Anxiety and stress are the two most common reasons people use medical cannabis, second only to pain.   Anxiety is a normal, yet unpleasant sensation of apprehension when confronted with a new or threatening situation, and may be accompanied by physical symptoms. It may also occur in the absence of a triggering event. It is considered a disorder when it interferes with social or occupational functioning.
Anxiety disorders include generalized anxiety disorder (GAD), panic attacks, agoraphobia, obsessive compulsive disorder, social anxiety, and acute stress disorders such as PTSD.  Although hemp has been used to address symptoms of anxiety for thousands of years,  caution is advised, as there is ample evidence that large doses of the cannabinoid, tetrahydrocannabinol (THC), found in high concentrations in the street form of marijuana, can trigger anxiety and even potential paranoia in susceptible individuals.  Studies have shown that females who have been diagnosed with social anxiety disorders may be more prone to developing marijuana dependency. 
The cannabinoid, cannabidiol (CBD) is one of many cannabinoids naturally occurring in the cannabis plant, along with terpenes, which have also proven valuable in bringing relief to symptoms of anxiety such as fear, stress, and worry. In the US, anxiety disorders affect roughly 30% of the population, but everyone has experienced anxiety at some time or another in their lives.
Cannabis has the ability to both reduce or increase anxiety, depending on the strain, variety, and ratio of CBD to THC present. Notably, THC is the main component responsible for side effects such as anxiety, paranoia, psychosis, and hallucinations in some individuals. Other factors involve the chemistry of the strain, the dose level, the mind-set of the user, and the setting in which plant is used. When you grasp an understanding of these variables, it can increase the likelihood of relieving the symptoms of anxiety disorders. Cannabis has often been described as “biphasic and bidirectional”, in that it can cause relaxation in some cases, or anxiety in others.  These variations are most often linked to dose, with lower doses relieving anxiety, while higher doses, especially in high-THC strains, may trigger a worsening of symptoms. 
The information contained in this article is for informational purposes only and does not constitute medical advice. Prior to making changes to your lifestyle or treatment plan, always consult with a licenced medical professional.
Frequent high-dose THC users may develop chronic anxiety and troublesome worsening of other psychiatric problems,  which paradoxically, they may try to “treat” with yet higher doses of high-THC cannabis  which only exacerbates the symptoms further. However, when CBD and THC were administered in separate doses, and together, cannabidiol (CBD) was able to reduce the anxiety associated with the use of THC. In one study, it was found that administering pre-emptive low-doses of CBD could reduce the likelihood of the onset of anxiety.  If cannabis is going to be used for treating anxiety, CBD or high-CBD strains are the best choice,  however low doses of THC may also be of value, especially with those experienced in using the plant. These people may be far less likely to become anxious.
The most common symptoms of anxiety include fear, worry, rumination, tension, and apprehension. Anxiety is also a feature of other psychiatric conditions, including depression, bipolar disorder, and schizophrenia. It is believed that the endocannabinoid system may be dysregulated in chronic anxiety disorders. More specifically, the density of CB1 cannabinoid receptors found in the brain’s amygdala, hippocampus, and anterior cingulate cortex - areas of the brain that are associated with anxiety; which supports the idea that the endocannabinoid system actually regulates anxiety. For more information, read The Endocannabinoid System Explained.
Limonene, which is a commonly occurring terpene found in hemp, is known as an anxiolytic and increases levels of both dopamine and serotonin via the 5-HT1A receptor, boosting serotonin’s presence in the prefrontal cortex and dopamine in the hippocampus.  Both of these areas in the brain are of importance in any therapeutic considerations of mood and anxiety. Linalool, another terpene found in many strains, is a well known antidepressant and calming agent.   For more information, read our Ultimate Guide to Terpenes.
Both CBD and THC have been found to be effective in relieving symptoms of anxiety, however it could be more effective to utilize each cannabinoid separately. The THC dosage for anxiety is successful at between 1 and 3 mg, whereas CBD dosage ranges between 2.5 and 10 mg. CBD dosage protocols for panic disorders and phobias has ranged in studies, reaching up to 600 mg, but such high doses have been characterized as causing mild mental sedation.  It is safe to assume that doses of up to 50 mg of CBD can be well tolerated by most people.
High CBD products can be utilized without any psychoactive effect if taken orally in a spray or sublingually in a ratio of CBD:THC of 10:1 or higher (such as 20:1), in doses of 5 mg CBD in the morning and again in the mid-afternoon. It can also be used throughout the day, as needed, but it is advised that the last dose of the day occurs before 5pm, as CBD can be wake-promoting. This is the best CBD use. Light doses of THC (typically around 2.5 mg, but can range from 1 to 5 mg), taken under the tongue (sublingually), have fairy clear effects and are proven helpful to shift or elevate mood. This dose can be increased to 5 mg, if needed.
Vaping and smoking medicinal cannabis medication for anxiety can be very effective, especially because the effects are instant, and also due to the fact that people using this method can quickly learn precisely how to titrate the proper dose. Here, 1 to 2.5 mg of vaporized or inhaled THC is typically the recommendation for faster onset than with oral administration. Use the lowest effective dose to avoid the development of a tolerance whenever possible. Those new to cannabis should exercise caution, and start with no more than 2.5 mg of THC (about a matchstick-head sized piece of cannabis flower) and wait 10 to 15 minutes before adding more. Start low, and go slow, titrating their way up. As with all cannabis use, you can always take more, but you can’t take less.
Just about any strain and type of cannabis can be of value in bringing relief to anxiety, including even the most anxiogenic varieties, such as Hazes and Diesels, provided that the dose is very tightly constrained. High-CBD strains seem to be very effective for treating social anxiety disorder and possibly panic disorders and phobias. Cookies and Zeta are great strains for shifting or improving mood and stimulating motivation while soothing anxiousness. These strains are very potent cultivars, so a matchstick-head-sized piece can suffice for a daytime dose. The terpene limonene is a known anxiolytic and antidepressant  and can be found in significant concentrations in the strains OG Kush and Tangerine Dream. “Purple” varieties are consistently noted to be effective for sleep disorders, quite possibly due to their increased concentrations of the calming and lightly sedative terpenes, linalool and myrcene.  Linalool can be found in the strain Bubba Kush and most Purple varieties. Myrcene, however, should be avoided if suicidal ideation is present in the person. This is why full spectrum can work better for anxiety and depression and post traumatic stress disorder (PTSD).
For further information, see our other article covering more research on how CBD oils work for anxiety, and be sure to look at our articles on related mental health conditions such as schizophrenia, and PTSD.
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