May 07th, 2020

Stress, Cannabis, Prescription Meds, Quarantine! How to balance it all ?

“Stress can make people feel like they are in a fog all the time or that everything is moving in slow motion. Sound familiar?

These days, most patients are contacting me for three reasons: 1) insomnia, 2) anxiety 3), and managing PTSD symptoms, all of which are stress related. So I thought it was a good time to address the relationship of COVID-19, stress and cannabis. When used correctly, cannabis can help put you in a relaxed state which makes it a key ally in fighting stress—and there are several biochemical reasons why this so. This blog is based on the most common questions I’m getting from my patients.

Why do I feel so out-of-focus? I was going to use some of this extra time to learn tap dancing and read Proust but I’ve never been less productive.
I’m not sure cannabis can help you finish Proust but it can certainly soothe your stress responses, which could encourage your productivity.

Intense trauma can temporarily rewire the body’s nervous system and trigger our sympathetic nervous system which activates our “flight or fight” response. Keeping up with COVID-19 can put your nervous system into a constant white-knuckled, holding-on-for-dear-life response. Hyperarousal means increased blood pressure and adrenaline. Short, fast breathing and heartbeat. Short-tempers and blown fuses. It can also cause people to re-experience traumatic memories that cause a vicious cycle of being too agitated to relax and too stressed to sleep. These changes can impair the immune system’s ability to respond to acute and chronic infections and can disrupt digestion, sleep, focus, and libido. It can also make people feel like they are in a fog all the time or that everything is moving in slow motion. Sound familiar?

But I haven’t been traumatized. I’m just constantly worrying about my health, my family’s health, the health of the economy.  
You don’t have to be directly exposed to a traumatic event. Right now fear is more prevalent than the virus. Simply contending with overwhelming situations and information or sensory overload can affect some people so profoundly that they develop symptoms of PTSD. These symptoms can include:
·      Anxiety
·      Sensitivity to light and sound 
·      Insomnia due to racing mind or trouble staying asleep
·      Irritability and jumpiness
·      Emotional sensitivity
·      Heart racing/palpitations
·      Blood pressure changes
·      Digestive issues 
 
Cannabis is a holistic, integrative plant medicine that can ease the body into a state of calm. When used correctly, it can:
·      improve mood
·      reduce anxiety 
·      promote restorative sleep
·      suppress nightmares. 
 
How can cannabis help anxiety and stress?
Did you know that our brains make their own internal cannabis molecules? It’s true. And one of them, anandamide (named after the Sanskrit word for bliss, ananda), helps temper stress and balance the nervous system, so we are not spiraling out of control on a high sympathetic overdrive.  

Take, for example, forgetting. Forgetting is a crucial aspect of treating anxiety, stress, and PTSD. Trauma survivors have been found to have problems with neurotransmitter signaling of serotonin and glutamate, which also correlate with the fight-or-flight response. Excessive glutamate signaling will lock in painful fear-related memories. Cannabinoids can help release these painful memories by facilitating memory extinction. This helps survivors switch off those traumatic memories. 

Here’s some deep chemistry to explain how this occurs. Cannabis mediates the neurotransmitter GABA (gamma-aminobutyric acid). GABA signals to our body that we are safe and directs the body to relax and power down. It helps to reduce anxiety, foster sleep, and relax the muscles. CBD and THC tell the brain to increase the flow GABA, which creates the quieting and calming effect. My patients report it works to“take the edge off and turn the volume on anxiety and stress way down. Once their racing thoughts and the “fight or flight” response tail off, patients say they feel better, “more comfortable in their own skin.” They can often quell racing thoughts that paralyze them at work or cause them to lie awake at night.

If you’re not an experienced cannabis user I recommend starting with CBD, which can ease the body into a state of “calm focus,” or very low amounts of THC in conjunction with CBD. Sometimes, just a few puffs on a vaporizer or no more than 2.5 mgs of THC will do the trick. You can always add more if you want more relief.

 It seems that my girlfriend is responding to cannabis so much more strongly than me (I’m a guy). Are there gender differences?

Not only do women and men respond to cannabis differently, they also respond differently to PTSD yet almost no one is aware of this. Statistics show that women suffer twice as much PTSD as men but because the majority of the trauma research focuses on male combat veterans this is overlooked. According to the National Center for PTSD, around 10% of women have PTSD sometime in their lives compared to 4% of men.

Thanks to the hormone estrogen, women are more sensitive to the effects of the cannabinoids and terpenes in the plant. We experience several distinct physiological changes throughout our lives (pregnancy, menopause) that drastically alter the amount of estrogen in our system. Understanding how cannabis can help us regulate hormonal flux and ease these transitions can be a revelation for women interested in health and wellness. Estrogen makes women more sensitive to cannabis, primarily THC. THC and your hormones interact quite a bit so your cycle can influence your high.
Researchers at Washington State University found that women experience the effects of THC most powerfully when their estrogen has peaked and is beginning to fall. This happens a day or two before you ovulate. Preclinical studies have shown that the interaction between estrogen and THC makes women more sensitive to the compound in general, which is why they seem to get more benefit out of the herb as a chronic pain fighter than men.

My husband is so much more carefree than I am. He also uses more cannabis. What’s the relationship between high use and low stress?

Recent neuroscience research has shown that certain lucky people have a genetic variation in the brain that makes them inherently less anxious and more able to forget unpleasant experiences. These folks, whom you categorize as carefree, also have brains that produce higher levels of anandamide, the body’s own version of THC. Normal endocannabinoid system functioning helps people’s nervous systems to reset and re-calibrate more quickly after stress exposure. Researchers and clinicians agree that vulnerability to PTSD and resilience to stress are the result of an interaction between ECS, genes and environment.

How much cannabis should I use to keep my stress at bay?
That’s the big question with cannabis meds. Everyone’s endocannabinoid system  is different and people’s experience with cannabis makes a difference when it comes to dosing. My15 years of treating patients with cannabinoid medicines have taught me that patients who are willing to experiment to create their own personal dosing regimen get the best results.

The "Start Low, Go Slow, Stay Low" dosing method begins with a CBD product, which you take in low doses (5-15 mgs) two to four times daily. You can increase the dose every 1 or 2 days until you feel relief. If you get no relief after a few weeks, try adding in a small amount (2.5 mgs of a tincture or a few vapor puffs) of THC to activate the CBD. Escalate your dose until you find relief. Inexperienced users may want to work with a health coach to get started. Experienced users will be more familiar with adjusting their doses to find optimal relief. The dosing guide below lists the average activation times and length of time effects will last. Refer to it until you are familiar with the timings.
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Tips for Increasing Your Dose
After 3 or 4 dosing cycles, you’ll know if you need more relief. If you do, there are three ways of proceeding.
·      Increase the amount of each dose of CBD
·      Increase the frequency of dosing – i.e., go from twice a day to every four hours
·      Add small amounts of THC to each dose of CBD and chart the effects.

The doses of THC in this method are very low and calibrated so that you don’t feel high. You may feel slightly elevated at first but you won’t feel out of control if you follow these guidelines. Any feelings of being altered will diminish after a few days. If it feels too strong, simply lower your dose of THC. Unless you are an experienced user we recommend not exceeding 5mg THC to start.

You’ll also learn what works best for you faster if you keep a record of how much you’re taking and how it’s making you feel. You can share this with your practitioner.  The goal is to reduce symptoms without causing impairment, decreasing motivation, or increasing avoidance behaviors. 

Other than using cannabis, what else can I do to calm myself immediately?

The other side of the sympathetic nervous system is the parasympathetic nervous system, which releases all sorts of chemicals to help us feel relaxed and safe. The parasympathetic system regulates our digestion, our connection to others and our sleep, which is the only time the body can repair itself.  Cannabis helps to ease the body into the parasympathetic nervous system.
In her upcoming book, Good Chemistry, the psychopharmacologist Dr. Julie Holland lists a few things patients can do to flip from “fight or flight” into the “tend and befriend” mode. I’ve used some of these techniques with patients over the years and though they may sound simple, they work.

Breathe through your nose. Believe it or not, simply breathing through your nose for five or ten minutes can trigger the parasympathetic nervous system and snap you out of fight or flight. This is because taking shallow breaths through the mouth can trigger the sympathetic nervous system.
 Balance the flow of negative thoughts. If you can’t stop thinking about how terrible things are at least give equal time to fantasizing about other things working out ok, or even well.  

Sing, chant, or make music.

Swim or float on your back with your arms and legs wide. If you can get to a sensory deprivation tank where it’s dark and quiet, the body can stop paying attention to sensory input and the mind can be more free.

Havening. This is a self-soothing technique in which you cross your arms like you’re hugging yourself. There are plenty of videos online.

Do nothing. Put down your phone. Get off your screens. Focus on your breath or something in your field of vision. As Julie writes, “Try to be as fascinated by your breath as your Instagram feed. If you stop what you’re doing, sit down, pay attention to your breath instead of what you’re going to make for dinner, don’t tell anybody, but you’re meditating.”
Get out in nature. Cannabis helps connect you to your body and to the natural world. The vastness of natural world can help you put your concerns in perspective.​