Anxiety is a very common complaint amongst chronically ill patients and can have devastating effects on your quality of life.  Anxiety can negatively impact appetite, sleep, work, relations, and over  time contribute to worsening states of health.

What are the Different Forms of Anxiety?

Anxiety is defined as the emotional state characterized by maladaptive and excessive emotional responsiveness to potentially dangerous circumstances.

Current Classifications as per Diagnostic and Statistical Manual of Mental Disorders (DSM-IV):

• Generalized Anxiety Disorder (GAD) – Chronic anxiety
• Panic Disorder – Episodes of overwhelming anxiety
• Social Anxiety Disorder (SAD) – Extreme agitation in social situations
• Post-Traumatic Stress Disorder (PTSD) – Prior intense trauma resulting in flashbacks, avoidance and emotional numbing
• Obsessive-Compulsive Disorder (OCD) – recurrent, anxiety producing thoughts (obsessions) and patterns of behaviors (compulsions) to try to reduce the anxiety caused by the obsessions

Each of the different forms of anxiety can be modulated by your endocannabinoid system (ECS)

The Endocannabinoid System

Your brain and nervous system contains many receptors for what are known as cannabinoids, chemicals that have cannabis like effects. These receptors are part of what is known as the “endogenous cannabinoid system” (ECS). Your ECS is responsible for facilitating many functions in your body including eating, sleeping, relaxing, helping to eliminate painful memories, regulating pain, inflammation and immune system response, sleep-wake cycles, hormone balance, and much more.

There are two major types of cannabinoid receptors, CB1 and CB2:

• CB1 receptors are very abundant and are located throughout your nervous system. The CB1 receptors help modulate your mood, behavior, energy usage, heart function and sexual function, cognitive abilities, memory, perception, pain levels and muscle functioning.
• CB2 receptors are located mostly in your immune system and help regulate your immune response and inflammation. The binding of cannabinoids to their receptors stimulates your endogenous cannabinoid system (ECS) to do its job regulating many functions of your nervous system, immune system and hormonal system. CB1 activation, for example, reduces the effects of calcium and enhances the effects of potassium which then helps control the release of various “brain chemicals” like serotonin, gamma-aminobutyric acid (GABA), adrenaline, dopamine and many more.
• CB2 activation helps control your immune system and can reduce inflammation through numerous pathways that involve immune cells like neutrophils and macrophages and by reducing the production of proinflammatory chemicals known as cytokines.

Endocannabinoids

Endocannabinoids (or endogenous cannabinoids) are molecules found in the human body (and most animals as well) that affect your ECS (endocannabinoid system).  There are numerous endocannabinoids including:

• Anandamide –is chemically much different from THC but has been shown to bind to CB1 and CB2 receptors and shares many of the pharmacologic properties of THC.
• 2-arachidonoyl-glycerol –has more affinity for CB2 than CB1
• Palmitoyl-ethanolamide – more CB2 specific, capable of reducing inflammation and allergic responses
• Docosatetraenylethanolamide (DTEA) and Homo-gamma-linoenylethanolamide (HLEA) are similar to anandamide and affect mostly CB1 receptors
• Oleomide (also known as cis-9-octdecenoamide) –has actions similar to anandamide, but is thought to exert its effects independent of CB1 and CB2 receptors

Exogenous cannabinoids are substances that interact with your endocannabinoid receptors, but they originate outside your body. The cannabinoids found in marijuana, such as tetrahydrocannabinol (THC) and cannabidiol (CBD) have physiologic effects because of their effect on your cannabinoid receptors. 

How does Medical Marijuana Help Anxiety?

Cannabis has been used for its relaxing and mood-enhancing properties throughout history, dating as early as Chinese pharmacopoeia almost 5,000 years ago. Studies show that the psychological and behavioral effects of marijuana are mediated mostly by activation of CB1 receptors by THC. However, there are a wide range of effects possible, many of which are dose-dependent. Low to moderate doses of THC can induce relaxation, euphoria, heightened perception, creativity and increased comfort in social situations, whereas excessive doses can lead to paranoia, panic, agitation and even psychosis.

The role of CBD in anxiety disorders is somewhat less clear-cut. Some studies indicate that CBD may actually antagonize (block) CB1 receptors, perhaps reducing the effects of excessive THC produced stimulation. Other studies reveal that CBD may prolong the effects of THC by slowing down the metabolic breakdown of this psychoactive substance. Still other studies indicate that CBD may have anxiety reducing effects related to serotonin receptors.

Many new strains of cannabis are now being bred to have various levels of THC and CBD in order to take advantage of CBD’s therapeutic properties without causing the psychoactive effects of THC. Cannabis contains almost 500 different chemical compounds, including terpenoids, flavonoids, phytosterols and cannabinoids. The amount of THC, CBD and other cannabinoids in any specific cannabis plant is a result of the particular strain of cannabis, techniques of cultivation and soil and climate conditions. The psychoactive effects, fragrance, potency, and all of the various therapeutic effects of cannabis are dependent on the relative amounts of these several hundred compounds. Consequently, each variety of cannabis offers you a unique therapeutic and psychoactive experience and ambience. As a medical marijuana patient, it is crucial to speak to the professionals at approved alternative treatment centers (dispensaries) on suggested strains, record your responses after medicating, and discuss with your physician in order to receive the best treatment possible.

Have You Read The Medical Marijuana Series by Dr. Michael Rothman?

In the corresponding blogs of this series, we discuss the role of cannabis, cannabinoids, and the endocannabinoid system in the treatment of chronic pain, anxiety disorders, cancer, multiple sclerosis, and Crohn’s Disease.

• Introduction of Cannabis and its History of Use in Medicine
• The Role of Cannabis, Cannabinoids and the Endocannabinoid System in the Treatment of Chronic Pain
• The Role of Cannabis, Cannabinoids and the Endocannabinoid System in Disorders of your Immune System – such as Cancer and Autoimmune Diseases
• The Role of Cannabis, Cannabinoids and the Endocannabinoid System in Anxiety Disorders
• Pharmaceutically derived Cannabis Extracts Now FDA Approved – Good News or Bad News for Medical Marijuana Patients?
• Pharmaceutical Agents that Affect the Endocannabinoid System, Better than Natural Cannabis?

A full list of references can be found here.

If you’d like to learn more about the benefits of medical marijuana or if you’d like to enroll in the New Jersey Medical Marijuana Program, schedule a consultation by calling (732) 268-7663 or request an appointment online.