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Is Cannabis Useful for Anxiety and Panic Disorders? Research Review

Researchers around the world have speculated on the potential anxiolytic benefits of cannabis and its primary active components, cannabinoids, for decades. Recently, new studies have been published that shed more light on the utility of tetrahydrocannabinol (THC) and cannabidiol (CBD) in treating anxiety and panic disorders. In this review, we will briefly discuss seven of the primary studies that have recently been conducted into the usefulness of cannabis in treating anxiety.

What Is Cannabis?

Cannabis sativa is an annual plant bearing resinous buds that contain terpenes, flavonoids, and cannabinoids. Unique to cannabis, cannabinoids interact with the human endocannabinoid system and are believed to have multitudinous beneficial properties.

What Are Panic and Anxiety Disorders?

Anxiety Panic and anxiety disorders are psychiatric conditions involving unadaptive responses to stressful stimuli. In anxiety disorders, affected individuals feel inappropriate degrees of fear or concern over life’s realities and responsibilities. In panic disorders, patients experience sudden and often overwhelming attacks of fear.

Cannabis and Anxiety Disorders: Primary Studies

Between 2021 and 2023, cannabis anxiety research was furthered the most by the following seven published journal articles:

1. The endocannabinoid system in social anxiety disorder: from pathophysiology to novel therapeutics (2022)

Social anxiety disorder (SAD) is only one type of anxiety, but data regarding how cannabinoids affect this disorder nonetheless have inferential bearing on other forms of anxiety as well. This study found that the endocannabinoid system (ECS) “could play a potential role in the pathophysiology of SAD,” providing the framework for considering cannabinoids (which strongly affect the ECS) as potentially relevant in the context of treating anxiety disorders.

2. Antidepressant and Anxiolytic Effects of Medicinal Cannabis Use in an Observational Trial (2021)

This clinical study was partially facilitated by Johns Hopkins University School of Medicine, a long proponent of alternative medical research. Consisting of 368 cannabis users and 170 control subjects, the study focused on the effects of cannabis use on depressive and anxiety symptoms. The researchers concluded that “cannabis use may reduce anxiety and depressive symptoms in clinically anxious and depressed populations.”

3. Medical cannabis use in Canada and its impact on anxiety and depression: A retrospective study (2022)

This study consisted of 7,362 patients and found “evidence to support the effectiveness of medical cannabis as a treatment for anxiety and depression.” Participants with anxiety disorders completed a GAD-7 questionnaire, eventually reporting “an average decrease in GAD-7 scores that was greater than the minimum clinically important difference of 4.”

4. The Effectiveness and Adverse Events of Cannabidiol and Tetrahydrocannabinol Used in the Treatment of Anxiety Disorders in a PTSD Subpopulation: An Interim Analysis of an Observational Study (2023)

This large clinical study consisting of 766 participants focused on the effects of both THC and CBD on individuals with post-traumatic stress disorder (PTSD), a form of anxiety. Individuals who used either cannabinoid “reported significantly improved anxiety, depression, fatigue, and ability to take part in social roles and activities.”

5. Cannabis containing equivalent concentrations of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) induces less state anxiety than THC-dominant cannabis (2022)

Limited research indicates that CBD-THC blends may be more promising anxiety treatments than THC alone. This clinical study consisting of 26 adults found that the best reductions in anxiety were observed when THC was used with CBD.

6. Cannabidiol for Treatment-Resistant Anxiety Disorders in Young People: An Open-Label Trial (2022)

Medical researchers must increasingly grapple with the impact of treatment-resistant anxiety, forms of anxiety that are not alleviated with conventional treatments. In this study, CBD alone was evaluated as an anti-anxiety agent using the OASIS anxiety evaluation criteria, observing results among 31 teens and young adults. Researchers found that average OASIS scores dropped by 4.5 points over 12 weeks, indicating an overall 42.6% decrease in anxiety symptoms. 

7. Cannabidiol as a Potential Treatment for Anxiety and Mood Disorders: Molecular Targets and Epigenetic Insights from Preclinical Research (2021)

Certain published research has started delving into the potential biochemical mechanisms that may be behind the perceived impact of cannabinoids on mood and anxiety disorders. Focusing on cannabidiol, this research review begins by observing that CBD appears to impact both vanilloid and serotonin receptors in the human brain, potentially explaining anxiolytic effects observed in connection with the cannabinoid. This journal article echoes the general scientific consensus that CBD deserves just as much attention as THC as research into cannabis and anxiety goes forward.

Further Research into Cannabis for Anxiety and Panic Disorders

In Dr. Bonni Goldstein’s seminal 2020 book Cannabis is Medicine, the potential usefulness of cannabis compounds for anxiety and panic disorders is explored at length. Beginning with the recognition that anxiety is currently the most common form of mental illness, Dr. Goldstein goes on to weave together various insights gleaned from contemporary research throughout two full chapters, one devoted to anxiety disorders and the other to PTSD.

 

As Dr. Goldstein tells us, studies show that reduced endocannabinoid system activity has been associated with the presence of anxiety disorders. Cannabinoid-like endogenous compounds (endocannabinoids) like anandamide, which are also affected by exogenous cannabinoids, appear to play a massive role in mental well-being with levels of anxiety notably rising when anandamide is blocked in the brain (p. 155).

 

Some further findings that Dr. Goldstein relates (p. 156) in her chapter on cannabis and anxiety include:

 

  • Women with depression show lower levels of the endocannabinoid 2-AG

  • Women with anxiety show lower levels of the endocannabinoid anandamide

  • Individuals with severe depression show endocannabinoid system imbalances

  • Depressed individuals with low anandamide also have higher levels of anxiety

 

How can cannabinoids help with these symptoms? Dr. Goldstein explains (p. 157):

 

  1. Most non-intoxicating cannabinoids (CBD, CBG, CBC, CBN) inhibit anandamide uptake, increasing its effects

  2. THC can also alter anandamide levels, but it should be used for anxiety with caution

  3. CBD appears to have direct anti-anxiety effects

  4. Cannabinoid precursors, such as CBDA and THCA, may also be useful for anxiety

 

What about the impact of cannabis on post-traumatic stress disorder, the most common form of panic-related mental illness? Beginning by noting that existing mainline treatments for PTSD are often ineffective, Dr. Goldstein goes on to relate that the amygdala, believed to be the emotional processing center of the brain, contains high levels of cannabinoid receptors (p. 249). She goes on to say that individuals with impaired amygdala function are more likely to develop PTSD, and the resulting endocannabinoid system dysfunction can then worsen the condition.

 

Compared to cannabinoids and anxiety, Dr. Goldstein admits that research into cannabis and PTSD is more limited. Some key highlights she covers, though, include (p. 250):

 

  • Individuals with PTSD generally show endocannabinoid system abnormalities

  • Synthetic forms of THC have been shown to eliminate nightmares in the majority of PTSD patients

  • Studies from New Mexico, Israel, and Canada confirm that cannabis treatment is reported as helpful by patients with PTSD

  • Both CBD and THC have been shown to reduce the severity of PTSD symptoms

Conclusion: Clinical Research Is Critical

Initial evidence clearly indicates a relationship between cannabinoids and anxiety and panic disorders. A paucity of clinical evidence persists, however, that can only be solved with continuing efforts within the global cannabis research community. We call upon cannabis scientists to better delineate the therapeutic potential of cannabinoids for anxiety and panic disorders with thorough and insightful clinical studies.

Sources

  1. Ahmed, M., Boileau, I., Foll, B. L., Carvalho, A. F., & Kloiber, S. (2022). The endocannabinoid system in social anxiety disorder: from pathophysiology to novel therapeutics. Revista Brasileira De Psiquiatria, 44(1), 81–93. https://doi.org/10.1590/1516-4446-2021-1926

  2. Martin, E. L., Strickland, J. C., Schlienz, N. J., Munson, J., Jackson, H., Bonn‐Miller, M. O., & Vandrey, R. G. (2021). Antidepressant and anxiolytic effects of medicinal cannabis use in an observational trial. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.729800

  3. Sachedina, F., Chan, C., Damji, R. S., & De Sanctis, O. J. (2022). Medical cannabis use in Canada and its impact on anxiety and depression: A retrospective study. Psychiatry Research, 313, 114573. https://doi.org/10.1016/j.psychres.2022.114573

  4. Stack, S. K., Wheate, N. J., Moloney, N., Abelev, S. V., Barlow, J. W., & Schubert, E. (2023). The effectiveness and adverse events of cannabidiol and tetrahydrocannabinol used in the treatment of anxiety disorders in a PTSD subpopulation: an interim analysis of an observational study. The Journal of Pharmacy Technology, 39(4), 172–182. https://doi.org/10.1177/87551225231180796

  5. Hutten, N. R. P. W., Arkell, T. R., Vinckenbosch, F., Schepers, J., Kevin, R. C., Theunissen, E. L., Kuypers, K. P. C., McGregor, I. S., & Ramaekers, J. G. (2022). Cannabis containing equivalent concentrations of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) induces less state anxiety than THC-dominant cannabis. Psychopharmacology, 239(11), 3731–3741. https://doi.org/10.1007/s00213-022-06248-9

  6. Berger, M., Li, E., Rice, S., Davey, C. G., Ratheesh, A., Adams, S., Jackson, H., Hetrick, S., Parker, A., Spelman, T., Kevin, R. C., McGregor, I. S., McGorry, P. D., & Amminger, G. (2022). Cannabidiol for Treatment-Resistant Anxiety Disorders in young people. The Journal of Clinical Psychiatry, 83(5). https://doi.org/10.4088/jcp.21m14130

  7. Melas, P. A., Scherma, M., Fratta, W., Cifani, C., & Fadda, P. (2021). Cannabidiol as a Potential Treatment for Anxiety and Mood Disorders: Molecular Targets and Epigenetic Insights from Preclinical Research. International Journal of Molecular Sciences, 22(4), 1863. https://doi.org/10.3390/ijms22041863

  8. Goldstein, B. (2020). Cannabis is Medicine: How CBD and Medical Cannabis are Healing Everything from Anxiety to Chronic Pain. Hachette UK.

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