continual progress and today is still maintaining this same self-care regimen. The primary difference is that he now knows exactly what he’s smoking or vaporizing. He generally avoids sativa strains, and prefers hybrids in a variety of forms—flower (both 50:50 hybrids and 60:40 indica-dominant strains), tinctures, edibles, tablets, and patches. He rarely misses a day of working out, feels better than he has throughout his entire adult life, and claims that “marijuana saved my life.”