Introduction

Cannabis sativa, also known as hemp, is a plant that is commonly used as a recreational drug. Its main compounds, tetrahydrocannabinol (THC) and cannabidiol (CBD), cause the users to feel relaxed, as well as experience mind-altering effects.¹

Due to these effects, there has been rising interest in using Cannabis cpmpounds as drug as it provides a way for people to relieve symptoms of anxiety. This article will go over current understandings of cannabis and its active compounds.

Cannabis compounds and their effects

Cannabis contains a wealth of compounds–chemicals with biological properties, such as terpenoids, flavonoids, and most notably, cannabinoids.¹

Endocannabinoid system (ECS)

Our neurones contain receptors, which can join with different chemicals to send signals across the brain and nervous system. Cannabinoids target cannabinoid receptors, making up the endocannabinoid system (ECS) across the body and brain. A vast majority of organs are affected by the ECS and it can stimulate pain, breathing, memory, movement, appetite, immunity, and metabolism.²

Primary cannabinoids:

The most notable cannabinoids are THC and CBD.

• THC is the main active compound of cannabis, causing psychoactive effects like hallucination
• CBD was isolated in 1963 and has no psychoactive effect but is associated with euphoria³

Research findings on cannabis for anxiety relief

Anxiety is an emotional response to threats in the environment. It can be useful in dangerous situations; however, when people feel anxious in the presence of non-threatening stimuli, it can be problamatic.

Overview of key studies

Research provides conflicting evidence for the use of cannabis as an anxiolytic (a drug that reduces anxiety). Some studies say that it is effective, but clinical trials have produced ambiguous results. 

Effects of CBD on anxiety

CBD has been shown to produce an anxiolytic effect on patients, specifically with disorders such as generalised anxiety disorder, social anxiety disorder, and anxiety implicated in post-traumatic stress disorder (PTSD). More research needs to be done in order to support the idea that it can do this across a general population.⁴ For example, CBD for separation anxiety may help animals, but this needs to be validated in humans.⁵

CBD seems to be well tolerated by patients. Some adverse effects that were reported include fatigue and sedation.⁶ Considerations into product purity, dosage, and legality need to be carried out before CBD can be used across a wider group of people for anxiety reduction. 

Effects of THC on anxiety

THC has produced mixed effects on anxiety, depending on the dosage. Larger doses of THC seem to induce anxiety rather than alleviate it. Some findings are inconsistent with this dose-dependent effect.⁷

More data suggests that THC’s ability to relieve anxiety is reduced in frequent cannabis users. THC, being the psychoactive compound of cannabis, has more side effects, altering the way people perceive reality and time. This can cause distress rather than relaxation in the user.⁸

Comparative findings

The combined effects of other plant compounds in cannabis compared to THC in isolation, may explain why regular cannabis users experience less reduction in anxiety.⁷ Cannabis overdoses can result in disrupted breathing as well as low blood pressure, amongst other severe symptoms, but are rarely fatal.⁹

How do cannabis compounds reduce anxiety?

CBD’s anti-anxiety mechanism

In relation to anxiety, CBD acts as a compound that is able to bind to serotonin receptors (a serotonin agonist), which can increase transmission. This is helpful for patients with anxiety because of its ability to regulate their emotional state through serotonin. 

Gamma amino-butyric acid (GABA) is another neurotransmitter that is dysregulated in anxiety; CBD is also able to act on receptors that control its signalling.¹⁰

THC’s role in stress and fear modulation

THC is the main compound that binds to cannabinoid receptors. A high density of cannabinoid receptors exists in areas of the brain such as the amygdala, which is implicated in fear responses.¹¹^,¹² 

At low dosages, it has been shown to help patients feel relieved in response to stressful stimuli, but at high concentrations, it has the opposite effect.¹³

Risks and limitations of cannabis

Despite some regions allowing cannabis to be used both recreationally and in a medical context, its use worldwide has been prohibited for reasons such as:¹⁴

• Potential adverse effects of THC, such as paranoia, psychosis and withdrawal with regular use 
• Challenges in dosage, making it hard to regulate the effects as THC and CBD concentrations vary within strains
• Research gaps, with limited human studies and standardisation, makes it hard to create accurate conclusions

Is cannabis safer than prescription anxiety medications?

There is ongoing discussion regarding the safety of cannabis in comparison to prescription anxiety medications like benzodiazepines and selective serotonin reuptake inhibitors (SSRIs). According to a survey of cannabis users, 13.6% of them had switched from prescription anxiolytics to cannabis, with medical cannabis users being 4.59 times more likely to do so than non-medical users. This suggests that some people believe cannabis to be a safer or better option. Nevertheless, the study does not definitively prove that cannabis is objectively safer. While research on cannabis is still in its early stages, prescription anxiety drugs are subjected to extensive clinical testing to determine their safety and efficacy.¹⁵

Future directions in research

Alternatives to cannabinoids from the plant have been synthesised, which can reduce the intoxicating effects that often follow the traditional use of the drug. To make more guided conclusions on whether cannabis and its compounds (both natural and synthetic) can be used for anxiety relief, more studies need to include larger sample sizes and placebo controls. This will ensure that we can be more sure that the results of the studies are due to the drug and not external factors such as baseline levels of anxiety. Long-term studies are also needed to observe any side effects that can occur with prolonged use. 

Additionally, as many different types of anxiety disorders exist, research into treating each kind must be done to avoid generalisation and to find out if there are differences in the ways in which these can be dealt with–for example, optimal dosages. 

Some studies on medical cannabis have been carried out on animals, which means that the results cannot be directly applied to humans as we have different biology. 

It may be of interest to study whether cannabis compounds can be used alongside other existing treatments for anxiety, such as cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs). 

Since anxiety and its effects can be caused by a stressful environment, it might be worth combining CBT with anxiolytics in order to maximise the effect for patients who need it. Drug treatments like SSRIs and cannabis only provide temporary relief for individuals with anxiety and may not help them to focus on the root cause of their disorders.

Summary

There is some evidence to suggest that CBD and THC, the main active compounds of cannabis, can be linked to anxiety relief. However, there is currently little knowledge available on the long-term effects on users.

With more research, healthcare providers can make more informed decisions about whether cannabis is a suitable medication for anxiety. Dosage and administration methods must be optimised to reduce the risk of adverse effects for users. As of now, SSRIs are the main drug treatment in the UK for treating generalised anxiety disorder. 

Using drugs to treat anxiety only provides a short-term solution. To ensure patients can take control of their mental health, it may be more suitable to prescribe CBT to individuals with anxiety disorders in a more holistic approach that targets the root cause.

FAQs

Can cannabis worsen anxiety instead of relieving it?

Yes, cannabis can occasionally make anxiety worse, especially when used in large quantities. Some people may experience increased paranoia, fear, or anxiety due to THC.¹⁶

How long does cannabis-induced anxiety last?

Usually lasting several hours, with an average of 6.1 hours and a range of 2.3 to 12.5 hours, cannabis-induced anxiety can include panic attacks, aggression, or hallucinations in severe cases.¹⁷