Medical Cannabis for Anxiety: What You Need to Know

Introduction

In today's fast-paced world, anxiety has emerged as a silent shadow, affecting millions globally. It's a condition that not only disrupts daily functioning but also deeply impacts the quality of life. Amidst a myriad of treatment options, medical cannabis offers a new approach to managing anxiety symptoms. 

Anxiety is the main symptom of several conditions including:

• Panic disorder

• Phobias, such as agoraphobia or claustrophobia

• PTSD

• Social anxiety disorder 
  

Generalised Anxiety Disorder (GAD) is a persistent condition leading to widespread anxiety over various situations, not just one event. Those with GAD frequently feel anxious, finding it hard to recall when they last felt at ease.

Traditional treatments include therapy, medication such as antidepressants, and lifestyle adjustments, but not everyone finds relief through these avenues. 

This article is designed to provide a comprehensive overview, empowering you with the information needed to make informed decisions about managing anxiety with medical cannabis.

What is Medical Cannabis?

Cannabis-based products for medicinal use (CBPM) or simply Medical cannabis, refers to the use of cannabis and its various chemicals called cannabinoids, as medical therapy to treat disease or alleviate symptoms. Cannabis has been used for medicinal purposes for thousands of years, but its therapeutic use has seen a resurgence in recent years, thanks to a growing body of research and changing societal attitudes.

At the heart of medical cannabis are two primary cannabinoids: Tetrahydrocannabinol (THC) and Cannabidiol (CBD). THC is the psychoactive component that produces the "high" associated with recreational cannabis use and may positively or negatively impact mood depending on how it’s used. In contrast, CBD does not produce this psychoactive effect and is often highlighted for its potential therapeutic benefits, including anxiety reduction. These cannabinoids work by activating the endocannabinoid system.

The Science Behind Cannabis and Anxiety

The relationship between cannabis and anxiety is complex and involves the body's endocannabinoid system (ECS), which plays a significant role in regulating vital bodily functions such as mood, appetite, sleep and pain perception. The ECS is partly made up of cannabinoid receptors (CB1 and CB2) which are activated by cannabinoids like THC and CBD.

Cannabinoid Receptors and Anxiety

CB1 Receptors

Primarily located in the brain and central nervous system, they play a key role in reducing fear and anxiety. The activation of CB1 receptors by endocannabinoids can influence mood in several ways:

• Neurotransmitter Release: CB1 receptors regulate the release of various neurotransmitters (natural brain chemicals), including serotonin, dopamine, and glutamate, which are crucial for mood balance.

• Stress Response: CB1 receptor activation can reduce the release of stress hormones.

• Neuroplasticity: The CB1 receptor plays a role in neuroplasticity – the brain's ability to reorganise itself by forming new connections. This process is essential for mood regulation, learning, and memory. Dysregulation of this system is associated with various mood disorders.
  

CB2 Receptors

The role of CB2 receptors in mood regulation is less direct than that of CB1 receptors but is increasingly recognised as significant, particularly in the context of neuroinflammation and neurodegenerative diseases:

• Neuroinflammation: CB2 receptor activation can reduce inflammation in the brain, which is associated with mood disorders such as anxiety and depression. 

• Stress Response: There is evidence to suggest that CB2 receptors may influence the stress response indirectly. By reducing inflammation, CB2 receptor activation could potentially prevent the negative effects of chronic stress on the brain and mood.
  

Studies have shown that CBD has potential therapeutic effects on anxiety without the psychoactive effects associated with THC. It also contributes to reducing the psychoactive effects of THC which means if taken together you are less likely to 'get high'.

However, some research suggests that low to moderate doses of THC can reduce anxiety, while higher doses may exacerbate it.

It is important to note that individual responses to cannabis can vary significantly, influenced by genetic factors, specific anxiety disorders, the dose and formulation of medical cannabis used. 

Using Medical Cannabis for Anxiety: Methods and Dosage

Methods of Consumption

The method of consuming medical cannabis can significantly affect its effectiveness and how quickly it works. Common methods include:

• Inhalation (by dried herb Vaping): Offers rapid relief as the cannabinoids enter the bloodstream directly through the lungs but effects do not last long. This method may be used as and when required when symptoms get worse. 

• Capsules: Provide longer-lasting effects but have a delayed onset time because the cannabinoids are absorbed through the digestive system which may take some time. However dosage control can be challenging with capsules as much of the cannabinoids are not absorbed by the body through this route.

• Oils and Tinctures: Administered under the tongue, they offer a balance between relatively quick onset and ease of dose control, making them a preferred choice for medical use.

Dosage Considerations

Determining the right dosage is crucial and can vary widely among individuals. Key guidelines include:

• Start Low and Go Slow: Begin with a low dose, especially if THC is present, and gradually increase until you find the most effective dose with the fewest side effects.

• Consult Healthcare Providers: It's essential to work with a healthcare provider experienced in medical cannabis to tailor the dosage to your specific needs.

• Monitor Effects: Keep a journal to track the dosage, method of consumption, and effects on anxiety symptoms to help fine-tune your regimen. Your healthcare provider can assist you with this. 

What the journey with medical cannabis for anxiety is like 

It is legal to use medical cannabis for anxiety, that is prescribed by a specialist doctor.

Where appropriate, starting medical cannabis treatment typically involves:

• An eligibility assessment which determines if an appointment with a specialist is suitable.

• An appointment consists of a 30 min consultation with a specialist doctor who will assess you and listen to your history with anxiety and address any concerns you may have.

• Your case will be checked and reviewed by a multidisciplinary team of specialist doctors who will determine whether medical cannabis is suitable for you.

• If appropriate they will create a personalised treatment plan and issue you with a prescription which may be dispensed at a specialist pharmacy.

• You will be continuously monitored by the clinic and your pharmacy to ensure the treatment is safe and effective.

• Regular follow ups with your specialist can ensure your treatment is optimised to your needs. 

• In addition to your personalised medical cannabis treatment plan your healthcare team consisting of specialist doctors, pharmacists and nurses may also recommend other forms of treatment that may help with your condition. 

Understanding the methods, dosage, benefits, and potential side effects of medical cannabis is crucial for anyone considering it as a treatment option for anxiety. With careful consideration and guidance from healthcare professionals, medical cannabis may offer a valuable alternative for managing anxiety symptoms, improving quality of life for those affected by this condition.

If you would like to check your eligibility for referral to a clinic who specialise in medical cannabis therapy, then contact us and one of our pharmacists will assist you. 

Check Eligibility

References:

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2. Ergisi, M., Erridge, S., Harris, M., Kawka, M., Nimalan, D., Salazar, O., Loupasaki, K., Ali, R., Holvey, C., Coomber, R., Platt, M., Rucker, J., & Sodergren, M. H. (2022). UK Medical Cannabis Registry: an analysis of clinical outcomes of medicinal cannabis therapy for generalized anxiety disorder. Expert Review of Clinical Pharmacology, 1–9. https://doi.org/10.1080/17512433.2022.2020640

3. Berger, M., Amminger, G. P., & McGregor, I. S. (2022). Medicinal cannabis for the treatment of anxiety disorders. Australian Journal of General Practice, 51(8), 586–592. https://doi.org/10.31128/ajgp-04-21-5936

4. Rifkin-Zybutz, R., Erridge, S., Holvey, C., Coomber, R., Gaffney, J., Lawn, W., Barros, D., Bhoskar, U., Mwimba, G., Praveen, K., Symeon, C., Sachdeva-Mohan, S., Rucker, J. J., & Sodergren, M. H. (2023). Clinical outcome data of anxiety patients treated with cannabis-based medicinal products in the United Kingdom: a cohort study from the UK Medical Cannabis Registry. Psychopharmacology. https://doi.org/10.1007/s00213-023-06399-3

5. Won, E., & Kim, Y.-K. (2020). Neuroinflammation-Associated Alterations of the Brain as Potential Neural Biomarkers in Anxiety Disorders. International Journal of Molecular Sciences, 21(18), 6546. https://doi.org/10.3390/ijms21186546

6. Stachowicz, K. (2023). Deciphering the mechanisms of reciprocal regulation or interdependence at the cannabinoid CB1 receptors and cyclooxygenase-2 level: Effects on mood, cognitive implications, and synaptic signaling. Neuroscience & Biobehavioral Reviews, 155, 105439. https://doi.org/10.1016/j.neubiorev.2023.105439

7. NHS website. (n.d.). Overview - Generalised anxiety disorder in adults. nhs.uk. https://www.nhs.uk/mental-health/conditions/generalised-anxiety-disorder/overview/