Cannabis for Anxiety: What you need to know before treatment

cannabis for anxiety
Anxiety is an emotion felt by our bodies and characterized by an unpleasant state of inner tumult, usually accompanied by nervous behaviour like pacing back and forth, somatic complaints like feeling butterflies in the stomach, and rumination or worries. (file image)

One of the most prevalent conditions that cannabis is used as a treatment for is anxiety, which usually coincides with depression.

I have encountered many patients who inquire about cannabis for the treatment of anxiety, and it usually does help alleviate it.

In order to understand how cannabis helps with anxiety, we need to take a deeper look into the condition that affects so many millions around the world.

Anxiety symptoms can be severe

Anxiety is an emotion felt by our bodies and characterized by an unpleasant state of inner tumult, usually accompanied by nervous behaviour like pacing back and forth, somatic complaints like feeling butterflies in the stomach, and rumination or worries.

It is essentially a feeling of dread that overcomes an individual like the fear of imminent death. However, it is to be noted that anxiety is not the same as fear, which is a response to actual threat. In anxiety, no such threatening peril exists to merit the response.

There are various types of anxiety. Existential anxiety, mathematical anxiety, somatic anxiety, stage fright, test anxiety, social anxiety, and stranger anxiety are all types of anxiety that can affect many individuals.

It is important to note that anxiety has been linked with physical symptoms such as IBS and can heighten other mental health illnesses such as OCD and panic disorder.

The treatment for anxiety is to prescribe anti-depressants like citalopram, benzodiazepines like lorazepam – which can prove to be very mind-altering to some patients, and other anxiolytic drugs. While these medications do work for patients, they can be harmful and cause extreme drowsiness in some patients. Cognitive behavioural therapy (CBT), which is a form of talk therapy has also been indicated to help anxiety.

The pathophysiology of anxiety

Anatomically speaking, anxiety starts in the amygdala. The amygdala is a pair of small, almond-shaped clusters of neurons near the base of the brain and it is responsible for how the body reacts to anxiety.

The job of the amygdala is to manage the storage of memories according to the strength of the emotional reaction associated with the memory. The amygdala, once triggered, sends distress signals to the other key parts of the brain. It does this by communicating with the parabrachial nucleus, a gray horseshoe like structure, which, in turn, triggers the medulla oblongata.

The medulla oblongata is located on the lower part of the brainstem near other primitive brain structures responsible for fight or flight response, which is a physiological reaction that occurs due to a harmful event, attack, or threat to survival.

The medulla oblongata controls involuntary functions of the body, including heart rate, breathing, and vomiting. Once triggered by the parabrachial nucleus, the medulla oblongata sends signals to the lungs and cardiac muscles to increase inhalation so that extra air can be circulated to the muscles of the body via the blood.

The problem arises when the body doesn’t need to fight or flee. Then the quick breathing and extra air that the medulla oblongata has sent for overwhelms the body system and results in both dyspnea, or shortness of breath, and hyperventilation.

Next, the nucleus ambiguus is triggered. The nucleus ambiguus is located below the medulla oblongata and its function is to receive the urgent call for more blood to transport extra oxygen by constricting the body’s arterioles, which essentially causes the heart to pump faster. This can also increase heart rate as well as blood pressure.

It also causes the the activation of the fight or flight response. Overstimulation of this response causes the body to always be in a state of distress and wreaks more unnecessary damage.

The activation of the sympathetic nervous system by the nucleus ambiguus alerts the adrenal medulla to release adrenaline into the body. The adrenal medulla is found on the adrenal gland, which is found sitting on top of the kidneys.

The release of adrenaline, also known as the adrenaline rush, communicates with the brain to release a neurotransmitter called epinephrine, which also spikes both blood pressure and blood sugar, thereby providing necessary energy used by the muscles.

However, the crash from the adrenaline causes the body to feel tired and unhappy. The prefrontal cortex of the brain is also affected because of anxiety, and this is the region of the brain that causes one to worry excessively.

Cannabis for anxiety is proving to help

Now that we understand how it is that anxiety affects the body, what role does cannabis play in easing all of these symptoms?

People suffering from anxiety are asked by physicians and other medical professionals not to self medicate with recreational cannabis since, mostly, recreational cannabis contains more tetrahydrocannabinol (THC), the psychoactive component of cannabis, rather than cannabidiol (CBD), the non-psychoactive component of cannabis.

Often times, patients are encouraged to choose a strain of cannabis with higher concentration in CBD for medical purposes. THC is known to trigger the amygdala area of the brain which is responsible for fear, which can actually cause anxiety and paranoia.

2014 study found that cannabis can increase the presence of endocannabinoids, which are naturally-occurring chemicals in the brain. These endocannabinoids, along with the endocannabinoid system, ensure that the body stays in homeostasis at all times.

recent landmark study coming out of Canada has found that 40% of patients who were prescribed medical cannabis to treat both anxiety and pain stopped using benzodiazepines, their prescription medication, within 90 days. 45% stopped using their medication after a year.

With so many stats backing cannabis as a viable treatment for anxiety, patients have to ensure that they choose a strain that works to help alleviate the symptoms and not exacerbate them. CBD, when it comes to anxiety, is working wonders.

 

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