Cannabis and mental health: anxiety, psychosis and dependency

The relationship between cannabis and mental health is one of the most important and, at the same time, most poorly understood topics in the debate about this substance. It is often approached from extreme positions: those who present it as a natural remedy for anxiety and those who describe it as the direct cause of madness. Neither version does justice to reality. To truly understand the connection between cannabis and mental health, especially with regard to anxiety, psychosis and dependence, requires a nuanced, evidence-based view.

This article aims to offer that view. Not to frighten nor to reassure artificially, but so that those who use or are considering using, and those who accompany a loved one who does, have honest information about what we know and about the risks worth bearing in mind.

How cannabis acts in the brain

The main agent responsible for the psychoactive effects of cannabis is THC, a compound that acts on the endocannabinoid system, a network present in our brain that takes part in regulating mood, memory, appetite, sleep and the response to stress. When THC binds to the receptors of this system, it alters their normal functioning, which explains both the sensation of relaxation or euphoria and the less desirable effects.

This system is especially important during the development of the brain, which does not finish maturing until around the age of twenty-five. That is why cannabis use in adolescence and early youth is a particular concern: it can interfere with brain maturation processes that are delicate and, to some extent, irreversible.

Cannabis and anxiety: a double-edged relationship

Many people use cannabis precisely to calm anxiety, and in the short term they may experience a sensation of relaxation. However, the relationship between cannabis and anxiety is more complex and, often, paradoxical.

Immediate relief and the rebound effect

The relief that cannabis provides is temporary. When the effect wears off, it is common for the anxiety to return, sometimes with greater intensity. With regular use, the brain adapts and the person may begin to need the substance simply to keep at bay an anxiety that, to a large extent, the continued use itself feeds. This creates a circle: one uses to calm the anxiety, and that use ends up generating more baseline anxiety, which pushes one to use more.

Anxiety during intoxication

Cannabis, especially in high doses or with a high THC concentration, can cause acute anxiety attacks during the intoxication itself: rapid heartbeat, a sense of imminent danger, racing thoughts and panic attacks. These experiences, far from calming, are highly distressing.

Anxiety in withdrawal

On stopping use, anxiety is one of the most frequent symptoms of withdrawal syndrome. This reinforces the false idea that "cannabis took away my anxiety", when in reality much of that anxiety is a consequence of the dependence itself. Distinguishing the original anxiety from that generated by use is an important part of therapeutic work.

Cannabis and psychosis: what the evidence says

This is the point that generates the most fear and the most confusion, and it deserves to be explained carefully so as to fall into neither alarmism nor minimisation.

Psychosis is a state in which contact with reality is lost, with symptoms such as delusions (firmly held false beliefs), hallucinations (perceiving things that do not exist) and disorganised thinking. It is not the same as "going mad" in the colloquial sense, but a specific clinical condition.

What we know

The scientific evidence consistently shows that there is an association between cannabis use and a greater risk of suffering psychotic episodes. This risk is higher when several factors coincide:

• Heavy and frequent use.
• Onset of use in adolescence.
• Use of cannabis with a high THC concentration.
• The existence of a personal or family predisposition or vulnerability.

What needs to be qualified

This does not mean that cannabis causes psychosis in anyone who uses it. Most people who use it do not develop a psychotic disorder. What the evidence suggests is that cannabis acts as a risk factor that, in vulnerable people, can precipitate or bring forward the appearance of a problem that might not have manifested, or might have done so later and in a milder form. It is an important distinction: it is not a single, direct cause, but a factor that adds to others.

There is also cannabis-induced psychosis, an acute psychotic episode that appears in direct relation to use, especially in heavy intoxications. Although it usually subsides, in some people it can be the prelude to a more persistent disorder.

Cannabis and depression

Beyond anxiety and psychosis, regular cannabis use has also been linked to a greater risk of depressive symptoms, apathy and lack of motivation. The so-called "amotivational syndrome", although disputed, describes a pattern of disinterest, passivity and difficulty in setting goals that many heavy users recognise in themselves. Determining to what extent the apathy is a cause or a consequence of use can be difficult, but clinical experience shows that, on stopping use, many people recover energy, motivation and enthusiasm.

Dependence and its relationship with mental health

Cannabis dependence and mental health problems usually feed each other. It is common for a person to use in order to relieve emotional distress (anxiety, insomnia, sadness) and for that use, over time, to worsen the distress it was meant to calm. This establishes a circular relationship in which it becomes hard to know which came first, the emotional problem or the use.

When an addiction and a mental health problem coexist, we speak of dual pathology. Treating only one of the two parts is usually insufficient: if the anxiety is addressed without touching the use, the use will keep feeding it; and if only the use is addressed without attending to the underlying distress, the person will tend to relapse, seeking in cannabis the relief they cannot find in any other way. That is why the most effective approach considers both dimensions at once.

The role of age of onset

A factor that runs through everything above is age. The adolescent brain is especially sensitive to the effects of cannabis because it is in full development. Use at these ages is associated with a greater risk of dependence, a greater impact on cognitive functions and a greater likelihood of mental health problems. Delaying the age of onset of use is therefore one of the most protective measures available to us, and a weighty reason to pay particular attention to use in adolescents and young people.

Warning signs to pay attention to

It is worth being alert to certain signs that indicate cannabis may be affecting mental health:

• Increased anxiety, especially when not using.
• Ideas of distrust or of feeling watched or judged.
• Progressive social isolation.
• Apathy, lack of motivation and abandoning activities.
• Sleep disturbances.
• Difficulty giving up use despite noticing these effects.

In the face of experiences such as hallucinations, delusions or a disconnection from reality, it is important to seek professional attention as soon as possible, since early intervention greatly improves the prognosis.

A relationship that can be turned around

The final message is not one of fear, but of possibility. The relationship between cannabis and mental health can be turned around. Many people who stop using experience a notable improvement in their anxiety, mood and mental clarity within a matter of weeks or months. The brain has a capacity for recovery, and much of the effect on mental health improves with abstinence and the right support.

Using cannabis to self-medicate distress

A very frequent pattern deserves special attention: the use of cannabis as a form of self-medication. Many people do not use it seeking euphoria, but relief. They use it to sleep, to calm anxiety, to cope with painful memories or to switch off an emotional distress they do not know how to manage in any other way. From the outside it can look like controlled, sensible use, and even the person doing it experiences it as a solution rather than a problem.

The drawback is that this strategy, effective in the short term, tends to worsen the underlying problem over time. The sleep obtained with cannabis is of poorer quality; the anxiety calmed today returns tomorrow reinforced; and the emotional distress that is covered up is never worked through, so it remains intact beneath the surface. The person is left trapped in a dependence that prevents them from developing their own resources to face what makes them uncomfortable, because the quick way out is always at hand.

Detecting when cannabis serves this function of emotional patch is key, because it completely changes the treatment approach. It is not enough to withdraw the substance: real alternatives must be offered for managing whatever was being covered up with it. Otherwise, the void left by the use becomes unbearable and relapse almost inevitable.

If you feel that cannabis is affecting your emotional wellbeing, if you use it to manage anxiety or mood and notice that the situation is not improving, or if you are worried about the use of someone close to you, at Reconectar we can help you. We offer outpatient, individual and personalised treatment that takes into account both the addiction and the emotional distress that usually accompanies it, in a confidential and close setting in Las Palmas de Gran Canaria. Consulting a professional commits you to nothing, but it can help you understand what is happening and find a way to recover your balance. We are here to accompany you in that process.