Anxiety and Cannabinoid-based treatments

ANXIETY AND THE PANDEMIC

It would be difficult to deny the impact of the COVID-19 pandemic on anxiety and anxiety disorders in the population. Whether there are new anxiety symptoms or an exacerbation of existing ones, most of us know people who have been affected, if not ourselves.

Reasons for increased anxiety in 2020/2021?

Social isolation, monetary stress, sudden major changes, uncertainty about the future, sensation of losing control, fear of illness, etc. Some people have been in extremely close contact with COVID-19: people who have been infected, people who have lost loved ones or who have feared losing them, essential workers and, of course, healthcare professionals in many areas.

According to a survey by Statistics Canada and the Public Health Agency of Canada conducted between September and December 2020 and published in March 2021, 7 out of 10 Canadians have been negatively affected by the pandemic and 2 out of 5 have experienced distress related to it.

A survey was also conducted by the University of Sherbrooke on the psychosocial impacts of the pandemic:

“What we see today is that levels of depression and anxiety in Quebec are currently considerably higher than what was observed pre-pandemic. These numbers are similar to the levels observed in the community of Fort McMurray, 6 months after the 2016 forest fires” (Dr Mélissa Généreux, septembre 2020 – Link available in french)

WHAT IS ANXIETY?

Anxiety is an emotion characterized by feelings of tension, worry and physical changes such as increased blood pressure.

Although this emotion can be useful to us, it sometimes takes on magnitudes that have a negative impact on our ability to function, our quality of life and on our interpersonal relationships. It can even have a significant impact on our long-term health. The effects that anxiety and anxiety disorders can have on a person are real, undeniable and deserve our attention.

According to Anxiety Canada, there are 11 categories of anxiety disorders in adults: Agoraphobia, Separation Anxiety, Health Anxiety, Body-Centred Repetitive Behaviours, Specific Phobia, Generalized Anxiety Disorder, Compulsive Hoarding Disorder, Social Anxiety Disorder, Post-Traumatic Stress Disorder, Obsessive Compulsive Disorder and Panic Disorder.

In addition to considering the impact of anxiety on a person, specialists also evaluate 4 broad categories of symptoms and their frequency:

Physical responses
Thoughts
Emotions
Behaviors

If you think you may be suffering from anxiety, an anxiety disorder or any other psychological condition, it is important to talk to your doctor. You can also refer to several resources such as those offered by the Government of Canada on their website.

TREATMENTS AVAILABLE AT THIS TIME

Pharmaceutical Treatments: The main pharmaceutical treatments for anxiety are usually antidepressants. Benzodiazepines may also be prescribed for acute symptoms and/or until the therapeutic effects of the antidepressant are achieved, as antidepressants can take several weeks to have an impact on mood-related symptoms.
Psychotherapy: Several approaches in psychology are recommended for the management of anxiety, such as cognitive-behavioral therapy and psychodynamic therapy, and can be of great help.
Exercise: Experts agree that exercise has great benefits on anxiety. This is because physical activity activates the production of neurotransmitters in the brain. These neurotransmitters include those targeted by many antidepressants such as serotonin, which helps combat anxiety.
Mindfulness techniques: Often associated with meditation, mindfulness is an approach, an attitude as well as a set of techniques including meditation. Many of these techniques can also be practiced in everyday life, for example, while eating, walking or exercising. These techniques allow you to better understand and identify what triggers anxiety. They allow you to take a step back from these stressors and make it easier to manage them. Moreover, as this approach can be very beneficial both mentally and physically, we have recently partnered with MindSpace to offer opportunities for our patients to practice mindfulness techniques. If you are interested, you can join the mindfulness-based stress reduction program this coming fall. Our patients are eligible to 20% off. You can ask our clinic staff for the promo code!
Cannabinoids: The endocannabinoid system present in our body also plays a role in the mechanisms related to anxiety. This is why they are also used as an adjunctive therapy for anxiety symptoms.

A treatment that combines several options (e.g., pharmaceutical treatment and psychological therapy) is far more effective than each treatment option alone.

CANNABINOID-BASED TREATMENTS FOR ANXIETY

The human body has an endocannabinoid system that manages many functions, including emotional behavior. This system includes cannabinoids and enzymes produced by this system that bind to various receptors. Cannabis is a plant that includes more than 100 cannabinoids, the main ones being cannabidiol (CBD) and delta-9 tetrahydrocannabinol (THC). We also know that CBD interacts with many receptors/anxiety targets. Indeed, strong preclinical evidence supports the use of CBD as a short-term treatment for generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and post-traumatic disorder (Blessing et al., 2015). The promising effects demonstrated by CBD in the preclinical phase – certainly influencing the “CBD craze” – highlight the critical need for more clinical studies. We recently published an article on this craze, and you can read it here.

However, it is important to note that, for now, only limited evidence supports the use of medical cannabis for anxiety disorders (Walsh et al., 2015).

Nevertheless, Santé Cannabis has observed some success with medical cannabis for the treatment of anxiety. In addition, in reviewing our patient data, we have also seen positive results with medical cannabis in patients with unrelieved secondary symptoms of anxiety or depression (chronic pain being the most common primary condition) (Rapin et al., 2021).

The place of medical cannabis in the treatment of anxiety

On May 5th 2021, Santé Cannabis held a large-scale Conference on Cannabinoid-Based medicine focused on International Research and Innovation. As part of this event, Dr. Howard Mitnick presented a workshop exploring the question regarding the place of medical cannabis in the treatment of anxiety and managed to make this interactive workshop both amusing and incredibly insightful. He delivered powerful arguments starting with stating that cannabis isn’t the only field where evidence-based medicine and it’s usual hierarchy is a challenge. Obstetric and breast-feeding medicine are examples among others and for various reasons. In his clinical practice, particularly in 2016, when many veterans were coming back from Afghanistan, Dr. Mitnick said he was impressed by the very significant impact cannabis had on patients that were struggling with PTSD-related anxiety, grasping at anything to just stop their brain. He humorously pointed out that “if this talk was about what evidence there is supporting the use of medical cannabis on anxiety, it would be a very short talk.” The question then becomes, how can we, as clinicians and as a community, negotiate with this limited evidence, while clinicians see that medical cannabis helps many patients effectively manage their anxiety?

ANXIETY AT SANTÉ CANNABIS

As clinicians, we have seen first hand the improvement many patients are able to experience with medical cannabis treatment. However, we know that individual success stories are not enough to provide insight into how to prescribe this medicine on a large scale. Through the use of our real-world data, our clinic strives to provide better patient care by advancing science including data regarding the place of cannabis in the treatment of anxiety.

We also offer our patients support groups, presentations and tools including stress management and mindfulness.

The combination of formal training of healthcare professionals and high quality research is essential to increase the selection of anxiety treatments and provide the best care for patients.

Join us in working to develop the highest quality treatments for people with anxiety.

Santé Cannabis is committed to advancing knowledge about anxiety and cannabinoid-based treatments, and as such, we offer research services to companies and institutions interested in developing clinical studies.

For clinicians currently treating people with anxiety who wish to include medical cannabis in their practice, our preceptorships are available to all local and international physicians. For prescribers in Quebec, we also offer a free training program on cannabinoid-based treatments and how to prescribe them.

Author

Andrée Charbonneau, Nurse Coordinator

With thanks to the Research Department

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.