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How Using Marijuana Affects Panic Disorder
Before discussing this issue it is important to quickly differentiate the difference between having a diagnosis of panic disorder, having an occasional panic attack, or just being anxious or nervous. A lengthier explanation of this differentiation can be found in references.
Panic attacks are very intense periods of anxiety that develop very quickly and typically peak in about 10 minutes. They can be triggered by some stimulus or can occur spontaneously. Having an occasional panic attack is not uncommon and the difference between someone who has an occasional panic attack and someone who has panic disorder has to do with how a person responds to having panic attacks. Having panic disorder indicates that the person experiences panic attacks relatively often and that the person is reacting to having recurrent panic attacks in a manner that negatively affects other aspects of their life. Thus, a person that experiences a panic attack does not necessarily have panic disorder. Panic disorder is diagnosed by a trained mental health professional; a person cannot diagnose themselves.
Experiencing periods of nervousness or anxiety associated with some event is a common occurrence that everyone will have. Thus, being nervous is quite common and represents less intense anxiety panic attack. A panic attack is a brief period of intense anxiety. Having a panic disorder diagnosis indicates an individual experiences numerous panic attacks and reacts to these in a specific way.
The focus of this discussion is on how the use of marijuana affects a person who is been diagnosed with panic disorder, not on how marijuana affects a specific panic attack or how marijuana effects the common experience of nervousness or anxiety.
What is Panic Disorder?
People who are diagnosed with panic disorder have recurrent panic attacks. A number of things can trigger these panic attacks including any type of stimulus that increases their heart rate or breathing. While panic attacks often come “out of the blue” meaning that they are random, some people experience panic attacks to specific situations such as leaving their house, being in a crowded area, etc. In all these situations the person experiences what is called autonomic nervous system arousal or an increase in heart rate, breathing, skin temperature, etc. Many people who use marijuana report that its initial effects are calming and sedative, thus some people may think that marijuana is a natural remedy for panic disorder.
Can Marijuana Be Used To Treat Panic Disorder?
Overall the research does not support the notion that panic disorder should be treated with marijuana. Initially using marijuana leads to relaxation, a feeling of euphoria, an intensification of sensory experiences, and distortions of the perception of time and other sensory perceptions like vision, hearing, etc. However, the most common physical reaction to marijuana use is an increase in heart rate.
A common issue in people who have been diagnosed with panic disorder is that they often develop what are known as “anticipatory panic attacks.” What this means is that if a person with panic disorder experiences a sudden increase in their heart rate they often interpret this as a sign of an impending panic attack. This interpretation often makes them more anxious which leads to an increased heart rate and breathing, leading to increased anxiety, etc. until the person actually experiences a panic attack. Thus, marijuana use can very easily trigger a panic attack in a person is been diagnosed with panic disorder.
Moreover, it is well established that the most common side effect of marijuana use is anxiety and/or panic attacks, although there is some debate is to why this is so. Thus, even though on the surface many would believe that the calming and sedative effects of using marijuana would be conducive to treating panic disorder, the empirical research actually indicates that the opposite is most likely to happen in the long run. So the majority of the research on panic disorder and marijuana use indicates that marijuana is not a solid treatment choice for the vast majority of people who are diagnosed with panic disorder. There may be some initial feelings of decreased anxiety with use, but over the long-term it appears that marijuana use in the majority of individuals who have panic disorder is detrimental.
However, research findings are always conditional. For instance, there still is quite a bit of speculation as to whether or not marijuana may be useful in treating anxiety disorders like panic disorder if specific therapeutic dosage ranges could be determined that would reduce the possibility of side effects. This would require a lot of research and in individual cases quite a bit of trial and error to determine specific therapeutic ranges for specific individuals.
In addition, there appears to be a relationship between substance abuse and having an anxiety disorder, however, the research has not yet formally determined any particular type of causal mechanism such that for example marijuana use actually leads to being diagnosed with an anxiety disorder, people with an anxiety disorder are using marijuana for self-medicating their disorder, etc. Thus, while currently is not advisable to use marijuana to treat and anxiety disorders such as panic disorder, in the future it is quite possible that therapeutic guidelines could be established. However, there are no reliable guidelines at the time of this writing.
The bottom line right now is that anyone diagnosed with panic disorder should not attempt to use marijuana as a treatment for their anxiety as in the long run this will only make things worse.
 American Psychiatric Association. (2013). The diagnostic and statistical manual of mental disorders (Fifth edition). Washington, DC: Author.
 Hatfield, R. C. (2013). The everything guide to coping with panic disorder. Avon, MA: Adams.
 Crippa, J. A., Zuardi, A. W., Martín?Santos, R., Bhattacharyya, S., Atakan, Z., McGuire, P., & Fusar?Poli, P. (2009). Cannabis and anxiety: a critical review of the evidence. Human Psychopharmacology: Clinical and Experimental, 24(7), 515-523.;Zvolensky, M. J., Cougle, J. R., Johnson, K. A., Bonn-Miller, M. O., & Bernstein, A. (2010). Marijuana Use and Panic Psychopathology Among a Representative Sample of Adults. Experimental and Clinical Psychopharmacology, 18(2), 129–134.
 Cheung, J. T., Mann, R. E., Ialomiteanu, A., Stoduto, G., Chan, V., Ala-Leppilampi, K., & Rehm, J. (2010). Anxiety and mood disorders and cannabis use. The American journal of drug and alcohol abuse, 36(2), 118-122.
Dr. Hatfield is a clinical neuropsychologist with extensive experience assessing and treating neurological and psychiatric disorders. His areas of expertise include neurobiology, behavior, dementia, head injury, addiction, abnormal psychology, personality disorders, statistics, rehabilitation psychology and research methodology.