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Cannabis and Anxiety: A Critical Review

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Beletsky, Alexander, Liu, Cherry, Lochte, Bryson, Samuel, Nebiyou, Grant, Igor·2024·Medical Cannabis and Cannabinoids
DOI 10.1159/000534855PMC PMC10890807
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Abstract

Introduction: Cannabis has been reported to have both anxiogenic and anxiolytic effects. Habitual cannabis use has been associated with anxiety disorders (AD). The causal pathways and mechanisms underlying the association between cannabis use (CU)/cannabis use disorder (CUD) and anxiety remain unclear. We examined the literature via a systematic review to investigate the link between cannabis and anxiety. The hypotheses studied include causality, the common factor theory, and the self-medication hypothesis. Methods: Critical systematic review of published literature examining the relationship of CU/CUD to AD or state-anxiety, including case reports, literature reviews, observational studies, and preclinical and clinical studies. A systematic MEDline search was conducted of terms including: [anxiety], [anxiogenic], [anxiolytic], [PTSD], [OCD], [GAD], [cannabis], [marijuana], [tetrahydrocannabinol], [THC]. Results: While several case-control and cohort studies have reported no correlation between CU/CUD and AD or state anxiety (N = 5), other cross-sectional, and longitudinal studies report significant relationships (N = 20). Meta-analysis supports anxiety correlating with CU (N = 15 studies, OR = 1.24, 95% CI: 1.06–1.45, p = 0.006) or CUD (N = 13 studies, OR = 1.68, 95% CI: 1.23–2.31, p = 0.001). PATH analysis identifies the self-medication hypothesis (N = 8) as the model that best explains the association between CU/CUD and AD or state-anxiety. Despite the support of multiple large cohort studies, causal interpretations (N = 17) are less plausible, while the common factor theory (N = 5), stress-misattribution hypothesis, and reciprocal feedback theory lack substantial evidential support. Conclusion: The association between cannabis and anxiety is best explained by anxiety predisposing individuals toward CU as a method of self-medication. A causal relationship in which CU causes AD incidence is less likely despite multiple longitudinal studies suggesting so.

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  • The causal pathways and mechanisms underlying the association between cannabis use, cannabis use disorder and anxiety or mood disorders remain unclear.

    “The causal pathways and mechanisms underlying the association between cannabis use, cannabis use disorder and anxiety or mood disorders remain unclear [40].”

    From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [40]

    The Abstract’s Introduction says that the causal pathways and mechanisms linking cannabis use or cannabis use disorder with anxiety remain unclear. The claim extends that statement to mood disorders, which the cited passage does not address; the Results likewise frame the review’s hypotheses around anxiety disorders. No page numbers are available in our copy. (LLM, conf=0.91)

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  • Some individuals use cannabis to reduce symptoms of mood or anxiety disorders.

    “Research is showing that there are some individuals who use cannabis to reduce symptoms of mood or anxiety disorders [40].”

    From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [40]

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Research works printed but not linked: 52

  1. [1]Touw M. The religious and medicinal uses of Cannabis in China, India and Tibet. J Psychoactive Drugs. 1981; 13(1): 23– 34. 7024492
  2. [2]National Academies of Sciences E, Medicine, Health, Medicine D, Board on Population H, Public Health P,. The national academies collection: reports funded by national institutes of health. The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. Washington (DC): National Academies Press (US) Copyright 2017 by the National Academy of Sciences. All rights reserved; 2017. 28182367
  3. [3]Bonn-Miller MO, Sisley S, Riggs P, Yazar-Klosinski B, Wang JB, Loflin MJE,. The short-term impact of 3 smoked cannabis preparations versus placebo on PTSD symptoms: a randomized cross-over clinical trial. PLoS One. 2021; 16(3): e0246990. 33730032 PMC7968689
  4. [4]Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009; 339: b2535. 19622551 PMC2714657
  5. [5]Brook JS, Cohen P, Brook DW. Longitudinal study of co-occurring psychiatric disorders and substance use. J Am Acad Child Adolesc Psychiatry. 1998; 37(3): 322– 30. 9519638
  6. [6]Gilder DA, Lau P, Dixon M, Corey L, Phillips E, Ehlers CL. Co-morbidity of select anxiety, affective, and psychotic disorders with cannabis dependence in Southwest California Indians. J Addict Dis. 2006; 25(4): 67– 79. 17088227
  7. [7]Roberts RE, Roberts CR, Xing Y. Comorbidity of substance use disorders and other psychiatric disorders among adolescents: evidence from an epidemiologic survey. Drug Alcohol Depend. 2007; 88(Suppl 1): S4– 13. PMC1935413 17275212
  8. [8]Low NC, Lee SS, Johnson JG, Williams JB, Harris ES. The association between anxiety and alcohol versus cannabis abuse disorders among adolescents in primary care settings. Fam Pract. 2008; 25(5): 321– 7. 18753288
  9. [9]Feingold D, Weiser M, Rehm J, Lev-Ran S. The association between cannabis use and anxiety disorders: results from a population-based representative sample. Eur Neuropsychopharmacol. 2016; 26(3): 493– 505. 26775742
  10. [10]Reilly D, Didcott P, Swift W, Hall W. Long-term cannabis use: characteristics of users in an Australian rural area. Addiction. 1998; 93(6): 837– 46. 9744119
  11. [11]McGee R, Williams S, Poulton R, Moffitt T. A longitudinal study of cannabis use and mental health from adolescence to early adulthood. Addiction. 2000; 95(4): 491– 503. 10829326
  12. [12]van Laar M, van Dorsselaer S, Monshouwer K, de Graaf R. Does cannabis use predict the first incidence of mood and anxiety disorders in the adult population? Addiction. 2007; 102(8): 1251– 60. 17624975
  13. [13]Hayatbakhsh MR, Najman JM, Jamrozik K, Mamun AA, Alati R, Bor W. Cannabis and anxiety and depression in young adults: a large prospective study. J Am Acad Child Adolesc Psychiatry. 2007; 46(3): 408– 17. 17314727
  14. [15]Cheung JT, Mann RE, Ialomiteanu A, Stoduto G, Chan V, Ala-Leppilampi K,. Anxiety and mood disorders and cannabis use. Am J Drug Alcohol Abuse. 2010; 36(2): 118– 22. 20337509
  15. [17]Kedzior KK, Laeber LT. A positive association between anxiety disorders and cannabis use or cannabis use disorders in the general population- a meta-analysis of 31 studies. BMC Psychiatry. 2014; 14(1): 136. 24884989 PMC4032500
  16. [18]Stapinski LA, Montgomery AA, Araya R. Anxiety, depression and risk of cannabis use: examining the internalising pathway to use among Chilean adolescents. Drug Alcohol Depend. 2016; 166: 109– 15. 27427415
  17. [19]Swadi H, Bobier C. Substance use disorder comorbidity among inpatient youths with psychiatric disorder. Aust N Z J Psychiatry. 2003; 37(3): 294– 8. 12780467
  18. [20]Buckner JD, Schmidt NB, Lang AR, Small JW, Schlauch RC, Lewinsohn PM. Specificity of social anxiety disorder as a risk factor for alcohol and cannabis dependence. J Psychiatr Res. 2008; 42(3): 230– 9. 17320907 PMC2254175
  19. [21]Cougle JR, Bonn-Miller MO, Vujanovic AA, Zvolensky MJ, Hawkins KA. Posttraumatic stress disorder and cannabis use in a nationally representative sample. Psychol Addict Behav. 2011; 25(3): 554– 8. 21480682
  20. [22]Martin M, Ledent C, Parmentier M, Maldonado R, Valverde O. Involvement of CB1 cannabinoid receptors in emotional behaviour. Psychopharmacology. 2002; 159(4): 379– 87. 11823890
  21. [23]Degenhardt L, Hall W, Lynskey M. The relationship between cannabis use, depression and anxiety among Australian adults: findings from the National Survey of Mental Health and Well-Being. Soc Psychiatry Psychiatr Epidemiol. 2001; 36(5): 219– 27. 11515699
  22. [24]Buonomano LS, Mitnick MM, McCalmont TR, Syracuse P, Dugosh KL, Festinger DS,. Clinical characteristics and quality of life in adults initiating medical marijuana treatment. Med Cannabis Cannabinoids. 2022; 5(1): 95– 101. 35950051 PMC9247440
  23. [25]Ashare RL, Kelly E, Hajjar ER, Pant S, Meghani SH, Worster B. Characterizing anxiety, pain, sleep, and quality of life among patients in a state Medical Marijuana Program. Complement Ther Clin Pract. 2022; 48: 101612. 35667225
  24. [26]Martins SS, Gorelick DA. Conditional substance abuse and dependence by diagnosis of mood or anxiety disorder or schizophrenia in the U.S. population. Drug Alcohol Depend. 2011; 119(1–2): 28– 36. 21641123 PMC3179836
  25. [27]Gage SH, Hickman M, Heron J, Munafò MR, Lewis G, Macleod J,. Associations of cannabis and cigarette use with depression and anxiety at age 18: findings from the Avon Longitudinal Study of Parents and Children. PLoS One. 2015; 10(4): e0122896. 25875443 PMC4395304
  26. [28]Danielsson AK, Lundin A, Agardh E, Allebeck P, Forsell Y. Cannabis use, depression and anxiety: a 3-year prospective population-based study. J Affect Disord. 2016; 193: 103– 8. 26773900
  27. [29]Stewart SH, Karp J, Pihl RO, Peterson RA. Anxiety sensitivity and self-reported reasons for drug use. J Subst Abuse. 1997; 9: 223– 40. 9494951
  28. [30]Boys A, Marsden J, Fountain J, Griffiths P, Stillwell G, Strang J. What influences young people's use of drugs? A qualitative study of decision-making. Drugs Educ Prev Policy. 2009; 6(3): 373– 87.
  29. [31]Agosti V, Nunes E, Levin F. Rates of psychiatric comorbidity among U.S. residents with lifetime cannabis dependence. Am J Drug Alcohol Abuse. 2002; 28(4): 643– 52. 12492261
  30. [32]Clough AR, d’Abbs P, Cairney S, Gray D, Maruff P, Parker R,. Adverse mental health effects of cannabis use in two indigenous communities in Arnhem Land, Northern Territory, Australia: exploratory study. Aust N Z J Psychiatry. 2005; 39(7): 612– 20. 15996143
  31. [33]Schofield D, Tennant C, Nash L, Degenhardt L, Cornish A, Hobbs C,. Reasons for cannabis use in psychosis. Aust N Z J Psychiatry. 2006; 40(6–7): 570– 4. 16756582
  32. [34]Dorard G, Berthoz S, Phan O, Corcos M, Bungener C. Affect dysregulation in cannabis abusers: a study in adolescents and young adults. Eur Child Adolesc Psychiatry. 2008; 17(5): 274– 82. 18301941
  33. [35]Temple EC, Driver M, Brown RF. Cannabis use and anxiety: is stress the missing piece of the puzzle? Front Psychiatry. 2014; 5: 168. 25505428 PMC4241884
  34. [36]Streiner DL. Finding our way: an introduction to path analysis. Can J Psychiatry. 2005; 50(2): 115– 22. 15807228
  35. [37]Hollister LE. Health aspects of cannabis. Pharmacol Rev. 1986; 38(1): 1– 20. 3520605
  36. [38]Tournier M, Sorbara F, Gindre C, Swendsen JD, Verdoux H. Cannabis use and anxiety in daily life: a naturalistic investigation in a non-clinical population. Psychiatry Res. 2003; 118(1): 1– 8. 12759155
  37. [39]Steiner MA, Wotjak CT. Role of the endocannabinoid system in regulation of the hypothalamic-pituitary-adrenocortical axis. Prog Brain Res. 2008; 170: 397– 432. 18655899
  38. [40]Hill MN, Tasker JG. Endocannabinoid signaling, glucocorticoid-mediated negative feedback, and regulation of the hypothalamic-pituitary-adrenal axis. Neuroscience. 2012; 204: 5– 16. 22214537 PMC3288468
  39. [41]Roy-Byrne PP, Uhde TW. Exogenous factors in panic disorder: clinical and research implications. J Clin Psychiatry. 1988; 49(2): 56– 61. 3276668
  40. [42]Langs G, Fabisch H, Fabisch K, Zapotoczky H. Can cannabis trigger recurrent panic attacks in susceptible patients? Eur Psychiatry. 1997; 12(8): 415– 9. 19698564
  41. [43]D’Souza DC, Perry E, MacDougall L, Ammerman Y, Cooper T, Wu YT,. The psychotomimetic effects of intravenous delta-9-tetrahydrocannabinol in healthy individuals: implications for psychosis. Neuropsychopharmacology. 2004; 29(8): 1558– 72. 15173844
  42. [44]Manzanares J, Urigüen L, Rubio G, Palomo T. Role of endocannabinoid system in mental diseases. Neurotox Res. 2004; 6(3): 213– 24. 15325960
  43. [45]Fergusson DM, Horwood LJ. Early onset cannabis use and psychosocial adjustment in young adults. Addiction. 1997; 92(3): 279– 96. 9219390
  44. [46]Iversen L. Cannabis and the brain. Brain. 2003; 126(Pt 6): 1252– 70. 12764049
  45. [47]Boydell J, van Os J, Caspi A, Kennedy N, Giouroukou E, Fearon P,. Trends in cannabis use prior to first presentation with schizophrenia, in South-East London between 1965 and 1999. Psychol Med. 2006; 36(10): 1441– 6. 16854250
  46. [48]Patton GC, Coffey C, Carlin JB, Degenhardt L, Lynskey M, Hall W. Cannabis use and mental health in young people: cohort study. BMJ. 2002; 325(7374): 1195– 8. 12446533 PMC135489
  47. [49]Arendt M, Rosenberg R, Fjordback L, Brandholdt J, Foldager L, Sher L,. Testing the self-medication hypothesis of depression and aggression in cannabis-dependent subjects. Psychol Med. 2007; 37(7): 935– 45. 17202003
  48. [50]Karniol IG, Shirakawa I, Kasinski N, Pfeferman A, Carlini EA. Cannabidiol interferes with the effects of delta 9: tetrahydrocannabinol in man. Eur J Pharmacol. 1974; 28(1): 172– 7. 4609777
  49. [52]Gomes FV, Resstel LB, Guimarães FS. The anxiolytic-like effects of cannabidiol injected into the bed nucleus of the stria terminalis are mediated by 5-HT1A receptors. Psychopharmacology. 2011; 213(2–3): 465– 73. 20945065
  50. [54]Gomes FV, Del Bel EA, Guimarães FS. Cannabidiol attenuates catalepsy induced by distinct pharmacological mechanisms via 5-HT1A receptor activation in mice. Prog Neuropsychopharmacol Biol Psychiatry. 2013; 46: 43– 7. 23791616
  51. [55]Izzo AA, Borrelli F, Capasso R, Di Marzo V, Mechoulam R. Non-psychotropic plant cannabinoids: new therapeutic opportunities from an ancient herb. Trends Pharmacol Sci. 2009; 30(10): 515– 27. 19729208
  52. [56]Rioux C, Castellanos-Ryan N, Parent S, Vitaro F, Tremblay RE, Séguin JR. Age of cannabis use onset and adult drug abuse symptoms: a prospective study of common risk factors and indirect effects. Can J Psychiatry. 2018; 63(7): 457– 64. 29682999 PMC6099774

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Authors
Beletsky, A., Liu, C., Lochte, B., Samuel, N., & Grant, I.
Affiliations
  • Riverside Community Hospital (US)
  • University of California, Los Angeles (US)
  • University of California San Diego (US)
Corresponding author
Beletsky, Alexander
ORCID
Beletsky, Alexander
Venue
Medical Cannabis and Cannabinoids
Publisher
S. Karger AG
Published
2024-02-23
Volume
7
Issue
1
Pages
19-30
ISSN
2504-3889 (ISSN-L)
DOI
10.1159/000534855
PMC
PMC10890807
OpenAlex
W4392093734
Cited by
53
References
4
Citations by year
2026: 21 · 2025: 17 · 2024: 4 · 2019: 2 · 2018: 8
FWCI
2.63
Type
journal article
Language
en
Open access
Licence
Locations
  • Medical Cannabis and Cannabinoids (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • University of California, San Diego
  • Center for Medicinal Cannabis Research, University of California, San Diego
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, cannabis use disorder, anxiety disorders, state anxiety, self-medication hypothesis, causal pathways, tetrahydrocannabinol, post-traumatic stress disorder, obsessive-compulsive disorder, generalized anxiety disorder

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