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Cannabis and Anxiety

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“What, me? Worry?” This iconic signature phrase was on the front cover of MAD magazine, emblazoned under the face of Alfred E. Newman. Anxiety, and the associated psychological and physical symptoms, is the most prevalent mental illness in the US—affecting approximately 18% of the population. Anxiety manifests differently in each person and it originates from a variety of risk factors including life events, genetics, and personality. And although the “What, me? Worry?” attitude is attributed to male archetypes like Alfred E. Newman, it is women who primarily suffer from anxiety disorder, twice as frequently as men.

There are traditional therapies that are used to treat anxiety and its co-associated disorders. The treatment protocols and success rates vary, just like the anxiety presentation itself varies from patient to patient. Patients respond differently to different treatment options, and some may do well with a combination of techniques such as cognitive behavioral therapy, meditation, other complementary treatments, and a pharmaceutical medication. This multi-modal approach is well-accepted by traditional medical practitioners even though it has varied success rates. 

So how does cannabis fit? It depends. Some physicians and other health care providers are suspicious of cannabis, believing it will cause more harm than good—and in truth, that is a possibility. The over consumption of cannabis products containing high concentrations of THC, the intoxicating molecule in cannabis, may actually mimic a panic attack. Patients who do not consume cannabis regularly, overconsume cannabis with high concentrations of THC, or who are completely new to consuming cannabis may be sensitive to some of THC’s effects. THC may cause a rapid heart rate, dry mouth, and an overwhelming feeling of fear or anxiety—which is similar to many of the symptoms experienced with a panic attack! 

However, there are many patients who use cannabis to help treat their anxiety disorders. How can this be if the effects of THC imitate a panic attack? Well, the answer is that not all cannabis is alike. Cannabis is like an entire pharmacy in a plant. Different cultivars and cannabis products contain varied amounts of THC and the non-intoxicating CBD (the second most predominant cannabinoid), as well as other constituents. The different combinations of chemicals can be used to discover which mix helps reduce anxiety for each individual patient. 

If you are considering using cannabis to see if it works for your anxiety, you may want to start with a cannabis product that contains all or mostly CBD. CBD is a non-intoxicating chemical that carries no risk of causing panic attack-like effects, as it works differently in the body than THC does. There are also animal studies which report that CBD does work on serotonin receptors—and these are the very same receptors that pharmaceutical drugs known as SSRIs target to treat anxiety. 

Another animal study showed that CBD helped increase the number of hippocampal nerve cells in the brain. (Hippo-what?) The hippocampus is a structure in our brain that is in charge of many things, such as regulating memory and emotions. This includes anxiety. Brain scans of people who suffer with anxiety show that they have a smaller hippocampus than people who do not have anxiety. Both CBD and SSRIs may help to regrow the hippocampal nerve cells to increase the hippocampus size and possibly reduce anxiety. 

What about terpenes? As we know, cannabis is more than just cannabinoids. There are over 400 constituents in the cannabis plant. Terpenes are some of the chemicals that give cannabis its scent and taste. They also have therapeutic effects. Cannabis products that contain the terpenes myrcene and limonene, for example, may create a sense of relaxation and may lessen the feeling of anxiety. Cannabis products that contain a lot of the terpene pinene may create an energized and focused feeling in some, but may make other people feel anxious. 

The upshot? Is THC the evil demon? Not necessarily. There are patients who require some amount of THC in combination with CBD to effectively treat their anxiety. It is just prudent to start at a very low concentration of THC or start with no THC and slowly add THC and titrate to higher concentrations of THC if needed. The panic-like feeling dissipates with continued cannabis use. 

There is no one cure for every person, whether it is conventional medical therapy, medical cannabis, or a combination. Risks and benefits of every treatment need to be weighed before starting any treatment. Consult your recommending physician and be willing to try different combinations, as every person responds differently.

Be well,

Dr. Deb

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Combating Menstrual Pain with Cannabis

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Many women are plagued with menstrual pain each month. According to The American College of Obstetricians and Gynecologists, dysmenorrhea is the most commonly reported menstrual disorder. The pain can vary from throbbing cramps to cramping pain in the lower abdomen. Other symptoms can include lower back pain, nausea, diarrhea and headaches. Premenstrual Syndrome (PMS) symptoms usually begin 1 to 2 weeks prior to your period and can include weight gain, bloating, irritability, and fatigue. For some women, menstrual pain can be debilitating. Women who experience pain for several days a month have options to endure the pain or medicate to alleviate symptoms. 

Many women turn to over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) such as Ibuprofen for pain relief. At prescription doses, these drugs can provide relief with inflammation. However, these drugs are synthetic, and the human body does not have a regulatory system to process them. This leads to side effects. In addition, these treatments usually do not provide adequate symptom relief for patients. NSAIDs raise the risk of having a heart attack or stroke and can cause stomach bleeding and death. 

Prostaglandins are inflammatory chemicals that peak during menstruation. NSAIDs work by inhibiting the enzyme responsible for producing prostaglandins (COX-2). This means that NSAIDs could potentially decrease all the symptoms aggravated by prostaglandins, including inflammation, contractions, and pain. However, NSAIDs can also have unpleasant gastrointestinal side effects, because they inhibit another enzyme (COX-1). For this reason, NSAIDs should be used with moderation, and people with certain digestive issues might want to avoid them entirely. Research shows that, similar to NSAIDs, CBD also inhibits the prostaglandin producing enzyme. 

Unlike NSAIDs, CBD preferentially inhibits COX-2 over COX-1. In simpler terms, this means its anti-inflammatory benefits come without the gastrointestinal side effects. Not only does CBD inhibit the COX-2 enzyme, but both CBD and THC physically stop your DNA from producing as much of the enzyme overall. Many healthcare professionals suggest patients start taking painkillers an hour or more before symptoms start – whether they are NSAIDs or cannabis treatment. Not starting treatment until pain symptoms start makes it more difficult to regulate pain, because the prostaglandins are already causing inflammation. Having a natural option that provides tremendous symptom relief is why women are turning to cannabis products.

Cannabis has been used for its medicinal properties for thousands of years and with the expanding growth of knowledge and availability, it is quickly becoming a household treatment product. Cannabinoids found in the cannabis plant are credited with aiding a variety of conditions including anxiety, inflammation, nausea, pain and others. Cannabinoid receptors are found throughout the entire body, including the uterus. The receptors within the body’s Endocannabinoid System (ECS) work with the cannabinoids found in cannabis to help naturally regulate the body’s response to pain and inflammation. Cannabis is also known for its muscle relaxing and vaso relaxing benefits, which can aid in menstrual symptom relief. 

Incorporating cannabis foods can also help manage menstrual symptoms, because they contain gamma linolenic acid which helps maintain hormone balances. Cannabis foods contain high levels of magnesium, which can reduce pain and inflammatory prostaglandin levels as well. Other natural treatment options, such as heat application, exercise, vitamins, healthy lifestyle, and stress reduction may decrease discomfort for women. Patients may seek additional options if they don’t find relief with NSAIDs or cannabinoid therapy which could include a prescription for non-hormonal drug treatments, the contraceptive pill, stronger pain relievers, and the intra-uterine system (IUS). All come with lengthy side effect lists. Healthcare professionals are learning more about the benefits of cannabis and are educating and prescribing cannabis to their patients. 

Dr. Melanie Bone is a board-certified gynecologist and a medical cannabis practitioner.  Her mission is to, “be an educator and to provide the guidance and support so very necessary to give to patients, especially those who have no experience with cannabis.” Dr. Bone specializes in “the intersection of women’s health and cannabiniods.” She is working in the industry educate others about, “cannabiniods for women’s wellness from menarche through menopause.” 

With doctors like Dr. Bone prescribing cannabis for overall health and menstrual pain management, cannabis has become the natural go-to for maintaining a woman’s ability to function and manage pain, as well as overall health and wellness benefits. 

Dispensaries carry products that specialize in treating menstrual pain, such as vaginal suppositories. Patients can get cannabinoids directly to the area that needs it, with little or no psychoactive effects. Other cannabis products can aid in providing symptom relief like topicals, edibles, smokables, sublinguals, patches, and more. Modern women are beginning to take advantage of the cannabis plant as a tool for menstrual pain and as a health product for themselves and their families, as it was used thousands of years ago. With knowledge and availability growing, cannabis is spreading its power to provide health benefits and improve the quality of lives for millions around the world. 

References:

  1. https://www.acog.org/patients/FAQS/Dysmenorrhea-Painful-Periods#how
  2. https://www.webmd.com/arthritis/anti-inflammatory-drugs#1
  3. https://www.ncbi.nlm.nih.gov/pubmed/18556441
  4. https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/j.1476-5381.2011.01444.x
  5. https://www.womens-health-concern.org/help-and-advice/factsheets/period-pain/

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The Dis-List

Cannabis For Fibromyalgia

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Fibromyalgia is a common condition with very little understanding. The American Chronic Pain Association reports, “Fibromyalgia affects an estimated 2 to 4 percent of the US population, or as many as 6 to 12 million people.” The condition is much more prevalent among women than men, with women making up approximately 90% of fibromyalgia patients. Known for causing widespread pain, fatigue, and cognitive dysfunction, doctors still don’t know what causes the condition, and more research is being conducted.

However, back in 2004, a literary review suggesting a possible cause for fibromyalgia was published in the Neuroendocrinology Letters, an internal peer-reviewed medical journal covering neuroendocrinology. The review was published by neurologist, Dr. Ethan Russo, who suggested fibromyalgia and other conditions displaying “common clinical, biochemical and pathophysiological patterns, suggest an underlying clinical endocannabinoid deficiency that may be suitably treated with cannabinoid medicines.” This suggestion points to a lack of cannabinoids like THC and CBD, which interact with our endocannabinoid system to moderate homeostasis in the body, as being the underlying cause of the chronic pain and other symptoms sufferers of fibromyalgia experience.

Although Russo’s theory hasn’t been scientifically proven, newer research results are indicating cannabis can help fibromyalgia patients. In 2018, a study on treating fibromyalgia with medical cannabis was published in the Journal of Clinical Rheumatology which concluded, “medical cannabis treatment had a significant favorable effect on patients with fibromyalgia, with few adverse effects.” Their data was collected from two hospital registries of patients diagnosed with fibromyalgia and treating the condition with medical cannabis in Israel, which is the leading country in the world for cannabis research.

So why would it be important to discover that cannabis could help the millions of people who suffer from fibromyalgia? There’s two reasons for this. First, the current medical treatment plan for fibromyalgia is mostly prescriptions for pharmaceutical pain killers, antidepressants, and even anti-seizure medications. Several of these medications are known to have dangerous side effects, and many pharmaceutical pain killers are opioid based with have extremely high rates of addiction. Since our country is currently in an opioid epidemic, having an alternative medicine like cannabis can help keep fibromyalgia patients live a better quality of life without fear of getting addicted to a deadly painkiller.

The second reason is that it already falls in line with the complementary treatments being suggested in addition to pharmaceuticals. These treatments include other natural and organic healthcare remedies, like active exercise, acupuncture, massage, and physical therapy. Cannabis can actually be incorporated into all of these activities to encourage a synergistic focus of holistic healing. In the end, more research needs to be conducted in order to produce more conclusive evidence, but it’s starting to look like cannabis may be one piece of the answer to treating fibromyalgia.

References:

https://www.ncbi.nlm.nih.gov/pubmed/15159679

https://journals.lww.com/jclinrheum/Abstract/2018/08000/Medical_Cannabis_for_the_Treatment_of_Fibromyalgia.3.aspx

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