• Abby Stoddard, PharmD,MBA

Let's Talk Anxiety

Updated: Sep 23, 2020

And cannabis of course. But first, anxiety.

The year is 1990. A father returns home from Pittsburgh for the last time. He's been gone every week for the last two years as he works on a Master's degree, leaving his wife and two young daughters in Milwaukee. It has been hard on everyone but it has been incredibly worth it. The proud graduate enters the living room, greets his family and announces that they'll be celebrating in the the best way known to celebrities, sports stars, and 1990 engineering graduates - 'WE'RE GOING TO DISNEY WORLD!'

Elation. Exhilaration. Joy. All of the energy bound inside 5 and 7-year-old girls is unleashed and thrust upon Mom and Dad. No one is spared - even the arthritic family dog and reclusive guinea pig are squeezed, pinched and smooched with excitement. When the adrenaline finally subsides the 5 year old takes a deep breath, turns to her mom and says, "We can go to Disney World, but please buy me a leash before we go, the crowds are really big and I might get lost."

Whoa. That is one anxious 5-year-old girl. That was me.

For the past few months I've featured folks living with chronic conditions commonly treated with cannabis on the blog, and I've been extremely thankful for their honesty, vulnerability and collaboration. This month I thought it was time I honor those efforts by stepping to the plate myself and sharing my experience with a chronic condition - anxiety. I'll tell you a bit about my journey, and various pharmaceutical and non-pharmaceutical approaches I've used in the past. Then we'll take a look at what the evidence shows for cannabis, and how one state is poised to add anxiety to their list to qualifying conditions.

A Bit About My Journey

Let me begin with my typical disclaimer - always talk to your healthcare provider prior to beginning any treatment for any medical condition. What I'm about to describe is my unique experience, and what has helped me may not help you.

I have come a long way from being that high strung 5 year old. I am now a moderately well-adjusted 35 year old. And while I haven't required a tether to go anywhere recently I actively work on my anxiety every day with things that support my homeostasis - rest, activity, dietary choices, all the self help books and podcasts you can imagine, and anti-depressants.

My journey with anxiety is ongoing. I had my first panic attack when I was 8 and started therapy and anti-depressants shortly thereafter. At the time the products called selective-serotonin re-uptake inhibitors (Paxil, Prozac, Zoloft, and many more) were brand new, and over the last two decades I have tried nearly all of them.

Archival Footage of My Anxiety at a Birthday Party

There have been times in my life where I thought I had a handle on my anxiety, only be to told in no uncertain terms that I was kidding myself by the resurgence in panic attacks in broad daylight, unending insomnia, and obsessive negative thoughts. This led to re-starting anti-depressants, anxiolytics (e.g. Ativan), sleeping medications and the never-ending search for a therapy who will 'get it right'.

A Bit About My Present

While the paragraphs above sound a little intense, I can confidently say that I am in one of the best mental health spaces of my life. Given all of the events of the last 10 months this is no small feat, and I would have said it was impossible a year ago. I am where I am today because I have finally been able to shift my thinking of my anxiety from a 'situational' issue to the chronic condition that it is. It isn't something that I can medicate for a few months, stop, and be permanently repaired. It's something that I must accept will always be a part of me, and I must consciously incorporate ways to work on myself and keep myself in balance. As several of the guests on this blog have said - maintaining homeostasis is everything - and they are correct. For me this means eating as healthy as possible, moderating my alcohol intake, meditating several times a week, journaling, reading books on self development, going to therapy, taking an anti-depressant, and listening to a subliminal messaging tape at night. To be clear it's actually an mp3 file, but if it was a cassette it would be worn out by now.

Some Recent Reading Material

If someone would have told my 5 year old, 15 year old, or 25 year old self that this is what it would take I don't think they would have believed you, but I also don't think they would believed the amount of happiness, balance, and love their future self is capable of. That is the perspective I have today, but of course the work never ends.

And Now to Cannabis

I choose to write this month's blog post about anxiety because it is currently under consideration as a qualifying condition for the medical cannabis program in my home state of Minnesota. Anxiety is extremely common, with the National Institute of Mental Health reporting that 31.1% of adults will experience an anxiety disorder in their lifetime. Despite its pervasiveness, anxiety is rarely an explicit qualifying condition in medical cannabis programs.

There are a wide variety of pharmacological treatment options available today, and many people also benefit from non-drug treatments like cognitive behavioral therapy, meditation, and mindfulness practices. It's commonly known that cannabis can alter the mood, but it can be relaxing for some while activating for others depending on the product, person, and situation. All this begs the question - what is the evidence for cannabis as a treatment for anxiety?

A recent survey of 367 patients enrolled in the Illinois Medical Cannabis program asked what effects the patients perceived cannabis had on their health related quality of life. The majority of patients reported cannabis improved symptoms of pain, anxiety, depression and insomnia. Many patients had co-morbidities, and their response to the survey varied depending on their specific cluster of conditions. The researchers concluded that patients with co-occuring pain, anxiety and depression may benefit from cannabis treatment.

The American Society of Clinical Oncology published the results of their recent survey of breast cancer patients and cannabis use. Of the 612 breast cancer patients surveyed, 42% used medical cannabis to relieve symptoms including insomnia (70%), pain (59%), anxiety (57%), stress (51%) and nausea (46%).

A small survey of older adults published in the American Journal of Geriatric Psychiatry found that a small percentage of older adults reported using cannabis, but of those who did almost a quarter of them used it for anxiety. Seventy percent of the cannabis users with anxiety in the survey reported it was either 'extremely' or 'somewhat' helpful.

This all sounds promising, but it is still important to remember that mental health is extremely complicated, and treatment must be individualized, monitored, and ongoing. BMC Psychiatry recently published a systemic review of cannabis use across a variety of psychiatric disorders and summed it up by saying "There is currently encouraging, albeit embryonic, evidence for medicinal cannabis in the treatment of a range of psychiatric disorders." That is a Ph.D-level backhanded compliment if I there was one.

What Next

First - if you are suffering with anxiety or depression you are not alone, and there are many, many things that can help. What has worked for me is simply my own experience, and it's important to always consult with a trusted healthcare professional who can help you make a plan.

Cannabis is likely not the silver bullet to cure all anxiety, and the wrong product for the wrong person might even make things worse. Research into cannabis treatments for anxiety are promising, but we still have a long way to go. As one of my previous guests said 'every patient is a clinical trial of one' and I can't think of a truer statement for anxiety and what people use to cope with it, including cannabis.

If you want to add your voice to the consideration of anxiety as a qualifying condition in Minnesota, the public can send in their comments through Friday, October 16th. Click here for information on the anxiety petition and how to email your comments.

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