Does medical marijuana help relieve panic attacks?

Panic Attacks—Panic Disorder

Panic attacks are periods of intense fear or apprehension that are of sudden onset and of relatively brief duration.  Panic attacks usually begin abruptly, reach a peak within ten  minutes, and subside over the next several hours.  Often, those afflicted will experience significant anticipatory anxiety and limited symptom attacks in between attacks, in situations where attacks have previously occurred.  The effects of a panic attack vary.  Some, notably first-time sufferers, may call for emergency services.   Many who experience a panic attack, mostly for the first time, fear they are having a heart attack or a nervous breakdown.  Experiencing a panic attack has been said to be one of the most intensely frightening, upsetting and uncomfortable experiences of a person's life and may take days to initially recover from.  Repeated panic attacks are considered a symptom of panic disorder. 

Sufferers of panic attacks often report a fear or sense of dying, "going crazy," or experiencing a heart attack or "flashing vision," feeling faint or nauseated, a numb sensation throughout the body, heavy breathing (and almost always, hyperventilation), or losing control of themselves.  Some people also suffer from tunnel vision, mostly due to blood flow leaving the head to more critical parts of the body in defense.  These feelings may provoke a strong urge to escape or flee the place where the attack began (a consequence of the sympathetic "fight-or-flight response") in which the hormone which causes this response is released in significant amounts.  This response floods the body with hormones, particularly epinephrine (adrenaline), that aid it in defending against harm.

A panic attack is a response of the sympathetic nervous system (SNS).  The most common symptoms may include trembling, dyspnea (shortness of breath), heart palpitations, chest pain (or chest tightness), hot flashes, cold flashes, burning sensations (particularly in the facial or neck  area), sweating, nausea,  dizziness (or slight vertigo), light-headedness, hyperventilation, paresthesias (tingling sensations), sensations of choking or smothering, difficulty moving and derealization.  These physical symptoms are interpreted with alarm in people prone to panic attacks.  This results in increased anxiety, and forms a positive feedback loop.

Often, the onset of shortness of breath and chest pain are the predominant symptoms;  the sufferer incorrectly appraises this as a sign or symptom of a heart attack.  This can result in the person experiencing a panic attack seeking treatment in an emergency room.

Panic attacks are distinguished from other forms of anxiety by their intensity and their sudden, episodic nature.  They are often experienced in conjunction with anxiety disorders and other psychological conditions, although panic attacks are not usually indicative of a mental disorder

Causes

It is not known what causes panic attacks or panic disorder.  Things that may play a role include:

  • Genetics
  • Stress
  • Certain changes in the way parts of your brain function

Some research suggests that your body's natural fight-or-flight response to danger is involved in panic attacks.  For example, if a grizzly bear came after you, your body would react instinctively.  Your heart rate and breathing would speed up as your body prepared itself for a life-threatening situation.  Many of the same reactions occur in a panic attack.  It is not known why a panic attack occurs when there is no obvious danger present.

Symptoms

Panic attack symptoms can make your heart pound and cause you to feel short of breath, dizzy, nauseated and flushed.  Because panic attack symptoms can resemble life-threatening conditions,  it is important to seek an accurate diagnosis and treatment.

Panic attacks typically include a few or many of these symptoms:

  • A sense of impending doom or death
  • Rapid heart rate
  • Sweating
  • Trembling
  • Shortness of breath
  • Hyperventilation
  • Chills
  • Hot flashes
  • Nausea
  • Abdominal cramping
  • Chest pain
  • Headache
  • Dizziness
  • Faintness
  • Tightness in your throat
  • Trouble swallowing

Panic attacks typically begin suddenly, without warning.  They can strike at almost any time — when you're driving the school car pool, at the mall, sound asleep or in the middle of a business meeting.  Panic attacks have many variations, but symptoms usually peak within 10 minutes and last about half an hour.  You may feel fatigued and worn out after a panic attack subsides.

One of the worst things about panic attacks is the intense fear that you will have another panic attack. If you have had four or more panic attacks and have spent a month or more in constant fear of another attack, you may have a condition called panic disorder, a type of chronic anxiety disorder.

With panic disorder, you may fear having a panic attack so much that you avoid situations where they may occur.  You may even be unable to leave your home (agoraphobia), because no place feels safe.

When to see a doctor

If you have any panic attack symptoms, seek medical help as soon as possible.  Panic attacks are hard to manage on your own, and they may get worse without treatment.  Panic attack symptoms can resemble other serious health problems, such as a heart attack.

Risk factors

Symptoms of panic disorder often start either in late adolescence or early adulthood and affect more women than men.

Many people have just one or two panic attacks in their lifetimes, and the problem goes away, perhaps when a stressful situation ends.

Factors that may increase the risk of developing panic attacks or panic disorder include:

  • A family history of panic attacks or panic disorder
  • Significant stress
  • The death or serious illness of a loved one
  • Big changes in your life, such as the addition of a baby
  • A history of childhood physical or sexual abuse
  • Undergoing a traumatic event, such as an accident or rape

Treatment

Panic disorder can be effectively treated with a variety of interventions including psychological therapies and medication with the evidence that cognitive behavior therapy has the longest duration of effect, followed by specific selective serotonin reuptake inhibitors.  However, subsequent research by Barbara Milrod and her colleagues has shown that psychoanalytic psychotherapy is equally effective in relieving panic attacks as behavioral approaches and has fewer relapses.  A psychoanalytic approach that identifies actual but dissociated causes of panic reactions may lead to rapid disappearance of symptoms.

Today the term anxiolytic has become nearly synonymous with the benzodiazepines, because these compounds have been for almost forty years the drugs of choice for stress-related anxiety.  Low doses of complete-agonist benzodiazepines alleviate anxiety, agitation, and fear by their actions on receptors located in the amygdala, orbitofrontal cortex.

These areas of the brain are the same areas where medical marijuana has shown great promise.

Complications

Left untreated, panic attacks and panic disorder can result in severe complications that affect almost every area of your life.  You may be so afraid of having more panic attacks that you live in a constant state of fear, ruining your quality of life.

Complications that panic attacks may cause or be associated with include:

  • Development of specific phobias, such as fear of driving or leaving your home
  • Avoidance of social situations
  • Problems at work or school
  • Depression
  • Increased risk of suicide or suicidal thoughts
  • Alcohol or substance abuse
  • Financial problems

Does medical marijuana help with panic attacks (panic disorder)?

It’s not the marijuana that is causing the anxiety.  There is something going on in your life that is messing with you.  You need to figure it out. And deal with whatever it is.   That will stop your panic attacks.  In the meantime, stop using marijuana!    If you think (anticipate) you will have a problem if you smoke marijuana, then you probably will.  If you still get a panic attack, then it is not the marijuana.

Marijuana is used in an attempt to deal with the harsh effects of panic attacks by many users.  Small doses are best.  One drop at a time to begin.  You can always increase your dosage if necessary.

Try using a whole plant extract and make yourself a tincture.  Use an indica x hybrid.  A drop under the tongue is the best way to administer the tincture.  If you make your own medicine, you will know about the quality of the product.  Use the highest proof alcohol (ethanol) you can get:  Everclear or 151 Rum are two good choices. 

 

Studies:

US Institute of Medicine
The 'high' associated with marijuana is not generally claimed to be integral to its therapeutic value. But mood enhancement, anxiety reduction, and mild sedation can be desirable qualities in medications particularly for patients suffering pain and anxiety.  Thus, although the psychological effects of marijuana are merely side effects in the treatment of some symptoms, they might contribute directly to relief of other symptoms.

Source:  Joy JE, Watson SJ, Benson JA, eds. Marijuana and medicine:  Assessing the science base.  Institute of Medicine. Washington DC: National Academy Press, 1999.

Giovanni Marciano and colleagues
Here we show that the endogenous cannabinoid system has a central function in extinction of aversive memories.  Mice were trained to associate a tone with an electric footshock (conditioning).  After conditioning, animals shivered when they heard the tone. This response served as an indicator of aversive memory, and is gradually extinguished on repeated tone presentations.  Mice without cannabinoid-1 receptors showed strongly impaired short-term and long-term extinction of the aversive memory .

Overall our findings suggest that the endogenous cannabinoid system could represent a therapeutic target for the treatment of diseases associated with inappropriate retention of aversive memories or inadequate response to aversive situations, such as posttraumatic stress disorders, phobia, and certain forms of chronic pain.

Modified according to: Marsicano G, et al. The endogenous cannabinoid system controls extinction of aversive memories.  Nature 2002;418(6897):530-534.

Marciano and colleagues propose a new role for this endocannabinoid system - extinguishing fear-related memories in mice.  The finding might have implications for treating anxiety disorders in humans.

We can form memories in several different ways, one of which is Pavlovian conditioning - the classic example being that of Pavlov's dogs, which learned to expect food whenever they heard a ringing tone.  We all form these types of associations;  for instance, we may associate a particular piece of music with our first love . But the connection need not always be pleasant.  Imagine you are having a quiet walk in a park when you are threatened by an armed person.The attack you are terrified;  your heart races and your palms are sweaty.  You run and escape.  Later, you may find that entering the same park brings back in detail the memory of attack, right down to the sweaty palms.

It has been argued that the neuronal circuitry underlying fear conditioning has similarities to that responsible for fear-related clinical conditions, such as post-traumatic stress disorder.  Behavioural therapies for these conditions - including systematic desensitization and imagery therapies - share features with extinction.  The finding that the endocannabinoids contribute to extinction raises the possibility that drugs that target these molecules and their receptors could be useful new treatments for anxiety disorders. Finally there is much anecdotal evidence of patients using cannabis heavily in the early stages of psychiatric illness.  This has often been thought to contribute to acute illness.   It seems possible that it may instead be a form of self-medication for the sometimes extreme anxiety that these people experience.

Source:  Sah P. Neurobiology:  Never fear, cannabinoids are here.  Nature 2002;418(6897):488-9.

Franjo Grotenhermen
I would like to present a case of successful cannabis use in panic attacks.  A Swiss who was suffering from panic attacks recently reported, that cannabis use was very helpful for him between the attacks.  He had not used cannabis during the attack since it would be too late then.

The attacks had started about nine months ago without recognizable cause and occured nearly daily.  He also suffered from nausea, loss of appetite and dizziness.  He had been prescribed strong medical drugs from his doctor, which he would not like to take permanently.  Five  months ago he started to use cannabis, which he takes about three times a week now.  The panic attacks declined in frequency and intensity. Dizziness and nausea have disappeared completely and he regained appetite.  The  panic attacks nearly disappeared as well.

Source: Grotenhermen F. Kann Cannabis bei einer aufkommenden Panikattacke sinnvoll eingesetzt werden? [Can cannabis be used in an arising panic attack?]  Hanf-Magazin, September 2002.

References



1. http://m-w.com/dictionary/panic%20attack
2. Reid, Wilson (1996). Don't Panic: Taking Control of Your Anxiety Attacks. Revised Edition, HC.
3. a b c d e f g h i j k l m Bourne, E. (2005). The Anxiety and Phobia Workbook, 4th Edition: New Harbinger Press.
4. DSM-TR diagnostic criteria for panic disorder
5. Houck, P. R., Spiegel, D. A., Shear, M. K. & Rucci, P. (2002). Reliability of the self-report version of the Panic DisorderSeverity Scale. Depression and Anxiety,15(4): 183-185.
6. Shear, M. K., Rucci, P., Williams, J., Frank, E., Grochocinski, V., Vander Bilt, J., Houck, P. & Wang, T. (2001). Reliability and validity of the Panic Disorder: Replication and extension. Journal of Psychiatric Research, 35(2): 293-296.
7. Klerman, Gerald L.; Hirschfeld, Robert M. A.; Weissman, Myrna M. (1993). Panic Anxiety and Its Treatments: Report of the World Psychiatric Association Presidential Educational Program Task Force. American Psychiatric Association. pp. 44. ISBN 978-0-88048-684-2.
8. Power, B. and C. Goossens. (2009). Hallucinations arising in the context of torn attachment, traumatic childhood and tapeworms. Australas Psychiatry 17:3 240.(abstract).
9. Sternbach H, State R (1997). "Antibiotics: neuropsychiatric effects and psychotropic interactions". Harv Rev Psychiatry 5 (4): 214–226.doi:10.3109/10673229709000304. PMID 9427014.
10. Cohen SI (February 1995). "Alcohol and benzodiazepines generate anxiety, panic and phobias". J R Soc Med 88 (2): 73–7. PMC 1295099.PMID 7769598.
11. MedlinePlus Medical Encyclopedia: Panic disorder
12. Caffeine and Panic Disorder
13. Psychosomatic And Drug-induced Panic Attacks
14. http://www.mayoclinic.com/health/agoraphobia/DS00894
15. Psych Central: Agoraphobia Symptoms
16. Panic Disorder: Panic Attacks and Agoraphobia – familydoctor.org
17. Anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. National Institute for Health and Clinical Excellence. Clinical Guideline 22. Issue date: April 2007 [1] ISBN 1-84629-400-2
18. Milrod, B., Leon, A., Busch, F., Rudden, M., Schwalberg, M., Clarkin, J., Aronson, A., Singer, M., Turchin, W., Klass, E., Graf, E., Teres, J., & Shear, M. (2007). A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder. American Journal of Psychiatry, 164:265–272.
19. Blechner, M. (2007) Approaches to panic attacks. Neuro-Psychoanalysis, 9:93-102.
20. Breathing in and out of a paper bag
21. Hyperventilation Syndrome – Can I treat hyperventilation syndrome by breathing into a paper bag?
22. Breathing into a paper bag restricts the fresh air you are able to get. Without fresh air, less oxygen is inhaled. So, breathing into a paper bag, it is argued, dangerously lowers the amount of oxygen in your bloodstream. There have been several documented cases of heart attack patients incorrectly thinking they had hyperventilation syndrome and fatally worsening their heart attacks by breathing into a paper bag.http://firstaid.about.com/od/shortnessofbreat1/f/07_paper_bags.htm
23. To make matters worse, several studies now show a link between high concentrations of CO2 and panic attacks, which means that artificially increasing CO2 in inhaled air is likely to trigger more feelings of panic in patients who suffer from anxiety.http://firstaid.about.com/od/shortnessofbreat1/f/07_paper_bags.htm
24. http://www.anxietyawareness.com/overcoming-anxiety.php
25. http://www.apa.org/topics/anxietyqanda.html
26. Cramer, K., Post, T., & Behr, M. (January 1989). "Cognitive Restructuring Ability, Teacher Guidance and Perceptual Distracter Tasks: An Aptitude Treatment Interaction Study". Retrieved 2010-11-19.
27. Kabat-Zinn. "CALM THE PANIC". HEALTH FRONT.
28. Smoller, Jordan W., MD CsD, et al, Archives of General Psychiatry, 2007; 64(10):1153-1160.