Anxiety and anxiety disorders are the most common mental health complaints in the US, with over 40 million Americans suffering from some type of anxiety. That’s around 18% of the population. And although anxiety in its purest form is necessary for survival in humans and animals, anxiety in day-to-day life can have a debilitating effect on health and the quality of life. Thankfully, there are many pharmaceutical and natural remedies, including the use of cannabis for anxiety, that can be very helpful.
The DSM V classifies anxiety into three broad categories, each one encompassing more specific forms of anxiety. They are:
These different types of anxiety disorders can have different causes and different triggers. For example, PTSD is common in those who have witnessed or experienced very traumatic events, such as war veterans or those that have survived natural disasters or extreme violence or abuse. PTSD triggers can include things like hearing a loud bang or smelling a scent similar to that of a perpetrator.
There are also some risk factors that can contribute to you developing an anxiety disorder, and those include your genetics, your brain chemistry, your childhood and upbringing, your personality, and if you’ve experienced a traumatic event. Also, your physical health can either make you more or less vulnerable to the development of anxiety. Begin under chronic stress can also make you more vulnerable to developing anxiety, along with other health problems like adrenal fatigue as well.
Different anxiety disorders also exhibit different symptoms, but there are a few symptoms that are shared by most anxiety disorders. They include:
Some of these symptoms, such as sleep disturbances, can have lasting negative effects on health, especially if they become chronic. These negative effects can also worsen anxiety and even trigger other mental health issues. This compounding effect is why people with an anxiety disorder are more prone to drug and alcohol use, and are six times more likely than those without an anxiety disorder to be hospitalized for a psychiatric issue.
Having an episode of anxiety once in a while may not require medical assistance, and you may be able to deal with it on your own with some lifestyle changes. But if you suffer from an anxiety disorder, it’s important that you get medical support, including from integrative and functional medical professionals who may suggest using natural remedies, such as cannabis for anxiety.
Worsening anxiety can often be traced back to chronic stress, and chronic stress has become almost a feature of modern life. In our fast-paced and competitive lives, it has become easier to just eat the fast food, work till late at night, pop pain-killers for headaches and PMS, use the less expensive products with all the chemicals, and barely take time to exercise or meditate or go out into nature.
But this all comes at a price, and the price is paid by our bodies and minds.
Your NeuroEndoMetabolic (NEM) Stress Response is responsible for your body’s global response to stress. Your NEM is composed of six circuits, sets of related organs and systems, that work together to fight stress. Your adrenals, one of the main organs responsible for addressing stress, are part of the Hormone circuit. You also have the Bioenergetics, the Cardionomic, the Neuroaffect, the Inflammation, and the Detoxification circuits. Adrenal fatigue is a very common health condition that occurs due to chronic stress.
In the beginning stages of Adrenal Fatigue Syndrome (AFS), your adrenal glands still manage to work hard to produce more and more cortisol to meet the growing demand. But these increased levels, even though needed, are harmful over time. They bring with them a set of symptoms. And then, when the adrenal glands are exhausted and can no longer produce cortisol, you’re in the advanced stages of AFS, and then more symptoms show up.
Anxiety is one of the main symptoms of AFS. So if you’ve suddenly started to develop anxiety and you also notice you’re very fatigued, you’re easily gaining weight and having a hard time losing it, you have a hard time getting to sleep or tend to wake up in the middle of the night, you have brain fog, your hair is thinning, you’ve started to develop minor depression, your energy levels have dropped, and you just can’t seem to function as well as before, adrenal fatigue could be what is going on.
Although physical stress is the bigger culprit when it comes to adrenal fatigue, psychological stress can also weaken the body and make it more susceptible to these physical stressors. Physical stressors include stealth viruses, recurring infections, an unhealthy diet, a sedentary lifestyle, chronic insomnia, major surgery, chronic disease, overconsumption of sugar, alcohol and drug use, and the use of certain medications.
Having an already present anxiety disorder can trigger or worsen many of these physical stressors and bring about AFS, and so it is important to address both the anxiety and the AFS simultaneously when thinking about recovery. It is very difficult to recover from AFS while in the storm of an anxiety disorder, and vice versa. And because some anxiety medications, such as benzodiazepines, can be detrimental to health and the adrenal glands, a natural approach, such as using cannabis for anxiety, may prove to be very useful.
But to understand more about using cannabis for anxiety, we have to first understand how the endocannabinoid system works and also how cannabis affects your body through the Neuroaffect circuit of the NEM.
The Endocannabinoid System, or ECS, is a fundamental neuro-modulatory system that is older than the brain, though it was only discovered in the 1980s when cannabis was being researched (hence the name). It plays important roles in the development of the central nervous system, in synaptic plasticity, and in the response to endogenous and environmental injuries. It’s composed of endogenous cannabinoids, called endocannabinoids, cannabinoid receptors, and the enzymes that synthesize and degrade endocannabinoids.
And that’s a very interesting point to note: we actually produce our own cannabinoids, and that may be why cannabis derived from plants works so well on so many systems in the body, as we already have the receptors that can bind with such compounds in abundance.
A couple of examples of endocannabinoids are anandamide (Ananda is the Sanskrit word for bliss) and 2-arachidonoylglycerol (2-AG), and they are thus far the best studied endogenous cannabinoids. And although they are very similar in chemical structure, they are synthesized and degraded by different enzymatic pathways, and so they have quite different physiological effects.
The most abundant cannabinoid receptors in the body are the CB1 receptors. CB2 receptors, peroxisome proliferator-activated receptors (PPARs), and transient receptor potential (TRP) channels are also involved with different cannabinoids, including exogenous cannabinoids, whether sourced from plants (phytocannabinoids) or made synthetically.
CB1 receptors are more involved with the central nervous system, while CB2 receptors are more involved with the peripheral nervous system. With regards to phytocannabinoids, there are different components of cannabis that work on the ECS. The two most well-known are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the component that actually binds to CB1 and CB2 receptors. And while CBD doesn’t bind, it does indirectly modulate them, exerting its effects through other means.
The ECS is involved in every system in the body, and in each type of tissue, organ, and system, it plays a different role. It helps regulate appetite, metabolism, energy, sleep, stress responses, the immune system, the autonomic nervous system (ANS), and body temperature. It is essential in maintaining balance and homeostasis (which is always the body’s goal) and is crucial for recovery and repair.
Cannabis for anxiety works the same way as cannabis in general, whether we’re talking about brain-derived endocannabinoids, plant-derived phytocannabinoids, or pharmaceutically-developed synthetic cannabinoids: they all work on the ECS receptors to produce an effect.
This is why some natural remedies for anxiety will involve practices that help produce more endogenous cannabinoids and help the ECS function better, such as upping the intake of omega fatty acids, which are crucial for making endocannabinoid cofactors. This is also why some people find using plant-derived cannabis for anxiety quite effective, especially if prescribed by a health professional and supported by other methods. And the same goes for synthetic cannabinoids in the form of medications.
The Neuroaffect circuit is the part of the NEM that describes the biological aspects of mental health, and it is the main circuit involved when you experience symptoms such as anxiety, brain fog, and mild depression when you have NEM dysregulation. It’s composed of the brain, the ANS, and the microbiome. These three components use neurotransmitters to communicate with each other.
Acute stress, such as what comes with an anxiety attack, and chronic stress, which can look like having a generalized anxiety disorder, both affect the way the brain functions, and these effects are dependent on how severe and how long-lasting the brain’s exposure to stress hormones has been. Different parts of the brain have cortisol receptors, such as the prefrontal cortex, the amygdala, the locus coeruleus, and especially the hippocampus. If these areas are constantly flooded with cortisol, they begin to change.
The hippocampus can actually end up shrinking, and the brain centers responsible for regulating things like cognitive abilities and emotional responses can be gravely affected, creating distortions in perception and behavior. Stress can also increase the myelin in the hippocampus, causing learning difficulties, and it can even increase the risk of stroke due to changes in blood pressure. Long-term stress can result in a loss of gray matter and an increase in white matter, which can make it difficult for neurons to form connections with each other.
This is not to mention the neuroinflammation that can come from chronic stress, and this is why the microbiome plays an important role in the Neuroaffect circuit. Inflammation almost always begins in the gut, and it has to do with leaks forming in the gut lining and allowing substances into the bloodstream that prompt an immune response. These leaks form because the gut’s microbiome becomes unbalanced, a state called dysbiosis, and dysbiosis is a result of chronic stress.
As long as these leaks persist, the immune system keeps attacking the substances leaking into the bloodstream, creating a state of inflammation in the gut that can then spread to other parts of the body. Inflammation that reaches the brain and nervous system can cause a lot of damage there. Neuroinflammation and the dysregulation of the Neuroaffect circuit are usually what bring about anxiety and mild depression when dealing with AFS.
As for the ANS, its components – the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS) – normally work together harmoniously. But when exposed to stress, the SNS is overstimulated, keeping the body’s fight or flight response switched on. This fight or flight response engages three potent stress hormones: cortisol, norepinephrine, and adrenaline. When their levels are consistently outside of normal ranges, the PNS isn’t allowed to put the body into a state of rest, digestion, and repair.
Once again, this shows how interrelated the different systems of the body are, and how anxiety can trigger or worsen dysregulation in the NEM, especially its Neuroaffect circuit and its adrenal glands. It also shows how dysregulation in the NEM and a state of adrenal fatigue can bring about anxiety as a symptom. But where does cannabis for anxiety fit in?
Since the brain is part of the central nervous system, and the ANS is a division of the peripheral nervous system, the Neuroaffect circuit is therefore very much linked to the endocannabinoid system. More specifically, CB1 receptors are linked to the brain component of the Neuroaffect circuit, while CB2 receptors are linked to the ANS component.
The pathogenesis of anxiety can tell us a lot about how it affects the Neuroaffect circuit, and also how the use of cannabis for anxiety can help reverse this pathogenesis.
First of all, anxiety entails the overactivity (or the under-inhibition) of certain neurotransmitters as well as neuronal firing. It also entails an excess of glutamate, which is an excitatory neurotransmitter, and a decrease in GABA, which is an inhibitory neurotransmitter. GABA triggers the PNS to slow down the body’s processes that were previously sped up in order to deal with a stressor.
Anxiety can also increase the fight or flight chemicals, such as norepinephrine. But it also decreases serotonin, which is sometimes referred to as “the happy chemical” since it promotes a feeling of wellbeing. It decreases 5-HTP as well, which is a major precursor of serotonin and which also helps the body balance its neurotransmitters.
The standard pharmacological treatments for anxiety include the use of benzodiazepines, SSRIs, SNRIs, ketamine, TCAs, beta-blockers, MAOIs, mood stabilizers, and anticonvulsants. Though these treatments can be extremely useful for some people, they do have side-effects, and they don’t work so well for other people. Many sufferers have to adjust their medication multiple times before they find the right dose or combination, if ever, and some cases of anxiety and depression are resistant to pharmacological treatments altogether.
This leaves a gap to be filled by other means, and many people are searching for more natural alternatives, such as cannabis for anxiety. Although studies on the use of cannabis for anxiety, particularly CBD, are still preclinical and based mainly on mice studies, they are still quite promising and seem to be translating positively to human studies. Some of the preliminary findings are that CBD:
CBD has also been reported by users to help with the physical symptoms of anxiety, such as nausea, headaches, muscle tension, and tingling.
Cannabinoids affect many areas of the brain, such as:
As you can imagine with effects in all these areas, the misuse of cannabinoids, including using cannabis for anxiety and other stress-related issues, can bring about undesired effects. That’s why it’s important that when using any psychoactive substance, whether natural or synthetic, to do so under the guidance of a trained professional.
Also, because cannabis has many different components, such as THC and CBD, knowing which to use for what is another important consideration. THC binds to receptors and it is the one that gives the feeling of being “high”, while CBD indirectly modulates the receptors and doesn’t give that high.
Medical marijuana involves the use of the entire plant, which can have what some researchers term “the entourage effect” – the idea that the sum of the components of the cannabis plant together is more therapeutically effective than a single isolated compound, such as THC or CBD alone.
But not everyone does well with the high of marijuana, and not everyone needs the entourage effect. In some cases, the high can turn into paranoia and even more nervousness, effectively canceling the benefits of using cannabis for anxiety. In such cases, CBD oil or edibles may be a better choice.
It’s important to take a holistic approach to whatever health problem you are addressing when considering the use of cannabis. For example, if you have AFS, although using cannabis for anxiety can help with that specific symptom, the deeper imbalances and root causes still need to be addressed if you want to fully recover and enjoy true wellbeing. Cannabis for anxiety can be just one component of your recovery plan, and it can help you rest, sleep, and relax, which are all very important.
But you also need to stick with a healthy diet, such as the adrenal fatigue diet, deal with any physical or psychological conditions that put stress on your system, do the right type of physical activity, and take supplements to fill in any nutritional gaps and give you the boost you need. And, in the end, if you do all of these things, you may end up not needing to use cannabis for anxiety long-term, and you may also be able to reduce other medications you’ve been taking.
Whatever the case, it is very important to follow the guidance of an experienced health professional in order to avoid paradoxical reactions, side-effects, and common pitfalls when changing your health routine in any way.
© Copyright 2020 Michael Lam, M.D. All Rights Reserved.
Although cannabis has a controversial reputation, with many swearing by its effectiveness while others proclaiming it to be a gateway drug, the truth is that it can have many benefits when used correctly. Read to find out how one can safely and effectively use cannabis for anxiety.
