Cannabis For The Treatment Of Anxiety

Anxiety is a normal part of life. The nervous, fearful feelings and the physiological symptoms that accompany these like sweaty hands, trembling or butterflies in the stomach when starting the first day of school or a new job, giving that big presentation or speaking in front of strangers for the first time, are the body's natural response to stress.

For most, bouts of anxiety are transient and related to specific stressful events at various points in life. For some, however, feelings of anxiety are persistent, seemingly uncontrollable and often so overwhelming that they become debilitating. When this occurs, and anxiety interferes with daily activities and functioning, an anxiety disorder may be diagnosed.

What is anxiety disorder?

The term 'anxiety disorder' refers to a group of psychiatric disorders associated with extreme worry or fear that is persistent, difficult (or impossible) to control and that causes significant distress or impairs daily function. The major types of anxiety disorder are^1,2:

• Generalised anxiety disorder (GAD): This condition is characterised by chronic and exaggerated tension, worry, fear and anxiety with no particular source or provocation. The condition must be experienced more often than not, for at least 6 months to be diagnosed.
• Panic disorder (with or without agoraphobia): Those suffering from panic disorder experience panic attacks which are triggered by situations that most other people feel fine in. Intense feelings of fear accompanied by difficulty breathing and the feeling of having a heart attack are common symptoms of a panic attack. As a result, some people may also begin to experience agoraphobia, which is the fear of being in a situation that is difficult, embarrassing or impossible to escape and/or where help will not be available if something goes wrong. For a diagnosis to be made, these attacks must take place some of the time, with worry about future attacks or changes in behaviour related to the attacks being experienced for a month or more.
• Social phobia / Social anxiety disorder (SAD): Sufferers of social anxiety become overly anxious and excessively self-conscious in common social situations, often on a daily basis. Social phobia may occur in response to a particular type of situation, such as the fear of speaking in front of others in a formal setting or eating in front of others. In more severe instances, social anxiety may be experienced in almost every social setting.
• Obsessive-compulsive disorder (OCD): This form of anxiety disorder manifests in recurrent, unwanted thoughts that become obsessions and/or repetitive behaviours that become compulsive. These actions are performed repeatedly in an attempt to prevent or deal with the obsessive thoughts and make them go away. Performing repetitive actions only provides temporary relief and anything that prevents them causes a marked increase in anxiety.
• Post-traumatic stress disorder (PTSD): This condition develops after exposure to a traumatic event in which serious physical harm was threatened or occurred or in instances where one was witness to such events.
• Specific phobias: Many people experience irrational fear, phobias are, however, experienced on a much more intense level and affect a person's daily life as a result. Exposure to a phobia may induce intense fear, anxiety and panic attacks.

Other less common anxiety disorders include separation anxiety, selective mutism (i.e. sufferers cannot speak in certain situations), anxiety due to medical conditions as well as substance/medication induced anxiety disorder.

The World Health Organization estimates that 264 million people globally, most of them females, suffer with some form of anxiety³, although the numbers may be far higher given than many (some estimates say as many as 75% percent) never seek help for their condition. Research shows that this is due to various factors such as social stigma or feelings of shame, lack of access to the appropriate medical care or not knowing who to turn to for help⁴.

These figures are startling, given that anxiety disorders are real, genuine medical conditions, much like a broken bone or heart disease.

Symptoms of Generalised Anxiety Disorder

Generalised anxiety disorder (GAD) is the most commonly diagnosed anxiety disorder. Many of the symptoms experienced are also experienced by those with other forms of anxiety. These include^5,6:

• Fear
• Panic
• Hyperarousal – feeling as though one is on edge or high alert all the time
• Difficulty concentrating
• Autonomic hyperactivity – rapid heartrate or heart palpitations, shortness of breath, excessive perspiration, dry mouth, cold hands, tingling hands and feet, restlessness nausea and dizziness.
• Muscle tension
• Difficulty relaxing
• Difficulty sleeping
• Fatigue
• Chronic headaches, neck, shoulder and back pain

Stress versus anxiety

Stress and anxiety share many of the same characteristics, making it difficult to tell the two apart. The difference is that stress is the body's physical response to a threatening situation (whether real or perceived), while anxiety is a reaction to stress and focusses on worries or fears regarding the things that are perceived as threats⁷.

The endocannabinoid system and anxiety

The endocannabinoid system (ECS) plays an important role in the regulation of many bodily functions. It is comprised of various chemical compounds and receptors which are found throughout the body with CB1 and CB2 receptors located primarily in the brain and nervous system.

This system plays an important role in the body's response to stress as well as the regulation of fear and anxiety associated with it^8,9. As such, the endocannabinoid system can be targeted using cannabis in order to reduce feelings of stress, tension, and anxiety¹⁰.

Cannabis for anxiety

Most cannabis oils and products contain Tetrahydrocannabinol (THC). While this is responsible for the 'high' commonly associated with cannabis, this psychoactive compound can do considerably more than just induce euphoric effects. In low doses it can help to treat anxiety, however, it is important to note that high doses can induce it. So, getting your dosage right is extremely important. It is therefore always advisable to start very low and go slow when increasing doses.

Taking THC at night, just before bed is recommended as this will ensure that any intoxicating effects are used for beneficial purposes such as aiding relaxation and reducing muscle tension associated with anxiety, and the resultant 'high' does not inhibit proper daytime function.

Cannabidiol (CBD), another component of cannabis, but on that does not induce psychoactive effects, has also proven useful in the treatment of anxiety, as well as treating the insomnia often associated with it¹¹. However, the required dosages, 800-1200mg per day, for it to be effective are rather high, and this can become expensive for the user.

Emerald Health cannabis products for anxiety

Emerald Health harnesses the therapeutic benefits of both THC and CBD in our range of tablets and oils and take the guesswork out of dosages. The 2:1 THC to CBD ratio in these products ensures that the CBD buffers the negative side effects of THC, allowing for higher therapeutic doses without paranoia, something that is extremely important when treating anxiety.

In addition, because Emerald Health cannabis oil and tablets are manufactured in a professional facility that ensures that the same strains are used in consistent, accurately measured concentrations, you are assured of a high quality product that offers the same therapeutic benefits and results every time you use it.

If you suffer from anxiety or are being treated for it, speak to your doctor about the potential for including Emerald Health products in your treatment regime.

References

1. What are the five major types of anxiety disorders?. HHS.gov. https://www.hhs.gov/answers/mental-health-and-substance-abuse/what-are-the-five-major-types-of-anxiety-disorders/index.html. Published 2014. Accessed March 2, 2019.
2. Department of Health | What are the main types of anxiety disorder?. Health.gov.au. http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-w-whatanx-toc~mental-pubs-w-whatanx-typ. Published 2007. Accessed March 2, 2019.
3. Depression and Other Common Mental Disorders - Global Health Estimates. Apps.who.int. https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf?sequence=1. Published 2017. Accessed March 2, 2019.
4. Why 75 Percent of Anxiety Sufferers Fail to Get Proper Care. Psychology Today. https://www.psychologytoday.com/us/blog/psychiatry-the-people/201808/why-75-percent-anxiety-sufferers-fail-get-proper-care. Published 2018. Accessed March 2, 2019.
5. Watson B. Signs and symptoms of anxiety. Mymed.com. https://www.mymed.com/diseases-conditions/anxiety/symptoms-of-anxiety-and-anxiety-disorders. Published 2018. Accessed March 2, 2019.
6. Baldwin D. UpToDate. Uptodate.com. https://www.uptodate.com/contents/generalized-anxiety-disorder-in-adults-epidemiology-pathogenesis-clinical-manifestations-course-assessment-and-diagnosis?search=anxiety&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3#H448541448. Published 2018. Accessed March 2, 2019.
7. Stress - Understanding the facts. Adaa.org. https://adaa.org/understanding-anxiety/related-illnesses/stress. Accessed March 2, 2019.
8. Lutz B, Marsicano G, Maldonado R, Hillard C. The endocannabinoid system in guarding against fear, anxiety and stress. Nature Reviews Neuroscience. 2015;16(12):705-718. doi:10.1038/nrn4036
9. Ruehle S, Rey A, Remmers F, Lutz B. The endocannabinoid system in anxiety, fear memory and habituation. Journal of Psychopharmacology. 2011;26(1):23-39. doi:10.1177/0269881111408958
10. Korem N, Zer-Aviv T, Ganon-Elazar E, Abush H, Akirav I. Targeting the endocannabinoid system to treat anxiety-related disorders. J Basic Clin Physiol Pharmacol. 2016;27(3). doi:10.1515/jbcpp-2015-0058
11. Babson K, Sottile J, Morabito D. Cannabis, Cannabinoids, and Sleep: a Review of the Literature. Curr Psychiatry Rep. 2017;19(4). doi:10.1007/s11920-017-0775-9