We are all now well into the quarantine period of the coronavirus, and everyone is either spending an exorbitant amount of time alone or in close proximity to their family. An argument can be made for either situation to be, shall we say, extremely challenging.
Mild anxiety, if not properly acknowledged and treated, can swell into an unmanageable condition that can create or exacerbate underlying symptoms of depression. It’s critical that symptoms of anxiety, or depression, are acknowledged and action is taken to help alleviate the feelings so they do not worsen over time.
Mild anxiety symptoms can often be quelled by some simple lifestyle changes such as vigorous exercise, a low sugar diet, reduced amounts of caffeine, and a consistent meditation practice. These changes can offer tremendous relief for many that suffer on a daily basis.
For more severe symptoms, or when lifestyle changes are not enough, patients often turn to substances to help alleviate the uncomfortable feelings.
With their low cost and ease of availability, nicotine and alcohol are many people’s first-line treatment for anxiety or depressive symptoms. Many teens learn to self-medicate with alcohol, often setting them up for a lifetime of struggles.
As we mature, and perhaps as the anxiety (or the treatment) becomes unmanageable, many people consider prescription medications as a way to help manage symptoms.
Anxiety disorders affect about forty million adults aged eighteen and older in the United States and are our most common mental health issue.
The empirical clinical approach to anxiety and mild depression involves medications that modulate neurotransmitters in the brain, specifically serotonin, norepinephrine, and dopamine. Medications work to increase neurotransmitter levels which can help to alleviate many symptoms.
Although drugs like Prozac, Zoloft, Wellbutrin and many, many more have become household names, thirty years after their inception the limitations of these medications have become apparent.
A recent article on InformedHealth.org compared how ineffective antidepressants were at treating symptoms in adults with moderate to severe depression. The results are compelling:
Without antidepressants, 20 to 40 people out of one hundred (20– 40%) who took a placebo noticed an improvement in their symptoms within six to eight weeks.
With antidepressants, 40 to 60 people out of one hundred (40–60%) who took an antidepressant noticed an improvement in their symptoms within six to eight weeks.
In other words, antidepressants improved symptoms in just twenty additional people out of one hundred (20%) when compared to a patient taking nothing (placebo).¹
The endocannabinoid system was discovered just a few years after the 1987 launch of Prozac. It has been linked to human functioning which includes blood pressure, sleep, pain modulation, gastrointestinal inflammation, and motility, as well as anxiety, depression, and fear.
Our own endocannabinoid, anandamide, is loosely translated to “bliss” or “joy” in Sanskrit, further evidence of the endocannabinoid system influencing our happiness.
Dr. Ethan Russo, the Director of Research and Development for the International Cannabis and Cannabinoids Institute (ICCI), presented the theory of clinical endocannabinoid deficiency (CED) in two scientific articles in 2001.
Personally, the idea of a lack of endogenous cannabinoids leading to either the development or the exacerbation of disease makes a lot of sense to me.
“The theory of CED was based on the concept that many brain disorders are associated with neurotransmitter deficiencies, affecting acetylcholine in Alzheimer’s disease, dopamine in parkinsonian syndromes, serotonin and norepinephrine in depression, and that a comparable deficiency in endocannabinoid levels might be manifest similarly in certain disorders that display predictable clinical features as sequelae of this deficiency.”²
Cannabis has endless anecdotal stories regarding its ability to alleviate PTSD supported by advanced imaging studies which demonstrated ECS hypofunction in post-traumatic stress disorder.¹ A biomarker called brain-derived neurotrophic factor (BDNF) has been shown to be depleted in patients with depression and was shown to be elevated in animals who were given CBD.³
For patients looking for relief from anxiety and/or depression symptoms, the most important thing to remember when beginning a medication is that it can (temporarily) make symptoms worse. Prescription medications warn of the dangers for an increased risk of suicide within the first weeks of beginning therapy, but an uptick in anxiety can also happen when cannabis is used excessively, specifically with the use of THC.
THC can help to reduce the amount of fear in patients that suffer from excessive fear, but the wrong strain (in this case a Sativa strain) or doses that are too strong can actually make symptoms worse.
When helping patients choose a product for anxiety, the ideal starting point begins with a relaxing (indica based) CBD product. Once a patient reaches a dose of 25mg to 50mg of CBD with no relief, they may consider adding small amounts of a relaxing, indica-based THC product.
I have witnessed many patients who previously did not experience anxiety, come into the dispensary complaining of anxiety (not during a viral pandemic either). The culprit can often be linked to excessive Sativa dosing that, when changed, alleviates symptoms quickly.
Being that high doses of THC can make anxiety worse, I have always recommended a ratio of anywhere from 5:1 to 2:1 CBD: THC in a relaxing indica-heavy product for patients to consider. The dosages should be kept low (only 1 or 2 puffs!!) and very slowly increased every 24 to 48 hours.
The goal is to balance the endocannabinoid system, not overstress it. If a CBD isolated product is not sufficient, moderate to high dose CBD with low levels of THC (indica-based!) can often do the trick.
I remember one patient I saw who arrived with her husband feeling incredibly guilty about how she was afraid of everything. She was aware of her irrational thinking but was unable to get a handle on it.
After just one puff of a 2:1 CBD: THC indica vape she felt like a new person. For some reason, her unreasonable fear was quelled and she was able to see through the insanity.
She actually did make an appointment for a second consultation because she was too afraid to increase her dose to two puffs on her own. I was able to instill a bit of confidence at her ability to determine her best dosage, reminded her of the safety of cannabis, and, according to her husband, she was a new person.
Will we one day be able to have a blood test that supports the theory that a lack of anandamide in people that exhibit excessive fear or depression is real?
Probably.
For now, we just keep moving forward by spreading the knowledge of cannabis so the people who need it will always have access to it.
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Higgins, Colleen, The Cannabis Prescription: How to Use Medical Marijuana to Reduce or Replace Pharmaceutical Medications, Sway Innovations. 2020
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Ethan B. Russo. “Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes.” Cannabis Cannabinoid Research. 2016; 1(1): 154–165.
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Higgins, Colleen, The Cannabis Prescription: How to Use Medical Marijuana to Reduce or Replace Pharmaceutical Medications, Sway Innovations. 2020