Over 40 million Americans have an anxiety disorder, making it the most common mood disorder in the country. “Anxiety disorder” is an umbrella term encompassing numerous anxiety-related disorders, including generalized anxiety disorder (GAD), panic disorder, and sometimes post-traumatic stress disorder (PTSD). Anxiety may also be a symptom of another condition, like depression, chronic pain, or a thyroid disorder.
Whether a symptom of another ailment or a standalone disorder, anxiety is one of many conditions that may be effectively treated with medical cannabis. Cannabis flower and CBD-rich products with low-to-moderate THC levels are shown to be particularly useful at alleviating symptoms of anxiety, but more clinical research is needed.
Anxiety and panic disorder causes
Again, “anxiety” is a more general term for many different anxiety-related conditions. There are several subtypes of anxiety, including generalized anxiety disorder (GAD), social anxiety disorder (SAD), and obsessive-compulsive disorder (OCD). More and more mental health manuals now list post-traumatic stress disorder (PTSD) as a standalone disorder, whereas it was listed as an anxiety disorder in the past.
Panic disorder is an anxiety disorder where a person has sudden, acute attacks of panic or fear when there is no threat of danger. Panic disorder isn’t to be confused with phobias (an uncontrollable, irrational, and lasting fear of a particular object, situation, or activity), which also produce acute episodes of anxiety, but are not a feature of panic disorder.
Causes behind anxiety disorders are varied. The most common causes for anxiety are:
- Amygdala irregularities (the amygdala is the part of the brain that perceives fear, and those with anxiety disorders show above-average activity within the amygdala)
- Chemical imbalance (an imbalance of neurotransmitters like cortisol, serotonin, GABA, and dopamine, which affect mood, stress, and response to threat)
- Environmental factors, such as a response to a traumatic event, ongoing intense stress, or sudden life changes
- Genetic causes (those with a family history of anxiety may be more likely to develop anxiety themselves)
- Hormonal changes (changes in hormones like estrogen and progesterone can signal anxiety, and these changes are common in people with premenstrual syndrome as well as those experiencing menopause
- Nutritional deficiencies, as certain nutrients like vitamin B, vitamin D, and magnesium regulate nervous system function
- Underlying conditions that include anxiety as a symptom, like thyroid disorders, neurodegenerative disorders, and autoimmune disorders
Anxiety and panic disorder symptoms & health effects
Anxiety may present differently in each individual. For example, panic disorder is one type of anxiety disorder in which symptoms are usually intermittent and severe. Those with GAD, meanwhile, may feel a milder (yet sometimes equally debilitating) sense of uneasiness throughout each day.
Symptoms of anxiety include:
- Acute anxiety responses to specific triggers, which may or may not lead to avoidant behaviors related to those triggers
- An underlying feeling of dread, uneasiness, or worry
- Cold or sweaty hands and feet
- Digestive upset
- Dizziness
- Dry mouth
- Headache/migraine
- Hyperarousal
- Increased heart rate
- Lightheadedness
- “Pins and needles” sensations in the extremities
- Trouble concentrating
Anxiety/panic disorder diagnosis
Getting diagnosed can be the first step toward relief, as it can open the door to effective treatment. An anxiety or panic disorder diagnosis can only be provided by a psychiatrist or other type of doctor who specializes in mental health.
Because anxiety and panic disorder are mood disorders, they won’t show up in any lab tests. Instead, diagnoses are criteria-based, meaning that your healthcare provider will ask you a series of questions to confirm whether or not you have anxiety disorder or panic disorder.
A doctor may still wish to do a physical exam to rule out any underlying conditions in which anxiety may be a symptom.
Anxiety/panic disorder prognosis
Anxiety disorders, including panic disorder, are not inherently fatal. However, they may drastically reduce a person’s quality of life (QoL), and put a person at higher risk of addiction, self-harm, and suicide.
Anxiety/panic disorder treatments
Fortunately, anxiety disorders of all kinds are regarded as treatable. While anxiety may be a lifelong condition for many, there are various treatments that can help a person better manage their symptoms.
Depression is a very common comorbidity with anxiety, with up to 90% of patients with an anxiety disorder having comorbid depression and 85% of patients with depression having significant anxiety symptoms. Several treatments, such as use of antidepressants, are utilized for both conditions.
First-line treatments
Current treatment methods for anxiety and anxiety-related disorders include:
- Various modes of therapy, including cognitive-behavioral therapy (CBT), psychoanalysis and psychodynamic therapies, behavior therapy, humanistic therapy, and integrative or holistic therapy
- Exercise, improving diet and regulating sleep patterns
- Antidepressants, including SSRIs (selective serotonin reuptake inhibitors) such as escitalopram (Cipralex, Lexapro), paroxetine (Paxil, Seroxat), or sertraline (Zoloft); SNRIs (serotonin-norepinephrine reuptake inhibitors) such as desvenlafaxine (Pristiq), duloxetine (Cymbalta), levomilnacipran (Fetzima); and tricyclic antidepressants like amitriptyline (Elavil), doxepin (Sinequan, Quitaxon) and imipramine (Tofranil)
- Benzodiazepines, which have sedative effects
- Some people utilize herbal remedies such as chamomile, valerian root, and St. John’s Wort
Adjunctive therapy & alternative treatments
Some people opt for alternative forms of treatment for anxiety. Alternative anxiety treatments include mindfulness practices like yoga and meditation, which may help regulate nervous system response.
There’s growing interest in the use of psilocybin for anxiety disorders. The prominent psychoactive agent in “magic mushrooms,” psilocybin’s role in anxiety relief isn’t yet fully understood, but one theory is that it causes changes within the amygdala.
Cannabis for anxiety and panic disorder
Due to anxiety’s effect on serotonin receptors, selective serotonin reuptake inhibitors (SSRIs) are most often prescribed. In some instances, drugs such as valium, lorazepam, and others in the benzodiazepine class are used instead for their sedative effects. Sadly, these drugs can lead to addiction and many other adverse side effects. Moreover, for some forms of anxiety disorders (especially PTSD), benzodiazepines can make the condition worse.
Alternatives are sorely needed, and medical cannabis may be of particular use. Many cannabinoids and terpenoids, including THC, CBD, pinene, and limonene, have anxiolytic effects. However, too much THC may prompt an anxiety attack, so microdosing is critical.
Cannabis seems to be a potent anxiolytic, modulating anxiety-related behavior and neurotransmitter release in otherwise stressful situations. Medical cannabis may also help with anxiety-related health problems, such as chronic pain, insomnia, nausea/vomiting, irritable bowel syndrome (IBS), and headaches/migraine.
Again, when using cannabis to treat anxiety, proper dosage is key. Follow the guidance from your healthcare professional, and overall, consider a low-THC product or cultivar (strain). Alternatively, those seeking to avoid intoxication can opt for CBD-rich formulas, as CBD has been shown to be anxiolytic without being psychoactive.
Additional information for patients
There are a number of charities in the US that serve as valuable resources for those with anxiety and panic disorder. These include:
Anxiety/panic disorder FAQs
When does anxiety peak?
A person may experience anxiety at any age. However, most people who are clinically diagnosed with anxiety first start experiencing symptoms in their 20s.
If I experience anxiety, does that mean I have an anxiety disorder?
Not always. Experiencing the occasional episode of anxiety doesn’t necessarily mean a person has an anxiety disorder. Some people may experience a short period of anxiety due to an environmental factor, like the loss of a loved one, and once that factor is no longer present, they no longer feel anxiety.
Does anxiety get worse with age?
If anxiety is left untreated, it may or may not get worse with age, depending on factors like personal circumstances, brain chemistry, and lifestyle.
Resources
- New Insights into the Pivotal Role of the Amygdala in Inflammation-Related Depression and Anxiety Disorder: https://pmc.ncbi.nlm.nih.gov/articles/PMC9570160/
- Stress: Neurobiology, consequences, and management: https://pmc.ncbi.nlm.nih.gov/articles/PMC3697199/
- Benzodiazepines not recommended for patients with PTSD or recent trauma: https://www.wolterskluwer.com/en/news/benzodiazepines-not-recommended-for-patients-with-ptsd-or-recent-trauma
- Cannabidiol as a potential treatment for anxiety disorders: https://pmc.ncbi.nlm.nih.gov/articles/PMC4604171/
- The Comorbidity of Major Depression and Anxiety Disorders: Recognition and Management in Primary Care: https://pmc.ncbi.nlm.nih.gov/articles/PMC181193/
- Efficacy and Safety of Psychedelics in Treating Anxiety Disorders: https://pmc.ncbi.nlm.nih.gov/articles/PMC10741816/
- The effectiveness of inhaled Cannabis flower for the treatment of agitation/irritability, anxiety, and common stress: https://jcannabisresearch.biomedcentral.com/articles/10.1186/s42238-020-00051-z#Tab1
- THC, CBD, and Anxiety: A review of recent findings on the anxiolytic and anxiogenic effects of cannabis’ primary cannabinoids: https://pmc.ncbi.nlm.nih.gov/articles/PMC10722902/
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