Using Medical Cannabis for Anxiety

We’ve all experienced anxiety. It’s a normal part of life - our body’s way of telling us, “Hey! Something’s up. Get prepared.” We feel it before an important meeting at work, a big test, or on our wedding day. For people experiencing an anxiety disorder, the anxiety doesn’t subside. It’s chronic and ongoing, and often isn’t even tied to anything specific. It can get worse over time and interferes with daily activities; spilling over into school, work, and relationships. Anxiety disorders are the most common mental illness in the United States, affecting 40 million adults 18 and older, or 18.1% of the population. 

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Common Symptoms of Anxiety: 

  • Feeling nervous & restless
  • Irritability and feeling on edge
  • Sense of impending danger, panic, doom
  • Increased heart rate
  • Hyperventilation
  • Excessive sweating
  • Trembling, feeling week, or tired
  • Difficulty sleeping
  • Stomach upset & GI problems
  • Avoidance & isolation

Not all anxiety is the same.  Some of the most common conditions include Generalized Anxiety Disorder (GAD), Panic Disorder, Obsessive Compulsive Disorder (OCD) , Social Anxiety Disorder, and Specific Phobia.  While they all share common features and symptoms, the anxiety presents differently in each condition. 

Anxiety is also a common symptom in PTSD and trauma related disorders, depression, and a variety of chronic illness. It’s such a common experience that many of us have learned to grin and bear it - pushing through until it progresses to the point that we can’t anymore. Anxiety is highly treatable, yet the majority of people do not seek treatment. Muscling through it increases your risk of developing chronic disease and other stress related disorders. 

Using Medical Cannabis for Anxiety

For thousands and thousands of years people have used cannabis to calm symptoms associated with anxiety, depression, and stress. But, cannabis has a bit of a love/hate relationship with anxiety - it’s biphasic and bidirectional. This means the effects are person and dose specific, and while cannabis may be relaxing for some, it can cause anxiety in others. Fortunately, with a little education and planning many cannabis patients find relief from anxiety symptoms and are able to reduce or ditch conventional medications (and the side effects the come with them.) 

How It Works

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We know that cannabis works in the body by interacting with the CB receptors of the endocannabinoid system (ECS). Research has shown that we have a high concentration of CB1 receptors in amygdala, hippocampus, and anterior cingulate cortex - all areas of the brain responsible for regulating anxiety, fear, and related symptoms. Certain terpenes in cannabis, such as linalool, also contribute to the anti-anxiety effects. 

Dosing & Delivery

While there is no easy answer to cannabis dosing, research and anecdotal evidence both suggest that low intermittent dosing is most effective for managing anxiety. Since high doses of THC are more likely to increase anxiety and paranoia, it's extra important for patients with anxiety disorders, and those who are new to cannabis, to start with low doses. 

Common Dose Ranges
THC 1-3mg (often below the psychoactive threshold) 
CBD 2.5-10mg (but up to 50mg is typically well tolerated) 

Inhalation, sublingual, and oral delivery routes can all be effective for managing anxiety. Inhalation or sublingual drops are typically best for inexperienced patients, as it can be difficult to gauge the proper dose with edibles and other oral delivery methods. Since oral (swallowing) medicines have a long duration, dosing too high can be particularly uncomfortable.

Know Your Medicine  

In order to target anxiety symptoms, it's always best to be aware of what exactly is in your medicine. 

What is the Cannabinoid Content? 

CBD and THC, the most abundant cannabinoids in cannabis, work together to provide therapeutic benefit. Finding the perfect ratio of CBD to THC takes a little bit of experimentation, but many patients report significant anxiety relief with strains and products higher in CBD than THC. If you ever experience an increase in anxiety with a THC dominant medicine, you can use CBD to counteract the negative effects of THC. While both CBD and THC can be used to relieve anxiety, CBD is typically calming without being sedating - a benefit for daytime use. It's also the best starting place for patients who may have had an anxiety provoking experience with cannabis in the past. Individuals with anxiety may want to avoid strains high in THCV and CBDV as they are more prone to increase symptoms. 

What are the Primary Terpenes?

Terpenes are the essential oils of the cannabis plant. They provide the distinct aromatic scent and taste Along the with ratio of CBD:THC, each plant's terpene profile is believed to contribute to the strain effects. Knowing the terpene profile of your medicine can help you choose cannabis products and strains that match well for your condition. 

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Terpenes Beneficial for Anxiety
Linolool- calming, soothing
Myerce - sedating, relaxing
Limonene - uplifting, calming

Patients dealing with PTSD and phobias may wish to avoid strains high in pinene. THC can interfere with the ability to recall dreams & memories, which is often helpful to these patients. Pinene counteracts this effect. 

Pick the Right Strain

Heavy indica strains such as Grand Daddy Purple and uplifting Hybrids such as Girl Scout Cookies tend to be patients favorites for alleviating anxiety. Until you know how you react, it's best to avoid Sativa dominant strains as the heavy cerebral effects can sometimes increase anxiety. High CBD stains such as AC/DC are also a great choice. Leafly's strain database is a great place to learn more about strain effects. 

Florida Product Suggestions  

As a legal patient who suffers from PTSD and anxiety, I've had some experience trying different strains and products available in Florida. My top 5 for anxiety related symptoms: 

  • Surterra's Serene (5:1) : A CBD dominant product, Serene is my go to daytime vape pen. I find it to be calming and grounding, with a slight uplift in mood. It helps alleviate low levels of anxiety, while keeping me clear headed and alert.
  • Surterra's Soothe (1:1) : A balanced product, Soothe is my first choice for days when I'm feeling irritable, on edge, or "triggered" by PTSD. It's very balancing, helping to recenter and refocus. 
  • Surterra's Calm (12.5:1): A CBD dominant product with a small percentage of THC, Calm is my first choice as a "rescue" medication for panic attacks or increasing generalized anxiety. 
  • Trulieve's Grand Daddy Purple (THC Indica): A heavy indica, GDP provides a full mind and body relaxation experience. It can be very sedating, especially in high doses, so it's a great choice for difficulty sleeping or after a long day. 
  • Aphria's Pineapple Express (THC Indica): While I often try to avoid high THC strains when I'm feeling anxious, I find Aphria's PE to be exceptionally effective for anxiety and overall stress. It's very uplifting, while melting away fear, nervousness, and worry. 

Authored by: Kristina Risola, MA, CRC, CHWC
Director of Operations

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