Anxiety and Medical Marijuana: The Pros and Cons

If you struggle with anxiety – which can at times be debilitating, leading to panic attacks, chronic insomnia and depression – you may be considering using medical marijuana to treat the condition or have already self-medicated by experimenting with the drug.

“The biggest killer on the planet is stress and I still think the best medicine is and always has been cannabis,”

country singer Willie Nelson once said, and while he is not an official expert on the subject, he has by all accounts smoked enough marijuana to recognize the stress-relieving benefits of the herb.

A long history of as medicinal stress relief

Marijuana has more than 400 years of history backing its use as a medicinal to ease the symptoms of depression and anxiety.

Centuries ago, marijuana was used in India to ease stress, and its use as a treatment soon spread through Asia, the Middle East and Africa, where old-world physicians also prescribed it for other medicinal uses including relief of chronic pain.

Queen Victoria reportedly used marijuana to relieve menstrual cramps, and Irish Dr. William O’Shaughnessy was the first to explore the medical benefits of marijuana in England and America, where he used it to ease the pain, discomfort and nausea associated with rabies, cholera and tetanus.

In recent years, several studies have addressed marijuana’s ability to relieve stress, but as with most things, there are two sides to every story, and it all comes down to two of the compounds in cannabis that cause its effects.

THC vs. CBD: The stress factor

Marijuana contains multiple compounds called cannabinoids, but two of them – tetrahydrocannabinol (THC) and cannabidiol (CBD) – are most associated with anxiety.

While most strains of medical marijuana contain both compounds, the levels of each can vary from strain to strain, and while THC can sometimes trigger feelings of paranoia that elevate stress levels, CBD usually counters the negative effects of THC, soothing feelings of anxiety.

While early strains of marijuana contained higher levels of CBD, making it an ideal treatment option for anxiety, as the drug began to be used more recreationally, it was produced with higher levels of THC, reducing the medicinal levels of CBD at the same time.

Today, medical marijuana can be adjusted so that certain strains aimed at controlling high levels of anxiety also contain high levels of CBD, while medical marijuana used to help control the nausea and pain associated with cancer treatment would contain higher levels of THC, which is more effective at treating those symptoms.

Vanderbilt uncovers anti-anxiety factors

The reasons why one compound in medical marijuana can alleviate anxiety while another can trigger symptoms of stress are found in the brain.

A 2014 study headed by researchers at Vanderbilt University determined that the cannabinoid receptors in the brain are found in the central nucleus of the amygdala, the same place in the brain that regulates not only anxiety, but also the fight-or-flight response, the body’s physical response to stress.

Cannabinoid receptors – which respond to cannabis, synthetic cannabis and endocannabinoids that the body makes on its own – are found throughout the body, where they regulate appetite, pain, mood, and memory. The receptors in the brain, however, are found where the body regulates emotions including anxiety.

The research found that nerve cells in the brain make and release their own natural endocannabinoids to tackle stress, much like the gastrointestinal tract products probiotics, a finding that suggests that those with low levels of natural endocannabinoids could be more prone to stress. The study also shows why medicinal marijuana is an effective treatment for anxiety, since it replenishes natural endocannabinoid supplies.

The study could bring a better understanding of how cannabis helps ease stress for those not yet on board with medical marijuana’s benefits, according to the paper’s senior author, Dr. Sachin Patel, Ph.D., a professor of Psychiatry and Molecular Physiology and Biophysics at Vanderbilt.

The research, which was the first to identify cannabinoid receptors in the central nucleus of the amygdala, appeared in the medical journal Neuron.

There are two endocannabinoids – the neurotransmitter anandamide and 2-AG – but anandamide (called the “bliss molecule”) is the more important of the two, because it helps regulate stress. When levels of anandamide are normal, the fight-or-flight response, a natural reaction to anxiety, is more regulated, and unhealthy stress is reduced.

According to Patel, previous studies have shown that chronic stress or severe emotional trauma can do two things – first, it can reduce the production of natural endocannabinoids, and secondly, it can lessen the responsiveness of the receptors, sending anxiety skyrocketing.

For those with low levels of endocannabinoids, medical marijuana may restore levels of anandamide, easing symptoms of stress.

Cannabinoids also address PTSD

That same year, a study appearing in the medical journal Neuropsychopharmacology, the official publication of the American College of Neuropsychopharmacology, found that the cannabinoids in marijuana can not only treat anxiety, they are also effective at addressing the effects of post-traumatic stress disorder.

Conducted by scientists from the Department of Psychology of the University of Haifa in Israel, the study found that rats suffering from shock-induced PTSD – symptoms included lasting fear associated with the traumatic event, an elevated startle response and visible alterations in multiple areas of the brain – that were given a substance that mimicked the effects of cannabis either showed improvement of PTSD symptoms or were prevented from developing disorder altogether.

Experts estimate that approximately 8 million adults in the United States suffer from PTSD, with symptoms including insomnia, depression, anxiety and flashbacks.

The flip side: High anxiety

While marijuana is not considered as dangerous as alcohol – unlike booze, marijuana is not associated with overdose deaths, long-term health problems, violent crimes or serious injuries, according to the Marijuana Policy Project – there are some highs that are anything but chill.

When Eddie Ray Routh, a U.S. Marine who shot and killed famed Navy Seal Chris Kyle at a shooting range in 2013, he claimed he was not guilty by reason of insanity because he was experiencing a marijuana-induced psychosis.

Marijuana tends to impact some people differently, and what is calming for some is panic-inducing for others, experts say.

The reason is higher levels of THC, which causes the marijuana high. THC also works in the amygdala, but rather than activating the natural endocannabinoid anandamide, it triggers the fight-or-flight receptors, causing fear, anxiety and paranoia sparked in part by the release of cortisol, which elevates blood pressure and signals the body to release excess blood glucose for energy.

Strains with higher levels of CBD help counteract the amygdala’s reaction to THC, so the medicinal benefits are ultimately found in the right strain of medicinal cannabis.

Marijuana has also been linked to schizophrenia in some studies, which have led certain researchers to suggest that those who develop the psychological disorder are more likely to have smoked marijuana prior to being diagnosed, creating a link. One expert, however, Dr. Nora Volkow, director of the National Institute of Health’s National Institute for Drug Abuse, is more inclined to believe that those with schizophrenia were more likely to be self-medicating in order to assuage the symptoms of schizophrenia, and said that risk of schizophrenia is genetic, not triggered by marijuana. Although symptoms of schizophrenia can be exacerbated by cannabis, she said, they are not caused by it.

Overall, more studies suggest that centuries-old doctors were right when they prescribed marijuana to help alleviate stress and anxiety, making medical marijuana a viable option for someone suffering from either mild or chronic anxiety.