Anxiety and Cannabis: A Patient Guide

We have all had a case of the “nerves” at some time in our lives. We may even have experienced panic during times of crisis. For millions of Americans, however, feelings of anxiety and panic are a regular occurrence. According to the National Alliance on Mental Illness, over 40 million adult Americans suffer from anxiety disorder each year. That is close to 20 % of the U.S. population! What’s more, statistics estimate that an additional 10 to 40% of the population suffers from some form of anxiety disorder that has gone undiagnosed. The good news is that evidence proves that cannabis may often help. 

Are You Experiencing Anxiety? Here is How to Tell

Anxiety can occur for a variety of reasons. It can be associated with other conditions in the body, such as hormonal imbalance and cognitive issues like dementia or Alzheimer’s. There is even some research which links anxiety to autoimmune disease and leaky gut. Anxiety often has genetic components and may run in families. Whatever the cause, you know anxiety when you feel it. 

Some of the symptoms include: 

feelings of “dread,” irritability, and jumpiness
being on “high alert”
racing heartbeat
shortness of breath
tremors or twitches
shortness of breath 
upset stomach
frequent urination 
loose stool 

Researchers with the U.S. Department of Health and Human Services have also identified five main categories of anxiety: (1) 

Obsessive-Compulsive Disorder (OCD), where anxiety is coupled with repetitive behaviors or “compulsions,” such as (but not limited to) hand washing, cleaning, or counting things. 

Panic Disorder, characterized by periods of intense fear as well as physical symptoms such as heart palpitations and chest pain. Panic can often be mistaken for a heart attack. 

Social Phobia (Social Anxiety Disorder, or SAD), is a condition of anxiety and overwhelm around everyday social situations. 

Generalized Anxiety Disorder (GAD) is where a person is worried and tense in general, but there has been nothing to provoke it. A person who is experiencing GAD may have an overall feeling of dread about life in general.

Post-Traumatic Stress Disorder (PTSD/PTS) is a very common condition where any number of the above anxiety conditions can form after a traumatic event or crisis such as abuse in childhood, war experiences, natural disasters, or sexual assault.

How Does Cannabis Help with Anxiety?

The reason why cannabis (i.e., medical marijuana) is able to help with all forms of anxiety, including PTSD, centers around what this amazing plant does.  Plant cannabinoids assist the endocannabinoid system as well as the nervous system, the brain, and inflammatory levels in order to promote and maintain balance. No matter where anxiety starts, the biochemistry of the condition is pretty much the same for all people. 

Cannabis has been proven to affect the mechanisms within the body that can “turn on” neurotransmitters and key hormones responsible for the symptoms of anxiety, especially as it relates to adrenaline, epinephrine, norepinephrine, and cortisol. Cannabis can also help to regulate and calm the nervous system in general through providing support for the endocannabinoid system.

A 2008 study conducted at the University of British Columbia reflects dozens (if not hundreds) of similar studies which have found the endocannabinoid system to be a vital part of the endocrine system and stress-related mechanisms in both the body and the brain. Both of these systems play a major part in how anxiety manifests. (2) 

One of the ways that cannabis for anxiety can help downplay anxiety-producing chemicals is to help rebalance and upregulate chemicals in the body that connect with rest, relaxation, and healing.  These include the chemical messenger serotonin. A 2019 Canadian study found that cannabidiol (i.e., CBD) in particular can assist in the regulation of serotonin.(3) 

Not only is serotonin a chemical antidote for anxiety, the upregulation of this healing chemical also helps lessen the pain and inflammation that may be associated with this condition. 

A major study at Washington State University analyzed over 11,000 survey results. They found that 58% of those who suffered from anxiety and other stress-related symptoms found significant immediate relief with the use of high THC/high CBD cannabis. This is good news for those who suffer from panic attacks, which can be the most debilitating of all anxiety-related conditions. (4) 

Cannabis has also been shown to help with other conditions where anxiety plays a big role. For example, one of the key characteristics of people with Alzheimer’s Disease is “anxiety and agitation,” according to the Alzheimer’s Association. (5) 

A report published in The American Journal of Psychiatry found that as anxiety symptoms increase, levels of beta-amyloid proteins, key biomarkers for the disease, increase as well. (6) At the same time, an investigation done at the University of South Florida found that low dose THC helped to down regulate certain chemical factors related to beta-amyloid protein build up. According to the report authors, low dose THC did not imbalance levels of melatonin in the brain. Melatonin is a key chemical for the regulation of serotonin. (7) 

What Type of Cannabis is Good for Anxiety?

When it comes to what type of cannabis is best for anxiety, the question on most people’s mind is—will it be CBD, THC, or a little of both?

The answer to the question for you, of course, depends on your unique situation and constitution. That is why it is always best to work with a qualified physician or other specialist who has specific training in cannabis therapy.

The University of Washington study mentioned above presents very insightful findings regarding the types of cannabis that appear to be best for the ways anxiety may manifest. While low THC/high CBD strains helped the most with symptoms of depression, strains that were high in both THC and CBD seemed to work best for anxiety. 

They also found that this ratio was most effective in women. Although the study researchers did not say this, one can speculate that perhaps one of the reasons for this has to do with a woman’s unique hormonal system and how the endocannabinoid system plays into that. (8) 

Studies have also shown that THCV (tetrahydrocannabivarin, found in Sativa cannabis strains) can have both an anti-anxiety and an appetite-suppressing effect. (9) 

THCV can also help to prevent panic attacks and can be especially beneficial for people with PTSD, according to research. THCV is a close cousin to THC and is found in just a few strains, including Pineapple Purps, Girl Scout Cookies, and Jack Herer. 

Other cannabinoids to look at that are also beneficial in treating anxiety are CBN, CBG, CBDA and THCA.

What About CBD for Anxiety? 

On the other hand, all forms of high-THC cannabis strains are going to produce some amount of psychoactive effect (even when these strains are taken in small doses). If you want to completely avoid this, don’t worry. Studies have shown that CBD-only dosing forms can help with anxiety as well! 

A 2015 meta-analysis conducted by the New York University School of Medicine and the Miguel Hernández University and Higher Council for Scientific Research in Spain found that specific doses of CBD proved very effective for helping with all types of anxiety disorder, including GAD, OCD, and PTSD. (10) 

While CBD may not be able to help in the immediate onset of a panic attack like THC can, it can be amazingly effective for easing one out of the pattern of anxiety over the long term. CBD-only products can help you find a centered internal space on a day-to-day basis. With this effect on your sympathetic nervous system as well as on serotonin production, CBD alone as an oil or tincture can “retrain your brain” and body to perform anxiety-free living every day! 

Consider Terpenes When Choosing Cannabis for Anxiety

Besides THC and CBD, studies and anecdotal evidence suggest that particular terpene levels and types found in certain cannabis strains can help best with anxiety. Terpenes are chemical esters and phytonutrients responsible for certain aromas in plants. For example, limonene is the main terpene found in citrus fruit which gives these fruits their unique aroma and flavor. Terpenes can also provide antioxidant protection, especially for the brain since molecularly they are small enough to bypass the blood-brain barrier. 

The main terpenes found in cannabis that can help the most with anxiety are myrcene, pinene, and caryophyllene.

Does Cannabis Cause Anxiety?

Do you recall the studies, mentioned above, that point to the serotonin recovery and boosting effects of marijuana and CBD? This effect is absolutely true and verified by science. However, too much of a good thing also applies here!

Evidence-based research has shown that low doses of medical marijuana can boost serotonin levels. However, high levels of THC in particular can actually lead to “serotonin syndrome,” or a major depletion of serotonin.(11) 

One of the key symptoms of cannabis-related serotonin syndrome is anxiety. This is why, if you are using CBD and/or medical cannabis for anxiety or depression, it is absolutely vital that you find the right amount, dosing method, and strain type for you. We will be discussing these factors next.

How To Use Cannabis for Anxiety

The specific methods for administering a dose medical cannabis or CBD include: 

smoking or vaping
an edible, such as in a brownie or cupcake 
in a gelatinous substance, such as a gummy
in capsule form
as a tincture 
applying to the skin transdermally in a patch or as a lotion

In whatever form you choose to use medical cannabis, know that the best way to gain the desired effect is to utilize a product where the added full-spectrum plant or the extracted CBD/THC has been decarboxylated first. This is the process of applying high heat in a specific way so that the healing effects of both THC and CBD can be experienced.  For example, if you were to simply eat cannabis leaves or steep the leaves in a tea it would not have the same effects as consuming cannabis after decarbonization. (12) 

According to many research studies, the most utilized form of CBD-only product for anxiety is as an extract in a tincture. Most CBD tinctures are mixed with a supplement-grade oil and are administered via the mouth. 

When it comes to THC-based dosing mechanisms for anxiety, the research is fairly clear that vaping or smoking produces the most desired effect. This is because, for most people who use THC for anxiety, they are wanting to receive fast results in order to thwart a panic attack. 

If you live in a state, such as Utah, where smoking and vaping is illegal and you want to utilize THC-based medical cannabis for panic attacks, then the next best administration option (i.e. the option that would provide the fastest effect) would be transdermal patches, sublingual modalities, or rectal suppositories. (13) 

How Much Cannabis to Take for Anxiety

If you are using medical marijuana or straight CBD for anxiety for the first time, remember to go slow and be very observant about how your body and mind react to the strain/type (THC, CBD, or both), dosing method (gummy, tincture, vape, etc.), and the overall amount you are using. This applies to both THC and CBD, since for some people adverse effects can happen with too much CBD as well. 

Find Your M.E.D. For Dosing 

For new users, it is also important that you discover your own M.E.D., or Minimum Effective Dose, for both CBD and THC. 

The way you can find your M.E.D. is to start with a very small dose at first. Cannabis medical professionals often recommend that for THC, this may be 2.5 mg if you think you may be very sensitive or if you have a petite body type. You can start with 5 mg THC if you think you would not be sensitive or you have a larger body frame. Then monitor your reactions over the next fifteen to thirty minutes if you are using smoke or vape or over the next couple hours if you are using an edible or a tincture.  Again, cannabis medical professionals recommend that for CBD, start out with 5 mg or 10 mg, respectfully. Remember that smoked cannabis will go through the bloodstream almost immediately while any edible has to be moved through the digestive system so it will take longer to get into the bloodstream. 

Once you have achieved the desired effect, you have found your M.E.D.! Write that amount down to reflect upon the next time you use medical cannabis or CBD.

Does Cannabis Interact with Anti-Anxiety Medication?

More research definitely needs to be done on how THC and CBD interact with common prescription and non-prescription drugs in general. When it comes to anxiety, the most common prescription drugs most people use to counter symptoms and keep panic attacks at bay are Prozac, Lexapro, and Zoloft (as well as generic brands that mimic these major brands).

In general, most doctors recommend not mixing THC-based medical cannabis with any kind of prescription drug. For one thing, the studies are just not there as to how doing so may affect the body when used with most pharmaceuticals. The other reason is because if you use both medical cannabis and a prescription drug at the same time, it will be hard to tell what effect either is having on the body individually. 

Interestingly, a review conducted by the University of Connecticut hypothesized that one potential reason why there has not been that many studies done on cannabis-prescription drug interactions is because negative interaction rates between cannabis and the kinds of psychotropic medications used for anxiety (mostly a class of drugs called Selective serotonin reuptake inhibitors, or SSRIs) is actually relatively low. (14) 

In terms of CBD-only products, evidence does suggest that regularly taking these products may speed up the effects of SSRIs as well as of “tricyclic antidepressants, antipsychotics, beta blockers and opioids,” according to a report put out by the District of Columbia Department of Health. (15) 

All that being said, if you are on a prescription SSRIs and want to give THC-based cannabis or CBD-only products a try, start out slowly and monitor the effects. Connect with a professional in cannabis therapy who can help and guide you. Finally, understand that as you utilize cannabis in any form for any condition, you may have to adjust (and possibly reduce) your intake of prescription drugs along the way. 

Feeling Anxious? Cannabis Can Help! 

Anxiety and fear are just a part of life for us humans. In a healthy individual, we take these emotions in stride and learn to move in and out of them in a healthy way. For an increasing number of people in our stressed-out, uncertain world, however, General Anxiety Disorder, PTSD, OCD, and panic attacks are a debilitating part of everyday life. 

If this describes you, then you may benefit from THC, CBD, or a mixture of both.

The first step in determining what is right for you is to consult with a professional who has training in cannabis therapy. It is important that you know your options and having a knowledgeable advocate at your side is just a wise step. 

Then decide if CBD-only, THC-focused, or a mixture of the two is right for you as well as the best modality for your specific needs (and based on the regulations of the state that you are living in). In all cases, make sure to start slow and observe your results to determine your unique M.E.D. level!

There is relief from anxiety and panic. And you can get there through cannabis by utilizing it in a responsible way tailored for your unique body and journey towards health! 



What are the five major types of anxiety disorders?

Regulation of endocannabinoid signaling by stress: implications for stress-related affective disorders  

Cannabidiol modulates serotonergic transmission and reverses both allodynia and anxiety-like behavior in a model of neuropathic pain

A naturalistic examination of the perceived effects of cannabis on negative affect

Anxiety and Agitation

Longitudinal Association of Amyloid Beta and Anxious-Depressive Symptoms in Cognitively Normal Older Adults

The Potential Therapeutic Effects of THC on Alzheimer’s Disease 

Endocannabinoid system dysfunction in mood and related disorders    

Symptom-relieving and neuroprotective effects of the phytocannabinoid Δ9-THCV in animal models of Parkinson’s disease. 

Cannabidiol as a Potential Treatment for Anxiety Disorders 

Serotonin Syndrome versus Cannabis Toxicity in the Emergency Department

Decarboxylation Study of Acidic Cannabinoids: A Novel Approach Using Ultra-High-Performance Supercritical Fluid Chromatography/Photodiode Array-Mass Spectrometry

Human Cannabinoid Pharmacokinetics

Psychotropic Medications and Substances of Abuse Interactions in Youth

Medical Cannabis: Adverse Effects and Drug Reactions 

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