Everything We Know About Treating Anxiety With Weed
The state of weed science is often misrepresented.
Photo Illustration by Elizabeth Renstrom, Kitron Neuschatz, and Lia Kantrowitz
Weed can, for some, cause anxiety. This is one of the best-known bits of cannabis lore, and according to psychologist Susan Stoner (yes), who has reviewed the scientific literature on cannabis’s effects on mental health, it’s also one of the most commonly documented adverse effects of using pot or pot-based products.
At the same time, many in the cannabis community believe, weed can also help people to treat or manage their anxiety. Faith in this paradox is so widespread—and anxiety is such a common issue—that research psychologist Carrie Cuttler recently found “it was the number two reason medical cannabis patients reported using cannabis.
Is there research on weed and anxiety?
As with other common claims about weed’s purported benefits, though, most of the people who’ve researched cannabis and its components believe it’s too soon to say whether or not they can actually help with anxiety. “There is little research evidence on the effects of cannabis in treating anxiety,” Cuttler says, “or on the doses and strains that may be most beneficial.” Future research could nail down clear and effective weed-based treatments for at least some kinds of anxiety or some people, most of the researchers I consulted for this piece stressed; there are promising lines of inquiry in the works. But for now, anyone exploring weed or related products for anxiety management would be wise to take common wisdom on the subject with a grain of salt.
Common narratives hold that many weed-based anxiety stories stem from inexperienced users blindsided by the sensation of being high. More generally, though, the story goes that stressed brains often have cannabinoid shortages, so a little weed just evens things out. The relaxing effects of a good high can also help to cut down on the symptoms of a bout of acute stress.
Is a high CBD or THC strain better for anxiety?
Some people may feel anxious when smoking pot even as they gain experience because everyone reacts differently to it; these folks should just stay away from weed. But for everyone else, publications like High Times and Leafly regularly recommend particular strains they claim will help with various types of anxiety—often those heavier on soothing CBD than on high-inducing THC.
Existing research aligns with common wisdom and recommendations to a degree. We know, for instance, that THC and CBD—major components of weed—interact with systems in the brain that influence anxiety. THC can work on these systems to reduce anxiety in some people at low doses, but the risk of tripping over to anxious responses gets higher with higher doses.
A few studies, meanwhile, suggest that CBD has more general and reliable anti-anxiety effects. The mechanisms by which each of these substances affects anxiety remain a little murky. Still, this all seems to support the idea that “a higher ratio of THC to CBD is more likely to cause anxiety,” says Carl Stevenson, a neuroscientist who has researched the effects of compounds within cannabis on fear and anxiety, “while a lower ratio may have the opposite effect—relieving anxiety.”
However, research on cannabis and its effects on anxiety is entirely embryonic. Most of what we know is based on animal models, which neuroscientist and cannabis researcher Ryan McLaughlin stresses do not always translate well into humans. The few human studies that have been done, adds anxiety disorder researcher Michael van Amerigen, have been small and limited in their scope and methodologies. They have usually only explored healthy populations, not people with clear and defined anxiety disorders in clinical settings, and definitely not over long-term periods.
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How much does the type of anxiety you have matter?
“Anxiety is not a monolithic pathological entity,” says says James Giordano, professor of neurology and biochemistry at Georgetown University Medical Center. “There’s anxiety that’s acute versus chronic. There’s anxiety that has a more strongly traumatic aspect to it,” like PTSD. Different forms of anxiety may have slightly different neurochemical roots, leading to different cannabis-linked effects. Cannabis may also only affect some elements of anxiety rather than the whole condition; van Ameringen stresses, for instance, that while studies seem to show weed-based products may help people with PTSD sleep and avoid flashbacks, it may not help, and could even worsen, their overall conditions. On top of that, Stoner notes, every individual could have different reactions to cannabis and the compounds within it based on their genetics or even the cultural messaging they’ve internalized about how a given substance should affect them.
As of now, researchers do not know with any certainty what forms or aspects of anxiety THC or CBD might be able to help with in general or in specific populations. Nor do they know if these or other compounds might trigger anxiety or exacerbate anxiety disorders in certain populations.
The unknowns get even more extreme when we talk about whole plant cannabis versus specific compounds isolated from it. There are more than 100 other cannabinoids in the average pot leaf, McLaughlin notes, not to mention other potentially important compounds like terpenes. “We know almost nothing about these compounds,” he says. “We certainly do not know if any of the effects” cannabis users have reported over the years “are attributed to interactions between” them.
What kind of strain or weed products should I buy to help treat anxiety?
“All in all,” Stoner says, “it is practically pure speculation what any given strain or product might do to any particular person with regard to anxiety.” That’s especially true when one considers how unreliable the quality or contents of a given strain might be from store to store or batch to batch, and how many other elements might be in something sold as, say, a pure CBD supplement.
Current or prospective cannabis users interested in anxiety management don’t often hear about these nuances or limitations because so much information circulating in dispensaries and online is based on anecdotes or personal experiences. When cannabis resources engage with existing studies, Stoner argues, they often oversimplify and misrepresent them as well. Some resources and retailers do a good job of exercising caution and offering solid, nuanced advice, notes Giordano. But for potential customers it can be difficult to tell who those reliable brokers are.
Until the research advances to the point that we can speak more definitively about the intersections of cannabis, its constituent compounds, and anxiety—which could take quite some time given pot’s legal status, our current level of knowledge, and funding issues—most researchers recommend that people look elsewhere for help with their anxiety. Van Ameringen points out there are plenty of effective medications for anxiety. For those who don’t want to be dependent on pills, Cuttler adds that short-term cognitive behavioral therapy and similar treatments can be quite effective for managing many types of short- and long-term anxiety.
What should I do if I'm still going to take weed for anxiety?
For anyone who hasn’t had success with these treatments, or who is set on exploring weed for anxiety management, the researchers I’ve spoken to have a few pieces of advice: Given what we know thus far, they recommend using a high-CBD or CBD-only product—at least something with equal parts CBD and THC. McLaughlin notes that, so long as we lack definitive scientific evidence, anecdotal info about ideal strains can be useful, but should not be taken as gospel. Careful experimentation with different strains is a must. As with any new drug, Giordano recommends starting with a low dose and moving up slowly; Cuttler recommends methodically noting any changes in symptom and experience to get a sense of what’s working and what isn’t.
If you find something that does work for whatever type of anxiety you’re experiencing, that’s great. But Cuttler advises against relying on it as a long-term solution. The limited research we have suggests that people can develop tolerances to pot or related products’ useful effects, and may even develop negative side effects, perhaps even worsening their anxiety, over the long-term.
None of this is likely what those seeking relief from their anxiety through weed or a weed-based product want to hear. Unfortunately this is just the state of weed science right now: provisional at best and often misrepresented. Until that changes, it’s better to approach weed-based solutions with due caution.
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