CANNABIS AND ANXIETY We are currently living through anxiety provoking times. The coronavirus is the perfect recipe to turn even the most laid back and centered among us into worrying wrecks, imagining the most catastrophic (although unlikely) outcomes for ourselves and our loved ones.
And that, dear friends, is the day-to-day life of someone living with anxiety. I know because for the last fifteen years it’s an inner world I’ve inhabited. Only for me, it’s not a pandemic I’m freaking out about, but lesser evils such as whether I’m going to make a complete idiot of myself in some social gathering or my own favorite anxiety rabbit hole – feeling anxious about feeling anxious.
While there’s no magic bullet to banish anxiety for good, managing anxiety symptoms is a commonly stated reason why people take cannabis – medical or otherwise – with CBD showing particular promise in preliminary studies.
Anxiety disorders are a collection of mental health conditions characterized by disproportionate worrying about future events that brings about physiological responses in the body such as tightness in the chest, shortness of breath, muscle tension, sleep disturbance, excessive sweating, agitation, restlessness, irritability, and difficulty concentrating.
Avoidance behavior are common strategies amongst anxiety sufferers. If you’ve had a panic attack crossing a bridge, there’s a fair chance you’ll never make it to the other side of that river again. And for the socially anxious amongst us, myself included, not turning up to that party or after work drinks or a friend’s wedding are tactics regularly employed.
However, the more situations we avoid, the smaller our worlds eventually become, and it’s often at this point when an anxiety disorder is diagnosed. Right now, it’s estimated 264 million people worldwide have some kind of anxiety disorder, with approximately 40 millionof them residing in the United States.
An estimated 264 million people worldwide have some kind of anxiety disorder, with approximately 40 million of them residing in the United States.
Anxiety disorders include generalized anxiety disorder (GAD) when anxiety is felt about a wide range of situations or issues; social anxiety disorder (SAD) – the fear of being negatively judged or rejected in social situations; panic disorder – sudden feelings of terror resulting in panic attacks; obsessive compulsive disorder (OCD) – unwelcomed repetitive thoughts and behavior; phobias – an extreme fear triggered by a situation or object; and post-traumatic stress disorder (PTSD) – anxiety including flashbacks that develop after some kind of traumatic event.
Due to their complex and often individualized nature, there’s no one-size-fits-all approach to treating anxiety disorders. Talking therapies, such as cognitive behavioral therapy (CBT), are often combined with anti-anxiety drugs like SSRI antidepressants or benzodiazepines for a more immediate calming effect. Also known as tranquilizers, benzodiazepines include the likes of Xanax and Valium, and while they may lull patients into a state of anxiety-free calm, taken long term they can result in addiction.
It’s clear, therefore, that a new class of anti-anxiety medication, without risk of abuse or dependence and free from side effects, must be developed. And the big ‘green’ hope is that the cannabis plant might hold the key.
Coping with stress or unwinding from a hectic day, is one of the major reasons millions of people consume cannabis. While your average recreational user isn’t interested in the biological mechanisms behind why they feel more relaxed after smoking a joint, the reason is almost certainly due to the direct activation of their endocannabinoid system (ECS).
The ECS comprises fatty ligands called endocannabinoids which bind to a vast network of cannabinoid receptor sites (CB1 and CB2) throughout the brain, central nervous system, immune system, and organs. Dynamic in nature, it is constantly working to ensure all our physiological systems remain in balance.
Life is filled with external stressors – pollution, poor sleep, that argument with your boss, the 24/7 news reports about the millions of people dying worldwide from the coronavirus. Thankfully the ECS works as a buffer to ensure our organisms don’t develop some kind of illness as a result. It also plays a crucial role in regulating fear, anxiety and how we cope with stress.
Activating CB1 receptors in the brain and central nervous system has been found to calm feelings of anxiety, which explains why consuming cannabis tends to chill people out. However, it’s not a case of the more you smoke, the less anxious you feel as higher doses of THC, the main psychoactive compound in cannabis, can actually be anxiety inducing.
Enhanced signaling between CB1 receptors and the endocannabinoid anandamide in the amygdala, an area of the brain key to processing fear, has been shown to help mice forget frightening experiences. That’s something of clinical interest for the treatment of anxiety disorders where frightening events of the past become indelibly marked in a patient’s memory, fueling future feelings of anxiety.
However, chronic stress itself can eventually impair our endocannabinoid system. Prolonged exposure to stress downregulates CB1 receptor signaling in brain regions involved in emotional processing. Chronic stress also increases levels of fatty acid amide hydrolase (FAAH), the enzyme that breaks anandamide down in the body, resulting in lower concentrations of the feel-good endocannabinoid.
With weakened endocannabinoid signaling, we are more vulnerable to developing anxiety and depression. Indeed, one study showed a clear inverse relationship between anandamide levels and anxiety severity in women with major depression;So in basic terms, the more anandamide deficient we are, the more anxious we may become.
Thus, boosting CB1 signaling could be a potential therapeutic target for both protecting against and treating anxiety disorders – a theory explored in a preclinical study on mice with low anandamide levels caused by stress-induced anxiety. Researchers observed how inhibiting FAAH reversed the animals’ anandamide deficiency, which in turn reduced their anxious behaviour.
While drug companies around the world are experimenting with synthetic FAAH inhibitors, hoping they’ll become the next big thing in anti-anxiety medication, cannabidiol (CBD), the non-intoxicating compound found in cannabis, has been shown to inhibit anandamide reuptake and delay its metabolism by FAAH. Several studies confirm that administering CBD enhances CB1 signaling, in turn promoting the creation of new neurons in the hippocampus, which scientists believe further contributes towards the compound’s anxiolytic effect.
However, CBD’s anti-anxiety action extends beyond increasing endocannabinoid signaling. Animal studies show how CBD interacts with serotonin 5-HT1A receptors in the brain, which are tried and tested targets for anti-anxiety medication.
In one study, administering CBD to rats submitted to 60 minutes of enforced restraint not only lowered their heart rate and mean arterial pressure, but also reduced anxiety levels. However, these results were not replicated when the rats were given a 5-HT1A antagonist, which blocked CBD from interacting with the serotonin receptors, What remains unclear is whether CBD elicits this effect by directly binding with 5-HT1A receptors or by indirectly facilitating 5-HT1A serotonin signaling.
Neuroimaging in healthy subjects given 400mg of a CBD isolate suggested that the relaxation they reportedly experienced may have been caused by activity in the limbic and paralimbic brain system, areas of the brain associated with emotional processing, memory, and cognitive processes.