Cannabis and anxiety

THC's effects are biphasic for anxiety—is your current dose helping or hurting?

I anticipated being totally emotionally overwhelmed by going back to work after maternity leave, and, of course, I am. There are just simple biological truths about having babies, and one of them is that mother and baby are inextricably physically linked long after birth. We have cells in each others’ bodies and stuff. It’s why when I look at him I actually want to eat him sometimes. This means that—even though I need to work and I LIKE to work, and it’s okay that I do!!!—I am totally losing my mind and wracked with guilt over doing so. I am grateful I have cannabis in my life again to help ride the waves of anxiety.

I didn’t have that option while I was pregnant and that was hard for me. I weathered a broken ankle, gestational diabetes, and perinatal anxiety and depression in anticipation of giving birth without any of my usual tips and tricks (nor painkillers for the injury) while working 40+ hours a week putting out a monthly magazine. I’m proud of myself, and I had a lot of support, but to be completely honest, it sucked. I’m much happier being on this side of things, even if I’m struggling with anxiety still. I know this is all natural and, truth be told, I’m even grateful I get to experience it for the perspective it will give me.

Now, I’m writing all of this while considering my present cannabis use and contrasting it with how I used to smoke before having a baby. I wrote about that at length right before giving birth, and it was really well received. It turns out that many people in the cannabis world, and tons of people not in the industry or culture, too, are also wondering about how to evaluate their cannabis use.

For me, the ongoing question is whether the amount of cannabis I’m currently using is helping or hurting my anxiety. I am also not alone in pairing the two. This study claims 50% of medical marijuana patients use cannabis for anxiety. I have had depressive episodes before, but they have been tied to life adjustments—pregnancy, divorce, career changes. Personally, that is not a daily management issue for me. My problem is anxiety. Whatever brain I was graced with gave me the ability to think, yes, which has turned out to be a blessing and a curse. Basically, I’m like a Seinfeld character IRL.

Anxiety is a tricky one for cannabis users. That’s because THC is biphasic for anxiety, which means that at low doses it’s anxiolytic (anti-anxiety), and at higher doses, it’s anxiogenic or panicogenic, meaning it induces anxious feelings. There are studies that back this up. CBD at all doses is shown to be anxiolytic.

Pulling from an interview I did with cannabis research scientist Emma Chasen a few years ago, she had this to say about why people feel anxious when using cannabis:

“A few things happen physiologically that cause us to feel anxious when smoking weed. They’re all seemingly caused by THC,” Chasen says, referring to the compound in cannabis that gets people high.

This anxiety response is related to THC use, though it is largely dose-dependent and it doesn’t necessarily happen in all people. “THC interacts with areas of our brains that are responsible for both euphoria and anxiety. When we consume too much THC,” Chasen says, noting that the dose at which this occurs will be different for everyone, “the brain quickly switches from happy-go-lucky to imminent threat level danger.”

I have also had several medical doctors and researchers tell me that it’s also possible that feelings of mental discomfort come from THC-induced changes in perception, not necessarily inherent anxiety. For example, some people feel a loss of control, which they perceive as negative or dangerous. Their heart rate increases, breathing patterns change, maybe there’s a sense of dread or doom.

In other words, a lot of this anxiety has to do with physical changes caused by THC intake and the brain’s sometimes confused and hyperactive responses to them. THC is a vasodilator, which means it opens up blood vessels and allows blood to move throughout the body more quickly, increasing the heart rate. This increased heart rate, alone, can lead some to feel like they’re losing control, heightening the mind-body connection.

After the brain determines a threat via the amygdala, that signal gets sent to the hippocampus and the prefrontal cortex. The hippocampus gives context to anxiety and the prefrontal cortex will decide what to do about it.

“These areas of the brain often act as safeguards against THC-related anxiety because they can logically assess that there is no real threat and therefore suppress the anxiety. However, at some dose of THC, the hippocampus and prefrontal cortex will decide that there is danger and start panicking. This is most likely due to the suppression of GABA, a neurotransmitter in the brain. And this is when you will start to feel anxious,” Chasen explains.

Additionally, cannabis does not appear to offer the same longer-term effects as other anxiety treatments do, which means its more of a band-aid or immediate-term relief strategy. That doesn’t make it unimportant, but it means that its likely better utilized as part of a larger toolkit for longer-term symptom management. To me, that also means its effectiveness is extremely subjective.

Knowing this, I’m not 100% sure where my use fits in. I know for certain that I use cannabis with the intention of managing daily anxiety symptoms, but I’m not sure if I’m feeding the beast or helping my nerves in the end. So-called “self-medicating” is tricky that way, in that sometimes the immediate relief offered by something can reinforce its use, even if underneath it’s actually exacerbating long-term symptoms. That’s why I’m (surprise, surprise) worried.

How do you know if you’re masking and just getting by, or if you’re truly healing? What if weed isn’t making me less anxious, it’s just making me too distracted and tired to care? One 2017 study found “blunt stress reactivity in chronic cannabis users.” (I assume no puns intended but, come on, blunt stress reactivity in chronic cannabis users?) Another 2017 study found that higher doses of THC typically resulted in increased negative moods. This study noted that “epidemiological studies tend to support an anxiolytic effect from the consumption of either  CBD or THC, as well as whole plant cannabis. Conversely, the available human clinical studies demonstrate a common anxiogenic response to THC (especially at higher doses).” And, of course, there are a variety of hotly debated studies showing that THC use increases the likelihood of developing anxiety and depression, especially in the adolescent brain. (Though, this teen study said there was “no evidence of an amplified vulnerability to cannabis-related increases in subclinical depression, anxiety or psychotic-like symptoms in adolescence” with serious cannabis use).

Anyway, I welcome feedback from others on how they identify this line here in the comments or in the Substack app. Down the road, I’d also like to look into cannabis, depression and anxiety, and the postpartum brain. I’m looking forward to hearing what everyone thinks about weed and anxiety, particularly anxiety management.

---

Out of all the experiences I’m having coming back to my pre-baby life, one of the best so far was sending out Cannabitch last week. After five years (two as a print column, three as a newsletter!), it feels like coming home. Thanks for the warm welcome back, as well as a few new subscribers, too! Can’t wait to tell this kid what his dear, old mom does for a living. Hopefully, he will think it’s cool and won’t be too embarrassed.

One programming note: I’m completely open to feedback on this, but something that will help me publish more often over not is switching the format a bit to include more breezy essays and first-person narratives, as well as guest pieces from other writers, rather than just reported stories. Are people interested in this? I always report when I can, and even my essays always tend to have a bit of reporting (I’d say this one is a pretty good example), but the truth is I’m noticing people like my breezier posts, too, and I’m thinking this could be a good production solution. I want to make sure people are getting what they want and expect, too! I promise to never send out anything too rant-y or half-baked. No pun intended. Until the end of time.