CoChat
Sign Up
Cited by 509Cannabis and Cannabinoid ResearchAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMedicinal Plant Extracts Effects

Cannabis and anxiety: a critical review of the evidence

Open access
Crippa, José Alexandre, Zuardi, Antonio Waldo, Martín‐Santos, Rocio, Bhattacharyya, Sagnik, Atakan, Zerrin, McGuire, Philip, Fusar‐Poli, Paolo·2009·Human Psychopharmacology: Clinical and Experimental
DOI 10.1002/hup.1048
Open this paper in CoChat — free accountOpen PDF

Abstract

Background: Anxiety reactions and panic attacks are the acute symptoms most frequently associated with cannabis use. Understanding the relationship between cannabis and anxiety may clarify the mechanism of action of cannabis and the pathophysiology of anxiety. Aims of the present study were to review the nature of the relationship between cannabis use and anxiety, as well as the possible clinical, diagnostic and causal implications. Method: Systematic review of the Medline, PsycLIT and EMBASE literature. Results: Frequent cannabis users consistently have a high prevalence of anxiety disorders and patients with anxiety disorders have relatively high rates of cannabis use. However, it is unclear if cannabis use increases the risk of developing long‐lasting anxiety disorders. Many hypotheses have been proposed in an attempt to explain these relationships, including neurobiological, environmental and social influences. Conclusions: The precise relationship between cannabis use and anxiety has yet to be established. Research is needed to fully clarify the mechanisms of such the association. Copyright © 2009 John Wiley & Sons, Ltd.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1002/hup.1048

Cites

10 of 10 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Low doses of Δ9-THC engender anxiolytic-like effects, whereas higher doses produce anxiogenic reactions.

    “low doses of the best-known constituent of the plant, Δ9-tetrahydrocannabinol (Δ9-THC), engender anxiolytic-like effects, whereas higher doses produce anxiogenic reactions (Crippa et al, 2009).”

    From Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Naïve Social Phobia Patients (2011) · cites this paper as Crippa et al, 2009

    The Conclusion reports anxiolytic-like effects of low-dose Δ9-THC and anxiogenic behaviour at higher doses, but specifies that this dose-dependent finding is in laboratory rodents. The citing sentence omits that qualification and presents the effect without a population limit. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Cannabis use is associated with both reduction of anxiety and episodes of intense anxiety or panic.

    “Cannabis users reported the reduction of anxiety as one of the motivations for its use; on the other hand, episodes of intense anxiety or panic are among the most common undesirable effects of the drug (Crippa et al, 2009).”

    From Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Naïve Social Phobia Patients (2011) · cites this paper as Crippa et al, 2009

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 68

  1. Arendt M, Rosenberg R, Fjordback L, et al. 2007. Testing the self- medication hypothesis of depression and aggression in cannabis- dependent subjects. Psychol Med 37(7): 935-945.
  2. Berrendero F, Maldonado R. 2002. Involvement of the opioid system in the anxiolytic-like effects induced by Delta(9)-tetrahydrocannabinol. Psychopharmacology 163(1): 111-117.
  3. Bonn-Miller M, Zvolensky M, Bernstein A. 2007. Marijuana use motives: concurrent relations to frequency of past 30-day use and anxiety sensi- tivity among young adult marijuana smokers. Addict Behav 32(1): 49-62.
  4. Boydell J, van Os J, Caspi A, et al. 2006. Trends in cannabis use prior to first presentation with schizophrenia, in South-East London between 1965 and 1999. Psychol Med 36(10): 1441-1446.
  5. Braida D, Liminta V, Malabarba L, Zani A, Sala M. 2007. 5-HT(1A) receptors are involved in the anxiolytic effect of delta(9)-tetrahydrocan- nabinol and AM404, the anandamide transport inhibitor, in Sprague- Dawley rats. Eur J Pharmacol 555(2-3): 156-163.
  6. Bricker J, Russo J, Stein M, et al. 2007. Does occasional cannabis use impact anxiety and depression treatment outcomes? Results from a randomized effectiveness trial. Depress Anxiety 24(6): 392-398.
  7. Buckner J, Schmidt N, Bobadilla L, Taylor J. 2006. Social anxiety and problematic cannabis use: evaluating the moderating role of stress reactivity and perceived coping. Behav Res Ther 44(7): 1007-1015.
  8. Buckner J, Schmidt N, Lang A, Small J, Schlauch R, Lewinsohn P. 2008. Specificity of social anxiety disorder as a risk factor for alcohol and cannabis dependence. J Psychiatr Res 42(3): 230-239.
  9. Budney A, Hughes J, Moore B, Vandrey R. 2004. Review of the validity and significance of cannabis withdrawal syndrome. Am J Psychiatry 161(11): 1967-1977.
  10. Campos A, Guimara ˜es F. 2008. Involvement of 5HT1A receptors in the anxiolytic-like effects of cannabidiol injected into the dorsolateral peri- aqueductal gray of rats. Psychopharmacology 199(2): 223-230.
  11. Chabrol H, Duconge E, Casas C, Roura C, Carey K. 2005. Relations between cannabis use and dependence, motives for cannabis use and anxious, depressive and borderline symptomatology. Addict Behav 30(4): 829-840.
  12. Clough A, d'Abbs P, Cairney S, et al. 2005. Adverse mental health effects of cannabis use in two indigenous communities in Arnhem Land, Northern Territory, Australia: exploratory study. Aust N Z J Psychiatry 39(7): 612- 620.
  13. Crippa JA, Zuardi AW, Garrido GE, et al. 2004. Effects of cannabidiol (CBD) on regional cerebral blood flow. Neuropsychopharmacology 29(2): 417-426.
  14. D'Souza D, Perry E, MacDougall L, et al. 2004. The psychotomimetic effects of intravenous delta-9-tetrahydrocannabinol in healthy individ- uals: implications for psychosis. Neuropsychopharmacology 29(8): 1558-1572.
  15. Deas D, Gerding L, Hazy J. 2000. Marijuana and panic disorder. J Am Acad Child Adolesc Psychiatry 39(12): 1467.
  16. Dorard G, Berthoz S, Phan O, Corcos M, Bungener C. 2008. Affect dysregulation in cannabis abusers: A study in adolescents and young adults. Eur Child Adolesc Psychiatry 17(5): 274-282.
  17. Feeney G, Connor J, Young R, Tucker J, McPherson A. 2005. Cannabis dependence and mental health perception amongst people diverted by police after arrest for cannabis-related offending behaviour in Australia. Crim Behav Ment Health 15(4): 249-260.
  18. Copyright # 2009 John Wiley & Sons, Ltd. Hum. Psychopharmacol Clin Exp (2009) DOI: 10.1002/hup cannabis and anxiety · DOI
  19. Gilder D, Lau P, Dixon M, Corey L, Phillips E, Ehlers C. 2006. Co- morbidity of select anxiety, affective, and psychotic disorders with cannabis dependence in southwest california indians. J Addict Dis 25(4): 67-79.
  20. Giuliani D, Ferrari F, Ottani A. 2000. The cannabinoid agonist HU 210 modifies rat behavioural responses to novelty and stress. Pharmacol Res 41(1): 47-53.
  21. Glass R, Uhlenhuth E, Hartel F, Schuster C, Fischman M. 1980. A single dose study of nabilone, a synthetic cannabinoid. Psychopharmacol (Berl) 71(2): 137-142.
  22. Gregg J, Small E, Moore R, Raft D, Toomey T. 1976. Emotional response to intravenous delta9tetrahydrocannabinol during oral surgery. J Oral Surg 34(4): 301-313.
  23. Hall W, Solowij N. 1998. Adverse effects of cannabis. Lancet 352(9140): 1611-1616.
  24. Haney M. 2005. The marijuana withdrawal syndrome: diagnosis and treatment. Curr Psychiatry Rep 7(5): 360-366.
  25. Haney M, Hart C, Vosburg S, et al. 2004. Marijuana withdrawal in humans: effects of oral THC or divalproex. Neuropsychopharmacology 29(1): 158-170.
  26. Haney M, Hart C, Ward A, Foltin R. 2003. Nefazodone decreases anxiety during marijuana withdrawal in humans. Psychopharmacology 165(2): 157-165.
  27. Haney M, Ward A, Comer S, Hart C, Foltin R, Fischman M. 2001. Bupropion SR worsens mood during marijuana withdrawal in humans. Psychopharmacology 155(2): 171-179.
  28. Hayatbakhsh M, Najman J, Jamrozik K, Mamun A, Alati R, Bor W. 2007. Cannabis and anxiety and depression in young adults: a large prospective study. J Am Acad Child Adolesc Psychiatry 46(3): 408-417.
  29. Hollister L. 1986. Health aspects of cannabis. Pharmacol Rev 38(1): 1-20.
  30. Ilan A, Gevins A, Coleman M, ElSohly M, De Wit H. 2005. Neurophy- siological and subjective profile of marijuana with varying concentrations of cannabinoids. Behav. Pharmacol. 16(5-6): 487-496.
  31. Innamorati M, Pompili M, Ferrari V, et al. 2008. Cannabis use and the risk behavior syndrome in Italian university students: are they related to suicide risk? Psychol Rep 102(2): 577-594.
  32. Lynskey M, Heath A, Nelson E, et al. 2002. Genetic and environmental contributions to cannabis dependence in a national young adult twin sample. Psychol Med 32(2): 195-207.
  33. Manzanares J, Corchero J, Fuentes J. 1999. Opioid and cannabinoid receptor-mediated regulation of the increase in adrenocorticotropin hormone and corticosterone plasma concentrations induced by central administration of delta(9)-tetrahydrocannabinol in rats. Brain Res 839(1): 173-179.
  34. Manzanares J, Uriguen L, Rubio G, Palomo T. 2004. Role of endocanna- binoid system in mental diseases. Neurotox Res 6(3): 213-224.
  35. Marco E, Adriani W, Llorente R, Laviola G, Viveros M. 2009. Detrimental psychophysiological effects of early maternal deprivation in adolescent and adult rodents: Altered responses to cannabinoid exposure. Neurosci Biobehav Rev 33(4): 498-507.
  36. Meser K, Drake R, Wallach M. 1998. Dual diagnosis: a review of etiological theories. Addict Behav 23: 717-734.
  37. Moreira F, Lutz B. 2008. The endocannabinoid system: emotion, learning and addiction. Addict Biol 13(2): 196-212.
  38. Muntoni A, Pillolla G, Melis M, Perra S, Gessa G, Pistis M. 2006. Cannabinoids modulate spontaneous neuronal activity and evoked inhi- bition of locus coeruleus noradrenergic neurons. Eur J Neurosci 23(9): 2385-2394.
  39. Murray RM, Morrison PD, Henquet C, Di Forti M. 2007. Cannabis, the mind and the society; the hash realities. Nat Rev Neurosci 8(11): 885- 895.
  40. Naliboff B, Rickles W, Cohen M, Naimark R. 1976. Interactions of marijuana and induced stress: forearm blood flow, heart rate, and skin conductance. Psychophysiology 13(6): 517-522.
  41. O'Shea M, McGregor I, Mallet P. 2006. Repeated cannabinoid exposure during perinatal, adolescent or early adult ages produces similar long- lasting deficits in object recognition and reduced social interaction in rats. J Psychopharmacol 20(5): 611-621.
  42. O'Shea M, Singh M, McGregor I, Mallet P. 2004. Chronic cannabinoid exposure produces lasting memory impairment and increased anxiety in adolescent but not adult rats. J Psychopharmacol 18(4): 502-508.
  43. Ogborne A, Smart R, Weber T, Birchmore-Timney C. 2000. Who is using cannabis as a medicine and why: an exploratory study. J Psychoactive Drugs 32(4): 435-443.
  44. Patel S, Cravatt B, Hillard C. 2005. Synergistic interactions between cannabinoids and environmental stress in the activation of the central amygdala. Neuropsychopharmacology 30(3): 497-507.
  45. Patel S, Hillard CJ. 2006. Pharmacological evaluation of cannabinoid receptor ligands in a mouse model of anxiety: further evidence for an anxiolytic role for endogenous cannabinoid signaling. J Pharmacol Exp Ther 318(1): 304-311.
  46. Patton G, Coffey C, Carlin J, Degenhardt L, Lynskey M, Hall W. 2002. Cannabis use and mental health in young people: cohort study. BMJ 325(7374): 1195-1198.
  47. Pertwee RG. 2008. The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: delta9-tetrahydrocannabinol, cannabidiol and delta9-tetrahydrocannabivarin. Br J Pharmacol 153(2): 199-215.
  48. Prentiss D, Power R, Balmas G, Tzuang G, Israelski D. 2004. Patterns of marijuana use among patients with HIV/AIDS followed in a public health care setting. J Acquir Immune Defic Syndr 35(1): 38-45.
  49. Rosenberg M, Anthony J. 2001. Early clinical manifestations of cannabis dependence in a community sample. Drug Alcohol Depend 64(2): 123- 131.
  50. Sbrana A, Bizzarri J, Rucci P, et al. 2005. The spectrum of substance use in mood and anxiety disorders. Compr Psychiatry 46(1): 6-13.
  51. Schofield D, Tennant C, Nash L, et al. 2006. Reasons for cannabis use in psychosis. Aust N Z J Psychiatry 40(6): 570-574.
  52. Smith M, Barch D, Wolf T, Mamah D, Csernansky J. 2008. Elevated rates of substance use disorders in non-psychotic siblings of individuals with schizophrenia. Schizophr Res 106(2-3): 294-299.
  53. Spalletta G, Bria P, Caltagirone C. 2007. Differences in temperament, character and psychopathology among subjects with different patterns of cannabis use. Psychopathology 40(1): 29-34.
  54. Sundram S. 2006. Cannabis and neurodevelopment: implications for psychiatric disorders. Hum Psychopharmacol 21(4): 245-254.
  55. Szuster R, Pontius E, Campos P. 1988. Marijuana sensitivity and panic anxiety. J Clin Psychiatry 49(11): 427-429.
  56. Thomas H. 1996. A community survey of adverse effects of cannabis use. Drug Alcohol Depend 42(3): 201-207.
  57. Trezza V, Campolongo P, Cassano T, et al. 2008. Effects of perinatal exposure to delta-9-tetrahydrocannabinol on the emotional reactivity of the offspring: a longitudinal behavioral study in Wistar rats. Psycho- pharmacology 198(4): 529-537.
  58. Troisi A, Pasini A, Saracco M, Spalletta G. 1998. Psychiatric symptoms in male cannabis users not using other illicit drugs. Addiction 93(4): 487- 492.
  59. Tunving K. 1987. Psychiatric aspects of cannabis use in adolescents and young adults. Pediatrician 14(1-2): 83-91.
  60. Van Laar M, van Dorsselaer S, Monshouwer K, de Graaf R. 2007. Does cannabis use predict the first incidence of mood and anxiety disorders in the adult population? Addiction 102(8): 1251-1260.
  61. Vandrey R, Budney A, Moore B, Hughes J. 2005. A cross-study comparison of cannabis and tobacco withdrawal. Am J Addict 14(1): 54-63.
  62. Vann R, Gamage T, Warner J, et al. 2008. Divergent effects of cannabidiol on the discriminative stimulus and place conditioning effects of Delta(9)- tetrahydrocannabinol. Drug Alcohol Depend 94(1-3): 191-198.
  63. Windle M, Wiesner M. 2004. Trajectories of marijuana use from adoles- cence to young adulthood: predictors and outcomes. Dev Psychopathol 16(4): 1007-1027.
  64. Witkin J, Tzavara E, Nomikos G. 2005. A role for cannabinoid CB1 receptors in mood and anxiety disorders. Behav Pharmacol 16(5-6): 315-331.
  65. Zuardi A, Crippa J, Hallak J, Moreira F, Guimaraes F. 2006. Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug. Braz J Med Biol Res 39(4): 421-429.
  66. Zuardi A, Shirakawa I, Finkelfarb E, Karniol I. 1982. Action of cannabidiol on the anxiety and other effects produced by delta 9-THC in normal subjects. Psychopharmacology 76(3): 245-250.
  67. Zvolensky M, Bonn-Miller M, Bernstein A, McLeish A, Feldner M, Leen-Feldner E. 2006. Anxiety sensitivity interacts with marijuana use in the prediction of anxiety symptoms and panic-related catastrophic thinking among daily tobacco users. Behav Res Ther 44(7): 907-924.
  68. Zvolensky M, Lewinsohn P, Bernstein A, et al. 2008. Prospective associ- ations between cannabis use, abuse, and dependence and panic attacks and disorder. J Psychiatr Res 42(12): 1017-1023.

Cited by

Sorted by citations

Authors
Crippa, J. A., Zuardi, A. W., Martín‐Santos, R., Bhattacharyya, S., Atakan, Z., McGuire, P., & Fusar‐Poli, P.
Affiliations
  • Universidade de São Paulo (BR)
  • King's College London (GB)
Corresponding author
Fusar‐Poli, Paolo
ORCID
Venue
Human Psychopharmacology: Clinical and Experimental
Publisher
Wiley
Published
2009-08-19
Volume
24
Issue
7
Pages
515-523
ISSN
  • 0885-6222 (ISSN-L)
  • 1099-1077
DOI
10.1002/hup.1048
OpenAlex
W1978062254
Cited by
509
References
10
Citations by year
2026: 12 · 2025: 18 · 2024: 49 · 2023: 32 · 2022: 34 · 2021: 53 · 2020: 38 · 2019: 43 · 2018: 34 · 2017: 33 · 2016: 26 · 2015: 29 · 2014: 28 · 2013: 17 · 2012: 32
FWCI
2.07
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Human Psychopharmacology Clinical and Experimental (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion)
  • INFM-OAR (INFN Catania) (submittedVersion, other-oa)
Funders
  • GW Pharmaceuticals
  • Fundação de Amparo à Pesquisa do Estado de São Paulo (02/13197-2)
  • Conselho Nacional de Desenvolvimento Científico e Tecnológico
  • Medical Research Council
  • Fundação de Apoio ao Ensino, Pesquisa e Assistência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo
Topics
  • Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Complementary and alternative medicine › Medicinal Plant Extracts Effects
Keywords
cannabis use, anxiety disorders, panic attacks, cannabis use disorder, anxiety prevalence, neurobiological mechanisms, causal relationship
MeSH terms
Animals, Anxiety, Cannabis, Marijuana Abuse, Humans, Databases, Bibliographic

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review