Cannabis & Anxiety: Straight talk about cannabis as medicine, Part 1 of 2

Can Cannabis treat anxiety? Yes. Can cannabis cause anxiety? Yes.

First, it’s good to know that humans have known about the medicinal value of cannabis dating back to ancient cultures. Ancient Egyptian mummies have traces of the herb in their systems. In 1881 when Pharoah Ramesses II’s tomb was  discovered, there were traces of cannabis in the remains. In The Ebers Papyrus dating to 1550 B.C. is a statement that Egyptian females in particular used marijuana as a way to treat depression and other psychological problems. It is believed that the nomads from the Eastern Steppe region who settled Europe some 5000 years ago brought the practice of inhaling marijuana vapors with them. In 440 B.C. the Greek historian Herodotus documented that these nomads inhaled hemp vapors from heated rocks in their tents that made them “shout for joy.”

Second, it’s good to know that our body contains something called the endocannabinoid system.  This system is found throughout our bodies. There are chemical receptors that have natural binding compounds present in our body. This system is related to many of our basic functions such as pain, memory, mood, appetite, stress regulation, immune functioning and reproductive functioning. Recent molecular research indicates the endocannabinoid system plays an important role in the pathophysiology of anxiety disorders. Modulation of the endocannabinoid system may be an effective treatment.

How does this relate to the cannabis plant? Well, the cannabis plant contains chemicals that bind to these same endocannabinoid receptors throughout our bodies. Cannabis mimicks our own natural compounds. This sounds complicated. It is! How did the ancients know the plant was medicinal? We don’t know.

What we do know is that most long-term users of cannabis report that cannabis use is associated with a reduction in anxiety. Relaxation and relief of tension are the most common effects of using cannabis. 

OK now let’s learn a few things about the cannabis plant. Cannabis is a plant that is made up of many phytocannabinoids. Some of the most familiar to you will be THC and CBD. There are somewhere in the neighborhood of 150 compounds, including plant chemicals called terpenoids.  Thus far, research has focused on singling out these compounds and studying the effects. Based on these earlier studies, we know that THC alone can both lower anxiety and increase anxiety, depending on the dose. CBD largely lowers anxiety.  Terpenoids have properties that lower anxiety.

How much THC is in a given plant?

Well that depends on that plant’s particular genetics. Cannabis appears to have evolved some 28 million years ago on the Eastern Tibetan Plateau. Early strains most likely had low levels of THC, although it was documented as having “mind altering properties” even then by followers of the Zoroastrian religion. Cannabis has been bred over the centuries and has traveled many a mile.

It is believed it was used as a form of currency, traded and trafficked on the infamous Silk Road.

Infinite variations of ratios of cannabinoids and terpenes are possible through selective breeding. Cannabis breeders have focused on increasing the content of THC over the years.

If the plants and the chemicals that make up the cannabis plant are so complex, what do we know about the effects on the human body? Well we don’t have as much scientific research as we would like. When congress made cannabis an illicit Schedule 1 substance in 1970, research essentially halted. The studies we do have focused largely on the effects of THC or CBD as a single agent, not as a compound within a whole plant. The prescription medicines that have been developed are similarly simple in nature. They have been shown to be effective for seizures, pain, and nausea and vomiting.

After many states began to legalize cannabis for medical use, more studies have been completed. Two very recent studies have been conducted with groups of medical marijuana patients who responded to online surveys. These patients rated their symptoms and their responses to many sessions of cannabis use. They then rated the top four strains for reducing anxiety and the four strains least effective in reducing anxiety. After the results were in, the strains were then analyzed and broken down into the component plant parts. The researchers have been able to zero in on exactly which plant compounds lower anxiety the most. This has produced a list of anxiety reducing terpenes as well as further elucidated the effects of the ratio of CBD to THC on anxiety.

The results are exciting and complex. I’m going to give you the basics first, and then in a later article we can dig into more specifics for the science nerds among us.

THC and CBD exist in a ratio in each plant. Lower amounts of THC and higher amounts of CBD appear to have positive effects on anxiety and depression.

Terpenes interact with the large variety of cannabinoids in the cannabis plant. The whole plant is a very different “medicine” than the individual compounds that make it up. This is termed the “entourage effect” and means the effects of the whole are greater and more complex than the sum of the parts.

Low doses of THC are best for the treatment of anxiety. Doses below 7.5mg generally lower anxiety while doses above 7.5mg can induce anxiety.

CBD mitigates the sometimes anxiety producing effects of THC.

This is why strains with balanced ratios of THC and CBD are least likely to cause unwanted palpitations or induce paranoia.

If a patient with anxiety is using medical cannabis and does experience increased anxiety or even paranoia, straight CBD will resolve these unwanted experiences. I highly encourage my clients to talk to dispensary staff about which strains will be most effective and best tolerated.

The wise advice to use moderation in all things applies when we use cannabis as medicine.

I don’t recommend that my patients use more prescription pills than are necessary, and I don’t recommend that patients use medical marijuana in excess either.

Small doses are very effective. Low potency THC strains are generally the best tolerated.

I do have the reference articles used to compile this discussion.  Please e-mail me at
[email protected] if you would like this list of scientific and historical reference materials.

I look forward to talking more with you about cannabis and anxiety in our next article!