From the Guidelines
Medicinal cannabis is not recommended for anxiety management due to lack of evidence supporting its effectiveness for this condition. Research on medicinal cannabis and anxiety is limited, and current studies do not provide sufficient evidence to support its use for anxiety management 1. A 2023 systematic review assessed cannabis in relation to anxiety, depression, and insomnia, but none of the included studies addressed psychological symptoms as primary outcomes in adults with cancer 1. Additionally, a randomized controlled trial (RCT) published after the review found no significant difference in anxiety between patients treated with CBD oil and those receiving a placebo 1.
Key Considerations
- The current evidence does not support the use of medicinal cannabis for anxiety management
- CBD oil has been studied for its potential anxiolytic effects, but results are inconclusive and more research is needed
- Patients with anxiety should consider established treatments, such as therapy and medications, under the guidance of a healthcare provider
- If medicinal cannabis is considered, it should be used with caution and under close monitoring due to potential side effects and interactions with other medications
Treatment Approach
- Established treatments for anxiety, such as cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs), should be considered as first-line options
- Lifestyle modifications, such as regular exercise and stress management techniques, can also be beneficial for anxiety management
- Patients should work with healthcare providers to develop a comprehensive treatment plan that addresses their individual needs and circumstances.
From the Research
Medicinal Cannabis and Anxiety
- Medicinal cannabis is being used to treat anxiety disorders, with both Δ9-tetrahydrocannabinol (THC)-containing and cannabidiol (CBD)-dominant products being prescribed 2.
- Clinical trials and laboratory studies provide evidence of anxiolytic effects of CBD in healthy volunteers and clinical populations, although current evidence is insufficient to support CBD as a first-line treatment 2, 3.
- The evidence regarding the use of THC-dominant products for anxiety is ambiguous, with exacerbation of anxiety in some individuals and relief in others 2, 4.
CBD and Anxiety
- CBD has been shown to decrease social anxiety, producing an inverted U-shaped curve, with anxiety measurements being reduced at intermediate doses administered orally (300-600 mg), but not at lower or higher doses 5.
- CBD attenuates the anxiogenic effects of THC, and its effects on anxiety are associated with the modulation of fronto-limbic regions 5.
- CBD has a promising role as alternative therapy in the management of anxiety disorders, with improved clinical outcomes and minimal adverse effects 6.
THC and Anxiety
- THC can either reduce or increase social anxiety measurements, depending on the dose, with lower doses (6-7.5 mg) reducing anxiety and higher doses increasing it 5.
- THC can impair driving and cognitive function, and its use should be approached with caution, particularly in individuals with anxiety or psychotic disorders 2, 4.
Prescribing Medicinal Cannabis for Anxiety
- Medical practitioners should carefully consider potential risks and benefits when prescribing medicinal cannabis for anxiety disorders, and should 'start low and go slow' 2.
- Clinicians should be mindful of a range of prescriptive and occupational safety considerations, especially if initiating higher dose THC formulas 4.