Chronic Anxiety

By Sports and Health Editor

Colin Anders* presses the speckled glass bong to his lips. He flicks his lighter and holds it to the base, igniting the packed slider overflowing with green crumbly weed, and slowly inhales. Crippling anxiety feels much more tolerable when stoned, he reasons.

And then it hits.

Black spots slowly cloud his vision. His heart begins pounding out of his chest and his body shakes uncontrollably as he loses the ability to breathe.

He sprints to the bathroom, runs the water, stares at his reflection in the mirror and takes a deep breath. Another anxiety attack has passed.

“Nothing felt real. Everything felt like it was a dream,” Anders said. “In my head, at the time, I had actually [made] peace with death. I’ve had to go through the mental strain of feeling [as if] I was facing death or thinking I was going to die many times.”

Although he occasionally uses marijuana to calm his chronic anxiety attacks, Anders said it often produces the opposite effect.

The Mayo Clinic defines anxiety as an excessive and persistent worry about everyday situations. Most often, anxiety disorders involve repeated episodes of intense panic that peak within minutes. Anxiety disorders affect an estimated 40 million adults in the U.S.—18.1 percent of the adult population, many of whom have complex anxiety disorders such as obsessive compulsive disorder or fear of social situations, according to the National Institute of Mental Health. And the trend is on the rise. An increasing number of Americans are diagnosed with generalized anxiety disorder every year, prompting doctors to seek alternative treatments to calm their anxious patients’ symptoms.

According to the Anxiety and Depression Association of America, the primary treatments for anxiety are cognitive-behavioral therapy, prescription medications or a combination of both. Cognitive-behavioral therapy is associated with a range of techniques that help patients recognize anxiety triggers and increase their control and endurance over time. Four classes of drugs are used to treat anxiety disorders: selective serotonin reuptake inhibitors such as Prozac and Lexapro; serotonin-norepinephrine reuptake inhibitors such as Effexor and Cymbalta; benzodiazepines such as Xanax and Valium; and tricyclic antidepressants such as Norpramin and Anafranil. They have a range of side effects, some mild, others more serious—including addiction.

Anders said he had his first spiraling panic attack in 2012 on his 20th birthday.

“My family was coming down to meet me for dinner, [but] as soon as they showed up, I started blacking out and couldn’t see anything,” Anders said. “I was freaking out, [I] didn’t know what was happening because it was a feeling I had never felt before. So I spent my entire birthday dinner just walking around the block just to calm myself down.”

Anders said he once thought anxiety only affected him mentally, but he has learned it has physiological effects as well.

“I can’t control my body,” Anders said. “It gets very weak and very dizzy. My heart beats really fast [and] the main thing I have to do is control my breathing … sometimes I can get it under control pretty quickly. Other times I can’t get it under control and I need to be alone immediately and I need to breathe, just calm myself.”

To better treat the complexity of anxiety disorders, researchers are now looking to medical marijuana as a more efficient form of treatment than cognitive therapy or pharmaceuticals. However, the results are mixed.

In a study published March 5 in the journal Neuron, researchers at Vanderbilt University analyzed how cannabis- and cannabinoid-related neurochemicals affect a person’s mood and anxiety level. The study found that when the brain’s cannabinoid receptors are activated—which are involved in physiological processes including appetite, pain-sensation, mood and memory—anxiety level and accompanying symptoms, such as shortness of breath and chest pain, are reduced.

The primary chemical in cannabis is tetrahydrocannabinol, or THC, which binds to the cannabinoid receptors in the brain. Under certain circumstances, activating this particular receptor causes a reduction in feelings of anxiety and depression, according to Sachin Patel, assistant professor of psychiatry and molecular physiology at Vanderbilt University.

“When studies ask large-scale chronic marijuana users what they’re using it for, the most common reason given is people find it reduces anxiety and causes tension relief much more so than euphoria and getting high,” Patel said.

As an alternative to smoking marijuana to produce the cannabinoid reaction, Patel said he and his team are working to develop an anti-anxiety drug that would have the same effect. The team has called the general class of these drug compounds endocannabinoid hydrolysis inhibitors, Patel said.

Philip Kendall, Laura H. Carnell professor of psychology and director of the Child and Adolescents Anxiety Disorders Clinic at Temple University in Philadelphia, said that while some people may feel relaxed and calm after smoking marijuana, others become hyperactive, and overly sensitive, which will increase their anxiety levels. Kendall said he would be hesitant to prescribe medical marijuana to a patient to treat anxiety disorders, but he would not necessarily eliminate it as an option.

Anders said he quit smoking marijuana after he was diagnosed with chronic anxiety because he could not predict whether the drug would cause him to suffer anxiety attacks. To treat his condition, Anders said he was put on Lexapro and Klonopin, which treat panic disorders and anxiety.

When he first began smoking marijuana during his senior year of high school, Anders, who studies visual communication at Loyola University Chicago, said it made him feel calmer, helped lower his stress levels and allowed him to be creative. After being diagnosed with chronic anxiety, Anders said his doctor recommended he stop smoking.

Christine Strong, clinical physician at the Cannabis Patient Evaluation Center in Tempe, Ariz., said she was originally indifferent to prescribing medical marijuana to treat anxiety, but after many of her patients admitted to using cannabis illegally to self-medicate, Strong said she realized the drug could help them cope with symptoms such as emotional pain and insomnia.

“Anxiety is a very debilitating condition and it’s not well understood,” Strong said. “Many of my patients who come in with this diagnosis talk about how they feel isolated, how their family members don’t really understand them, [how] they can’t eat—the myriad of symptoms associated with it … They just feel helpless.”

Anxiety disorders spur an interaction between people’s predisposed medical disorders and symptoms and their thoughts and actions, according to Michelle Newman, professor of psychology and psychiatry at Pennsylvania State University. Biochemicals are then activated in the brain, causing people to experience symptoms such as greater muscle tension and escalated heart rates, Newman said.

However, anxiety disorder treatments can provide inconsistent results.

“That’s one of the features of treatment outcome,” Kendall said. “It’s what works for whom; it’s often not one treatment works for everybody.”

Researchers are studying the biology of how cannabinoids can both reduce anxiety and produce negative effects that make anxiety worse, Patel said, adding that people need to be cautious about using medical marijuana to treat mental illnesses.

“That doesn’t mean that there may not necessarily be some use for them. It just means that the studies haven’t been done and need to be so that we can make sure if people are going to be safe,” Patel said.

Strong remains a firm advocate of medical weed and said an increasing number of young patients are coming to her with a heightened sense of anxiety, though she does not understand why anxiety would be on the rise. She said marijuana has become a miracle drug for her patients struggling with anxiety.

“I sit here day in and day out shocked at the stories of people getting their lives back,” Strong said. “It’s just an amazing drug. I have hundreds of patients who, without medication, have five debilitating migraine headaches a week. [After] one year taking a small dose [of marijuana] every night, they’re telling me they’re having one migraine every three months—less severe, shorter duration. It’s just so alarming to me that [cannabis has] such a stigma and yet it’s so beneficial to many people.”

Marijuana is currently classified as a Schedule I drug under the Controlled Substances Act, a classification that also applies to heroin and methamphetamine. However, Strong said that gives a false impression of the otherwise helpful drug.

“Heroin is a Schedule I drug, which means it has no use for human consumption and is very dangerous,” Strong said. “I don’t know how [marijuana] got that schedule [but] it’s a ridiculous platform. I’d rather call alcohol a Schedule I drug.”

Strong said pharmaceutical companies are hoping the government will implement regulations on medical marijuana so it can be acquired through a drugstore.

However, Patel said it is important to note that certain strains can also invite a host of other issues, including short-term memory loss and impaired motor skills.

Marijuana does not have a permanent effect on the body, said Lester Grinspoon, professor of psychiatry emeritus at Harvard Medical School, adding that people cannot overdose on marijuana and kill themselves.

“[Marijuana] is generally more useful and less toxic than the pharmaceutical product it is displacing,” Grinspoon said.

But Newman said she is skeptical about marijuana’s effectiveness. She said the issue with using chemicals as a form of treatment is that people do not develop the natural ability to cope with their anxiety as they do through cognitive behavioral therapy, which requires people to immerse themselves in the particular situation that causes anxiety and learn how to cope.

Although this confrontation often causes panic attacks, Kendall said overcoming a nerve-racking situation helps people acquire a sense of confidence and eventually a decrease in anxiety.

Cognitive behavioral therapies have been found effective for approximately two-thirds of participants, Kendall said.

“Using biochemicals is a way to take away the immediate emotion, but it doesn’t actually help the individual learn to cope,” Newman said.

Anders said anxiety and the way it can be treated is different from person to person.

“I think it’s personal for everybody, because I’ve met people with anxiety where marijuana very much helps them,” Anders said. “If I have chronic anxiety and the other person has chronic anxiety, both of us are completely different and we handle it in completely different ways. It interacts with our lives completely differently.”

For Anders, being stoned is a necessary comfort to ease all the worries of a darting, anxious mind. However, at the same time, it can be seen as a vice that further cripples Anders and makes him a victim of his own illness.

“I feel like I know the points where I have to stop smoking or slow down if it does start to affect my anxiety,” Anders said. “It just makes me calmer.”

*Name has been changed.