Using Cannabis in the Treatment of Chronic Anxiety

When I first started exploring cannabis about 10 years ago, I immediately noticed that the plant had a significant positive effect on the feelings of anxiety and nervousness I regularly experienced due to daily stress and my personality type. Back then, I didn’t pay much attention to the strain, dosage, or cannabinoid composition of the product. The only thing I consistently noticed when smoking a joint was that cannabis provided a much stronger, deeper, and longer-lasting therapeutic effect on my anxiety than any available pharmaceutical medications.

Later, I began to notice certain patterns in my cannabis use, particularly the fact that different types of the plant and different dosages had dramatically different effects on my anxiety. Some strains worked great for relieving anxiety all day, while others, on the contrary, triggered paranoia and made my overall state worse. I also realized that consuming large amounts of cannabis, or using it in unfamiliar places with strangers, always had a more negative, anxiety-inducing, and paranoia-triggering effect.

After recognizing these factors, I started using cannabis more thoughtfully, preferring strains with balanced THC and CBD ratios and avoiding excessive consumption. I became more selective, choosing products with lower THC content and supplementing recreational cannabis use with CBD extracts and tinctures, which have a more targeted therapeutic effect on stress and anxiety attacks.

Of course, both the effects of cannabis on the body and mind and the manifestation of chronic anxiety are complex phenomena that are hard to categorize simply. Finding the ideal cannabinoid ratios and usage regimen for treating such conditions is an ongoing process, directly dependent on many ever-changing factors that require constant adjustment as one ages. Moreover, anxiety itself is not a one-size-fits-all experience: some people feel discomfort from work stress or sudden life changes, while others experience chronic depression or deep paranoia. Because of these differences, it’s difficult to offer a universal cannabinoid blend or “golden dosage” that would be effective in every situation.

This article will not only discuss the phenomenon of using cannabinoids to treat anxiety and nervousness but also explore different application methods depending on the symptoms and their severity. While these are general recommendations rather than precise instructions, they can serve as a starting point for anyone to experiment and find the product or combination with the most effective therapeutic effect on their anxiety.

Research on Cannabis for Anxiety and Nervous Disorders

Overall, medical experts agree that lower concentrations of cannabinoids are more likely to have a therapeutic effect on anxiety and stress without causing side effects that could worsen these symptoms. Although the ideal dosage varies from person to person, many cannabis medicine specialists universally recommend starting therapy with low concentrations of active compounds. This is especially true for psychoactive THC, which should be started at no more than 2.3 mg per serving. If the effect is insufficient, the dosage can be gradually increased by 1 mg or half a milligram until the optimal subjective effect is achieved.

No one disputes that cannabis is a relaxing substance for the mind. However, increasing the dosage or serving size can cause THC to have the opposite effect, leading to muscle tension, nausea, dizziness, and heightened anxiety, aggression, and paranoia. Scientists attribute this to the way endogenous cannabinoid receptors are activated. In small doses, THC produces a sedative effect, but above a certain threshold (which varies for each person), the receptors become overloaded, causing the opposite effect. Interestingly, the main therapeutic cannabinoid, CBD, works differently: in low doses, it has a mild sedative and tonic effect, but in higher doses, it becomes much more sedative and even sleep-inducing. Studies confirm that high doses of CBD have the strongest sedative and pain-relieving effects, sometimes even acting as a sleep aid.

This is due to the functioning of the body’s endocannabinoid system, a complex network of CB1 and CB2 receptors found throughout the body. CB1 receptors are closely linked to the central nervous system and are highly concentrated in the brain, while CB2 receptors are associated with the peripheral nervous system. These receptors interact with endogenous cannabinoids (2-AG and anandamide) to modulate and balance various biological systems and functions, including immune response, neural activity, and homeostasis. Many experts believe that deficiencies in this system can lead to various biological and neurological dysfunctions, which exogenous cannabinoids like THC and CBD can help correct.

The endocannabinoid system also directly affects psychological processes, including anxiety and stress, due to the close connection between CB receptors and brain regions responsible for emotional responses. Mechanisms that regulate anxiety are linked to the hippocampus, prefrontal cortex, and amygdala. At certain concentrations, exogenous cannabinoids slow down neural activity in these areas, reducing stress and negative emotions. However, higher doses can overload these regulatory mechanisms, leading to increased anxiety, aggression, and paranoia—even in people who did not previously experience these symptoms.

A recent study published in January 2020 demonstrated that the endocannabinoid 2-AG modulates connections between the amygdala and the cortex, weakening nerve impulses that trigger heightened alertness and aggression. Plant cannabinoids and their metabolites can similarly modulate other neural mechanisms, reducing or preventing stress responses in the mind and body.

It’s also worth noting that, in addition to cannabinoids, terpenes and flavonoids—volatile organic compounds found in cannabis—can have a significant relaxing effect. Compounds like limonene and linalool have mild sedative effects, and when combined with cannabinoids, they can synergistically enhance the therapeutic impact on anxiety and stress. Some experts even suggest that terpenes and flavonoids may have a stronger sedative effect than cannabinoids themselves, with cannabinoids amplifying their benefits.

Interactions Between Cannabinoids and Other Sedatives

Although there is little in-depth research on the interaction between pharmaceutical sedatives and cannabinoids, many therapeutic cannabis users report that their effects can overlap, sometimes leading to unexpected or negative results. Since cannabinoids can slow the metabolism of nutrients and psychoactive substances, it’s wise for those self-medicating with cannabis to be very cautious when mixing it with other medications.

Many users and their therapists consider SSRIs (selective serotonin reuptake inhibitors) to be in the “safe” group. This includes popular antidepressants like Prozac, Paxil, Celexa, Zoloft, Lexapro, and their generics. While some people report side effects when combining these with high doses of cannabinoids, such cases are relatively rare. Similarly, no significant negative interactions have been found between cannabis and NDRIs (selective norepinephrine and dopamine reuptake inhibitors) such as Wellbutrin, Aplenzin, and Forfivo.

However, a much wider range of sedatives are considered potentially risky, with more serious and dangerous interactions that can affect blood pressure and heart rate. These include:

• Strong sedatives (Xanax, Klonopin, Ambien, and their analogs)
• Tricyclic antidepressants (imipramine, amitriptyline, doxepin, trimipramine)
• MAOIs (monoamine oxidase inhibitors such as tranylcypromine, phenelzine, isocarboxazid)

In addition to obvious side effects, combining cannabinoids with even “safe” sedatives can mask the effects of the medication. For this reason, cannabinoids should only be introduced after a doctor has confirmed the effectiveness of other medications. Also, due to the physiological effects of cannabis, it’s recommended to avoid drugs that directly or indirectly affect the liver and kidneys, as slowed metabolism can greatly increase their toxicity, especially with repeated dosing.

Choosing Cannabis Strains for Anxiety: Therapeutic Recommendations

As mentioned earlier, the main factor in choosing a cannabis strain for anxiety or chronic nervousness is a higher CBD content or a balanced THC:CBD ratio. The optimal dosage will vary from person to person, so it’s best to start with strains low in THC and gradually increase the active dose (while also increasing CBD) until the desired effect is achieved. Once you find the ideal ratio, avoid further increasing the dosage to prevent side effects like overstimulation or excessive drowsiness.

The following strains have recently become popular among both therapeutic and recreational users who want to avoid overly stimulating effects. If possible, try these first as a reliable “base” for further experimentation:

• Harlequin
  Cannabinoid profile: Balanced THC and CBD
  Terpene profile: Myrcene, pinene, caryophyllene
  Harlequin is a popular therapeutic hybrid with high levels of both THC and CBD in roughly equal proportions, though often with a slight CBD dominance. This smooths out the intoxicating effects of THC and related side effects. The result is a long-lasting, mild euphoria that’s great for improving mood and managing anxiety. The high myrcene content, a terpene with strong sedative properties, also contributes to its calming effect.
• ACDC
  Cannabinoid profile: CBD-dominant
  Terpene profile: Myrcene, pinene, caryophyllene
  ACDC is an excellent strain for beginners. Thanks to its high CBD and low THC content, even large doses produce a mild calming and euphoric effect without significant intoxication or side effects. The combination of CBD and sedative terpenes provides relaxation while keeping the mind clear and focused, making it suitable for monotonous work or creative activities. It’s also ideal for calming nerves in stressful situations or after overconsumption of more stimulating cannabis types.
• Bubba Kush
  Cannabinoid profile: THC-dominant
  Terpene profile: Caryophyllene, limonene, myrcene
  Unlike ACDC, Bubba Kush is more of a recreational strain due to its high THC content and low CBD. However, its rich terpene and flavonoid profile, combined with THC, makes it a popular “relaxation strain” among experienced users. While its effects may be too intense for beginners or therapeutic users, seasoned smokers will appreciate its sedative impact and complex flavors, including notes of black pepper and fresh coffee beans.

Methods of Cannabis Consumption

Besides strain selection, the method of consumption also significantly affects the overall experience. The choice between whole flower, oil extracts, edibles, or other forms determines the speed of cannabinoid absorption and the strength and duration of effects.

All forms of cannabis consumption can be divided into three main groups:

• Inhalation methods: These involve heating (decarboxylating) the product, including smoking or vaporizing oils, extracts, or dried flower. The main advantage is rapid onset and ease of use, but it’s harder to dose accurately, and some active compounds are lost during heating. Effects are felt quickly but last only about 1.5–2 hours.
• Oral consumption: This includes edibles, drinks, capsules, and tinctures. Effects start much later (about 1–1.5 hours after ingestion, compared to 20 minutes for smoking), but the effects are much stronger and longer-lasting due to minimal loss of active compounds and direct absorption by the liver and kidneys.
• Topical and alternative methods: This includes topical oils, patches, sublingual sprays, and even suppositories. Topicals provide strong, long-lasting, and targeted effects, while sprays and suppositories act quickly and intensely due to rapid absorption into the bloodstream.

Regardless of the product type, always start with low doses. This is especially important with edibles and drinks, as even small miscalculations can lead to a prolonged and unpleasant “bad trip” due to THC overdose. Technically, CBD can also cause an overdose, but it usually manifests as sudden fatigue and, in some cases, stomach discomfort or nausea.

Recommendations for Cannabinoid Dosage

CBD Dosage

As mentioned, when starting cannabis therapy for anxiety and stress, choose products with equal or higher CBD content compared to THC. Beginners should look for products with isolated CBD or a significant CBD dominance. For extracts and edibles, a starting dose of 10 mg of CBD is recommended. After assessing the effect, adjust the dosage as needed. Alternatively, use pure CBD products (like hemp-derived oils) and adjust the dose to achieve the desired level of relaxation without lethargy.

THC Dosage

For THC, also start with 10 mg per serving (for edibles, extracts, or flower) and be cautious with tinctures and liquid extracts, as they are more purified and bioavailable. Products made from material with, say, 16% THC will yield extracts with about 80% pure THC. When using edibles, never consume the entire portion at once—start with a quarter, then increase after evaluating the effect.

Microdosing is also an option: use very small amounts (no more than 2.5 mg THC) throughout the day to achieve calming effects without intoxication. Many users and some experts report that even sub-psychoactive doses can have therapeutic and modulatory effects on the endocannabinoid system, including sedative benefits for the nervous system.

Original author: Bailey Run