Prescriptive concepts of cannabis-based products in anxiety disorders

One of the main clinical indications for Cannabis is in the treatment of anxiety. There are several scientific studies that prove the therapeutic potential of the plant in controlling this disorder, especially in relation to extracts that combine the phytocannabinoids CBD (cannabidiol) and THC (delta-9-tetrahydrocannabinol).

In this post, we will talk more about these substances and list the main prescriptive concepts for you to work safely and effectively in prescriptive practice in the context of anxiety disorders.

 

The use of phytocannabinoids in the treatment of anxiety

Assertive administration of CBD and THC is able to significantly reduce the manifestation of common symptoms in anxiety and stress disorders. These phytocannabinoids produce an anxiolytic effect that minimizes the expression of defensive responses in times of crisis for a prolonged period.

However, as Cannabis most often presents a biphasic dose/response relationship, it is necessary to be very attentive to some prescriptive concepts in order not to compromise the therapeutic effects of these  medications.

When we speak of a biphasic relationship, it means that, at first, increasing the dose of the product corresponds to increasing the desired therapeutic effects.

However, there is an optimal dose that should not be exceeded, otherwise there may be a reduction in the desired therapeutic effects or even the appearance of effects opposite to those intended to be achieved. 

THC, for example, in optimized doses is a powerful anxiolytic, bringing feelings of relaxation and well-being, in addition to inducing sleep and appetite.

In high doses, however, the substance causes just the opposite: psychomotor agitation, irritability, insomnia and inhibition of appetite. Therefore, it is essential to identify the optimal dose of the cannabinoid derivative for each patient, based on the improvement of symptoms and/or the appearance of potential adverse effects resulting from use.

 

 

Main prescriptive concepts of Cannabis

The overall objective of cannabis therapy is to relieve symptoms and increase the patient's quality of life without inducing adverse effects. In order to maintain this balance, some prescriptive concepts must be prioritized. Are they:

 

1. Screen risk profiles

Some patients present a risk profile for the use of Cannabis, such as adolescents, the elderly, pregnant women, nursing mothers, patients with severe and unstable cardiovascular diseases, and patients with serious or untreated psychiatric illnesses. 

In these cases, it is necessary to be even more careful in the prescription, individualizing the treatments and titrating the doses more slowly.

 

2. Investigate the history of the relationship with the plant

People who use Cannabis for recreational purposes and who report unpleasant experiences, such as extreme anxiety and feelings of paranoia, are more likely to  be  hypersensitive to THC. 

In these situations, the ideal is to prioritize CBD-predominant formulations and be even more careful in the titration of THC-enriched products.

 

3. Level expectations with patients

Although they represent a vast therapeutic arsenal, Cannabis-based medicines are not a magic solution, they are not indicated for all cases, nor do they present satisfactory responses in all patients.

Therefore, it is very important to build a solid and transparent relationship with your patients, in order to align real therapeutic goals so that the results do not disappoint the expectations of patients and their families.

 

4. Individualize treatments

Each individual has a unique biochemical structure and a Endocannabinoid System unique. This means that there is no “cake recipe” for the prescription of medicines based on  Cannabis. It is necessary to contextualize each case to choose the route of administration, the  formulation profile and  dosage according to the particularities of each patient.

 

5. Using full spectrum products

Prefer full spectrum products, the use of full spectrum products amplifies the medicinal effects of the plant. The cannabinoids, flavonoids, terpenes and other metabolites present in the plant act in synergy with each other to enhance the different therapeutic effects. We call this effect the entourage effect or entourage effect, and it has already been demonstrated in the literature that the use of herbal medicines is more effective than the use of single molecules, due to this synergy mechanism.  The entourage effect also modulates the  adverse effects of these medications. 

 

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