Monday, June 10th, 2019
Cannabis is commonly used to alleviate symptoms of panic disorders, but someone looking for quick answers might have trouble sifting through the contradictions and misconceptions about marijuana left over from the U.S. War on Drugs. To fully understand those contradictions, the benefits of medical marijuana (MMJ), and how to navigate the myriad of treatment options, it may be best to first get on solid footing with the basics.
Cannabinoids and Terpenes: The Building Blocks of Weed
Different strains of marijuana are most commonly divided into three broad categories: sativa-dominant, indica-dominant, and hybrid. The first category originally referred to the species Cannabis sativa, a variety of the marijuana plant now known simply as hemp. Hemp has no THC content but is high in CBD.
Similarly, “indica” referred to the psychotropic species Cannabis indica, so called because it was discovered in India.
Today, all forms of the plant other than hemp are derived from the indica species, but the words sativa and indica are still used to differentiate between strains that give a cerebral, energetic “head” high and a relaxing, sedative-like “body” high, respectively.
While these categories are helpful in choosing strains for medicinal use, the truth is that all species of cannabis contain hundreds of cannabinoids (such as THC and CBD) as well as terpenes.
Terpenes are a type of hydrocarbon produced by plants that are responsible for their strong aromas and some protective functions, and are the primary component in essential oils. They also have significant influence on the effects of a given strain of marijuana; for instance, linalool is relaxing while pinene is uplifting, and there are dozens more.
The Endocannabinoid System
The most well-known cannabinoids are TCH (delta-9-tetrahydrocannabinol), and CBD (cannabidiol), so most research into how marijuana affects the brain center on those two compounds. It turns out that humans (and other mammals) have an endocannabinoid (eCB) system that produces chemicals (called endocannabinoids) which mirror the functions of plant-produced, or phytocannabinoids.
When you ingest marijuana, those compounds bind to eCB receptors throughout the brain and body, of which there are at least two kinds, called CB1 and CB2. CB1 receptors exist mostly in the brain and central nervous system (CNS), while CB2 receptors are found more in peripheral immune cells and tissues.
Signaling from these receptors regulate mood, sleep, stress, heart function, CNS function, appetite and digestion, and immune function. It’s also thought that eCB systems play a major role in the “modulation of anxiety and depressive behaviors and emotional learning.” Marijuana could therefore be the ideal treatment for correcting imbalances in those areas, rather than commonly prescribed antidepressants and anxiolytics like benzodiazepines.
Cannabidiol activates the CB1 receptor, along with several outside the endocannabinoid system, including those regulating stress, arrhythmia, and perceived pain levels. An extensive review of 49 current studies concluded that cannabidiol was an effective treatment for a range of disorders, including:
- generalized anxiety disorder (GAD),
- panic disorder,
- social anxiety disorder (SAD),
- obsessive–compulsive disorder (OCD), and
- post-traumatic stress disorder (PTSD),
with “no reported psychomotor slowing, negative mood effects, or vital sign abnormalities.”
When THC binds to cannabinoid receptors, the brain releases dopamine and serotonin, and inhibits the release of harmful stress hormones like norepinephrine, which floods the brain to cause fear and alertness during a panic attack. This benefits the neuroendocrine system by protecting against the damage of chronic stress.
Points of Contention
The complexity eCB systems and prevalent cultural misconceptions about marijuana have led some research to conclude that “any benefit derived from THC with regard to mental health could result in symptom exacerbation when users are not under the influence of THC.”
However, it could easily be argued that the same is true for any prescription anxiolytic or antidepressant medication, which have far more dangerous withdrawal symptoms along with the risk of serotonin syndrome, which can cause suicidal ideation, seizures, coma, and death.
The chronic nature of mental health disorders is a simpler explanation for continued symptoms with long-term use. A diagnosis often means a lifetime of managing symptoms; most experts say a combination of lifestyle changes, medication, and therapy are needed for the best patient outcomes. In a country where black-market drugs and both legal and illegal marijuana are more readily available than well-rounded healthcare, it’s hardly surprising that users who self-medicate don’t always meet their mark.
A three-year longitudinal study found no correlation between long-term MMJ use and recurring symptoms, or between “anxiety and later cannabis use onset,” once data were controlled for things like demographics, personality, and using other illicit drugs.
Where access to medical marijuana is safe and legal, rates of narcotic addiction and overdose have been dropping all over the country.
It is true that some strains may increase anxiousness, or make the user feel paranoid. Individual genetics, brain chemistry, and other drug use also play a role in effects and reactions, so there are patients for whom MMJ might not be an appropriate treatment. However, it’s important to note that in multiple studies, high doses of either THC or CBD were anxiogenic (anxiety-causing) in isolation.
Because of the complex roles of other cannabinoids and terpenes present in each species, research that reflects the way real patients use MMJ in their everyday lives may be a better predictor of the plant’s many benefits.
A research paper released last year by Washington State University found strains high in both CBD (> 11%) and in THC (> 26.5%) had the greatest benefits for treating anxiety, and that there were no risks of increased symptoms or further diagnosis with long-term use.
An even more detailed study conducted by Whistler Therapeutics determined the chemotypes of the most effective strains based on surveys of patients provided with MMJ from the same organically-grown source each time. Researchers identified 4 strains that patients reported as managing their symptoms best, and discovered that 3 of the 4 had significant similarities in chemotype, terpene profiles included.
For patients looking to treat GAD and similar disorders with something they can use as-needed or daily without experiencing debilitating withdrawal symptoms, marijuana,and CBD oil for anxiety have been found safe, effective, and reliable even over long-term use. For the best results though, it’s good to know your body and medical history as well as possible. If you live in a legal state, bud tenders at any dispensary are trained and knowledgeable to help you out. If not, the resources above are a great jumping-off point.