Cannabis and Anxiety: The Facts, The Myths, and What You Should Know

A lot of my clients ask if marijuana can help relieve anxiety. So, I’ve spent time exploring research and attending workshops to understand the topic better. If you're considering cannabis for anxiety, it’s essential to listen to your body, pay attention to how it affects you, and consult with healthcare professionals to determine if it’s the right option (Yielding, 2021).

Marijuana has become more popular for medical use in many states, and where it’s legal, different strains are often advertised as being effective for anxiety. But is this true?

The reality is that there’s still debate over whether marijuana truly helps with anxiety. This advertising can be predatory, exploiting people’s desire for relief without sufficient scientific backing.

The research is not yet conclusive, particularly when it comes to the difference between the two primary compounds in cannabis: THC and CBD (Blessing et al., 2015).

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Marijuana and Anxiety: Key Terms to Understand

Before diving deeper, here are a few terms to keep in mind:

• Cannabis: A plant family that includes both hemp and marijuana. The term covers all varieties of the plant, regardless of THC content.

• Marijuana: A plant-based drug made from Cannabis sativa or Cannabis indica. It contains over 100 compounds called cannabinoids, with THC and CBD being the most well-known (Lee et al., 2017).

• THC (Tetrahydrocannabinol): The compound that gives the "high" feeling. THC can affect anxiety in different ways depending on the dose and the person (Cuttler et al., 2018).

• CBD (Cannabidiol): A non-psychoactive compound, meaning it doesn't cause a high. CBD has gotten a lot of attention for its potential to reduce anxiety without the euphoria or paranoia that THC might trigger (Blessing et al., 2015).

Products with higher levels of CBD and lower levels of THC may be better suited for anxiety relief, as CBD can reduce some of the anxiety-inducing effects of THC (Beletsky et al., 2024).

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The Endocannabinoid System’s Role in Anxiety

The endocannabinoid system is a complex system that helps regulate mood, sleep, and stress. It includes endocannabinoids (naturally occurring compounds in the body), receptors (called CB1 and CB2), and enzymes that break down cannabinoids (Lee et al., 2017).

This system also interacts with important neurotransmitters like GABA and serotonin, which are involved in anxiety. When the endocannabinoid system isn’t functioning correctly, it can contribute to anxiety. THC and CBD may impact this system in ways that influence anxiety symptoms (Blessing et al., 2015).

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THC and Anxiety: A Biphasic Effect

The research on THC and anxiety is mixed because THC can have biphasic effects. This means that it can produce opposite results depending on the dose:

• Low doses of THC may help reduce anxiety and make you feel more relaxed. Many people report feeling calm and less stressed after using small amounts (Cuttler et al., 2018).

• High doses, however, can cause anxiety, paranoia, or even panic attacks, especially for people who are predisposed to anxiety or are new to cannabis. THC interacts with the amygdala (the part of the brain that processes fear), which can heighten emotional responses, increasing the likelihood of anxiety at higher doses (Lee et al., 2017).

Key point: THC’s effects on anxiety are dose-dependent. While small amounts might help in the short term, larger doses can increase the risk of anxiety (Cuttler et al., 2018).

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Risks of Using THC for Anxiety

Though more people are using marijuana to manage anxiety, it’s important to be aware of the potential risks, especially with frequent or heavy use:

• Psychological dependence: Relying on marijuana can lead to dependence, making it harder to manage anxiety naturally (Blessing et al., 2015).

• Worsening symptoms: Long-term use of marijuana, mainly THC, can exacerbate anxiety (Cuttler et al., 2018).

• Avoiding healthy coping mechanisms: Relying on marijuana can prevent the development of other, healthier ways to manage stress and anxiety (Yielding, 2021).

There is also mixed evidence on whether cannabis directly causes anxiety disorders. Some studies show an association, while others suggest that people who use marijuana may already be predisposed to anxiety. Factors like genetics and environmental stress could play a role in this overlap (Beletsky et al., 2024).

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Social Anxiety Disorder (SAD)

Social Anxiety Disorder (SAD) is one of the most common anxiety disorders, and many people turn to marijuana for relief. However, research shows mixed outcomes:

• Low-dose THC might reduce anxiety in social situations temporarily (Cuttler et al., 2018).

• High-dose THC, on the other hand, can make social anxiety worse by increasing paranoia or self-consciousness (Blessing et al., 2015).

People with SAD are especially at risk of using THC as a form of self-medication, which can lead to chronic use and increased social withdrawal over time, ultimately worsening anxiety (Yielding, 2021).

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Generalized Anxiety Disorder (GAD)

People with Generalized Anxiety Disorder (GAD) often use marijuana to manage their symptoms. Some evidence suggests that CBD may help with GAD by influencing the body’s stress responses. Still, heavy use of THC-heavy strains can worsen anxiety over time due to tolerance and dependence (Cuttler et al., 2018).

There’s still not enough conclusive research to support marijuana as a long-term treatment for GAD (Blessing et al., 2015).

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Cannabis-Induced Anxiety and Panic Attacks

For some people, especially those prone to anxiety or new to cannabis, high doses of THC can trigger cannabis-induced anxiety or even panic attacks. This is particularly common when using strong strains or consuming cannabis in stressful environments (Yielding, 2021).

Key findings:

• THC can increase dopamine and cortisol levels, leading to an overactive fight-or-flight response (Lee et al., 2017).

• Cannabis-induced anxiety affects people differently, making it hard to predict who will experience relief and who may suffer from anxiety (Cuttler et al., 2018).

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CBD and Anxiety: A More Promising Option

CBD shows much more promise as a treatment for anxiety compared to THC. Since CBD is non-psychoactive, it won’t get you high, and research suggests it may help reduce anxiety by interacting with serotonin receptors and reducing the body's stress response (Blessing et al., 2015).

Key findings:

• CBD may be effective for several types of anxiety, including Generalized Anxiety Disorder (GAD), Panic Disorder (PD), Social Anxiety Disorder (SAD), Obsessive-Compulsive Disorder (OCD), and Post-Traumatic Stress Disorder (PTSD) (Lee et al., 2017).

• Public speaking studies have shown that CBD can significantly reduce anxiety in stressful situations (Blessing et al., 2015).

• CBD might even enhance treatments like exposure therapy, which helps people face their fears in a controlled setting (Lee et al., 2017).

Although CBD looks promising, more research is needed to fully understand its long-term effects and the best dosage ((Beletsky et al., 2024).

CBD comes from hemp plants, but getting high-quality CBD can be difficult due to inconsistent farming, extraction, and testing practices. Not all products are rigorously tested, and some may contain impurities or incorrect levels of CBD and THC.

It's important to look for third-party lab testing and buy from reputable brands to ensure you're getting a pure and effective product.

Conclusion: Is Cannabis Right for Managing Anxiety?

The research on marijuana and anxiety is still mixed. While CBD shows promise as a treatment for anxiety, THC presents more risks, particularly at higher doses or with prolonged use.

References

Beletsky, L., et al. (2024). The Role of Cannabis in Anxiety Management: Self-Medication Hypothesis and Dose-Dependent Effects. Journal of Cannabis Research, 12(1), 41-58.

Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R. (2015). Cannabidiol as a potential treatment for anxiety disorders. Neurotherapeutics, 12(4), 825–836. https://doi.org/10.1007/s13311-015-0387-1

Cuttler, C., Spradlin, A., & McLaughlin, R. J. (2018). A naturalistic examination of the perceived effects of cannabis on negative affect. Journal of Affective Disorders, 235, 198-205. https://doi.org/10.1016/j.jad.2018.04.041

Lee, J. L. C., Bertoglio, L. J., Guimarães, F. S., & Stevenson, C. W. (2017). Cannabidiol regulation of emotion and emotional memory processing: Relevance for treating anxiety-related and substance abuse disorders. British Journal of Pharmacology, 174(19), 3242-3256. https://doi.org/10.1111/bph.13724

Yielding, R. (2021, February 15). Marijuana and CBD: Benefit or Harm for Anxiety? ADAA Webinar.