Cannabis and You: Social Anxiety

Like conditions such as arthritis and cancer, social anxiety is a common illnesses in modern society. Also similar to these conditions, patients who suffer all forms of anxiety often find relief in cannabis medicine. The most challenging element of treating social anxiety with cannabis is finding the right strain and avoiding varieties that, ironically, cause additional stress or panic attacks.

According to Rochester, Minnesota-based Mayo Clinic, social anxiety disorder features the following “persistent” symptoms:

  • Fear of situations in which you may be judged.

  • Worrying about embarrassing or humiliating yourself.

  • Intense fear of interacting or talking with strangers.

  • Fear that others will notice that you look anxious.

  • Fear of physical symptoms that may cause you embarrassment, such as blushing, sweating, trembling or having a shaky voice.

  • Avoiding doing things or speaking to people out of fear of embarrassment.

  • Avoiding situations where you might be the center of attention.

  • Having anxiety in anticipation of a feared activity or event.

  • Enduring a social situation with intense fear or anxiety.

  • Spending time after a social situation analyzing your performance and identifying flaws in your interactions.

  • Expecting the worst possible consequences from a negative experience during a social situation.

Long History of Use

To the surprise of many modern-day patients, cannabis has been employed to treat psychological conditions such as social anxiety for centuries. In fact, it’s documented use specifically for anxiety extends back nearly half a millennium to 1563 when the herb was recommended by Garcia de Orta, a Portuguese physician and herbalist, in his book Colóquios Dos Simples e Drogas da India. The pioneering herbalist claimed that cannabis allowed anxiety sufferers to be “delivered from all worries and care.”

In 1621, English clergyman Robert Burton in his book The Anatomy of Melancholy suggested cannabis for the treatment of depression (something he dubbed a “chaos of melancholy”), a common symptom of anxiety disorders. Burton began preaching the efficacy of cannabis for depression after observing his Indian contemporaries doing the same. Interestingly, Burton also recommended satisfying socialization and exercise in the battle against depression.

In 1860, the Ohio State Medical Committee on Cannabis reported (while somewhat hauntingly also predicting the modern opioid epidemic): “As a calmative and hypnotic, in all forms of nervous inquietude and cerebral excitement, [cannabis] will be found an invaluable agent, as it produces none of those functional derangements that render many of the more customary remedies objectionable.”

Related anxiety disorders include Generalized Anxiety Disorder (GAD), panic disorder, and specific phobias (like agoraphobia and arachnophobia). While there is no single cure for social anxiety disorder, a variety of approaches have proven successful for a significant percentage of the patient population, including psychotherapy, medications, and techniques intended to reduce stress and increase relaxation (such as exercise, meditation, and yoga).

A Better Solution?

The appeal of cannabis for anxiety is amplified by the fact that commonly prescribed traditional pharmaceutical drugs often carry a risk of addiction and a slew of negative side effects. To assist patients with their own research, such drugs include Ativan (lorazepam), Prozac (fluoxetine), Valium (diazepam), Wellbutrin (bupropion), Xanax (alprazolam), and Zoloft (sertraline).

Despite the commonality of these drugs, many provide negative side effects that exceed the conditions they are prescribed to treat. These negative side effects include depression, hallucinations, insomnia, and even suicidal thoughts (especially in teen patients). Because cannabis typically delivers none of these unintended side effects and offers no opportunity for overdose, medical professionals and the patient community are seriously considering the natural herb and its constituent molecules in the treatment of all forms of anxiety.

Patient Testimonials

David Dean is a New Yorker who began suffering debilitating anxiety in his early 30s, shortly after moving to the congested city from smaller, less hectic areas of Colorado and Texas. In a 2017 article, Dean stressed the risks of using cannabis to treat extreme anxiety and provided direction for those considering the herb for their own relief.

“The key thing is to not dive in, but just dip a toe and see how the water feels. I would take one puff, then relax,” he wrote, adding, “The next night, maybe two puffs. I did it very gradually; as with starting any medication, I wanted to find the right amount that worked for me.” Dean stressed that his goal wasn’t to simply “get high.” “This wasn’t about getting stoned. It was about relaxing my mind and nerves,” he wrote.

“If you’ve never smoked [cannabis] before and are attempting to research how you’ll be affected once high, you are going to find no answers,” wrote anxiety patient Paul James for High Times in a 2017 article. “The only way to know is by inhaling the substance yourself and experiencing it first hand. However, with the knowledge that your biology and environment will determine [your specific] experience, you can set yourself up for a more relaxed attempt,” he wrote.

Like Dean, James recommends caution and careful experimentation on the part of anxiety patients seeking to use cannabis in their treatment regimen. “The best way to discover which strain is more likely to subside your anxiety is by doing your own research. Everyone reacts to marijuana differently,” he wrote. James recommended strains such as Granddaddy Purple, Jack Herer, and Strawberry Cough for fellow anxiety sufferers.

Doctor Testimonial

In his 2013 article for Psychology Today entitled “Medical Marijuana for Psychiatric Disorders,” Jeremy Spiegel, M.D., a psychiatry specialist with nearly a quarter century of experience, explained how he has seen the careful medical application of cannabis result in the successful treatment of conditions such as acute anxiety and depression within his own New York-based practice.

“Marijuana as a treatment has not been [widely] studied…due to political factors. Which, ridiculous as it sounds, is like a scientist shunning a particular chemical system in the body for reasons that have nothing to do with science,” wrote Spiegel in his groundbreaking article.

Spiegel stresses to his patients and colleagues the hit-or-miss nature of applying cannabis medicine in the treatment of difficult and extremely subjective conditions like anxiety and depression. “For some, medical marijuana is helpful, not curative,” he said, adding, “But others have been able to eliminate their dependence on other medications altogether.”

The Studies

A 2015 study entitled “Cannabidiol as a Potential Treatment for Anxiety Disorders” that was published in the journal Neurotherapeutics reported that “preclinical evidence strongly supports CBD as a treatment for generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive–compulsive disorder, and post-traumatic stress disorder when administered acutely.”

The study concluded that there is significant potential for the application of cannabis-derived molecules such as CBD for conditions like anxiety and depression. “Overall, current evidence indicates CBD has considerable potential as a treatment for multiple anxiety disorders, with need for further study of chronic and therapeutic effects in relevant clinical populations,” reported the researchers.

A 2012 study entitled “Cannabinoid-related Agents in the Treatment of Anxiety Disorders” and published in the journal Recent Patents on CNS Drug Discovery detailed many of the effects of a variety of cannabis-derived cannabinoids, including CBD and THC, in the modulation and treatment of emotions such as anxiety and fear.

“CBD is not psychotropic, but has nevertheless been shown to play a role in the modulation of behavioral effects of cannabis. In fact, the THC:CBD ratio is the main criterion to define different cannabis chemotypes,” reported the study’s researchers.

This research emphasized the subjectivity of patient responses to different strains and samples of cannabis medicine, providing guidance for both sufferers and their caretakers regarding the conditions leading to this extreme variance in an effort to improve treatment and titration (dosing) protocols.

“The high degree of inter-individual variability in the responses to cannabis is contributed by a wide spectrum of factors, including genetic and environmental determinants, as well as differences in the relative concentrations of THC and other alkaloids (such as [CBD]) within the plant itself,” concluded the study.

A 2011 study entitled “Neural Basis of Anxiolytic Effects of Cannabidiol (CBD) in Generalized Social Anxiety Disorder” and published in the British Journal of Psychopharmacology found that CBD increased cerebral blood flow in the areas of the brain that control emotion and acts in an anxiolytic (anti-anxiety) manner.

Concluded the study’s researchers, who utilized functional neuroimaging and administered 400 mg doses of CBD to participants of this human trials study, “Relative to placebo, CBD was associated with significantly decreased subjective anxiety. These results suggest that CBD reduces anxiety in SAD [Social Anxiety Disorder].”

A 2009 study entitled “Cannabis and Anxiety: A Critical Review of the Evidence” that was published in the journal Human Psychopharmacology: Clinical & Experimental found a correlation between cannabis use and social anxiety, but could not determine causation.

Reported the study, “Cannabis users consistently have a high prevalence of anxiety disorders and patients with anxiety disorders have relatively high rates of cannabis use. However, it is unclear if cannabis use increases the risk of developing long‐lasting anxiety disorders.” The study’s researchers concluded that “the precise relationship between cannabis use and anxiety has yet to be established.”