On February 16, Dr. Andrew Rosen gave a talk to the Doctoral Program in Clinical Psychology at Nova SouthEast University on Multidisciplinary Treatment of Anxiety Disorders.
See the full presentation below.
As of this writing, 30 states, Guam, the District of Columbia, and Puerto Rico all have approved the broad use of medical marijuana. Additionally, other states allow limited medical use and 8 states (and the District of Columbia) allow recreational use of the drug. Even though the use of pot and weed is becoming more acceptable, the Drug Enforcement Administration (DEA) still considers marijuana to be a Schedule I substance, meaning it is likely to be abused and it completely lacks medical value. This classification also means there hasn’t been much research into the efficacy of the drug for medical conditions and, in particular, we lack long-term studies that would tell us whether it is safe and/or effective when used over a long period of time.
What we do know is that, in clinical practice – both in our practice and in discussions with colleagues in other practices – mental health professionals are seeing an increase in the number of incidents of anxiety, panic attacks, depression, and even psychotic reactions now that marijuana use has become more mainstream.
Did you know that:
Whether it’s used recreationally or medicinally, both forms of pot are the same product. The medical version contains cannabinoids just like recreational marijuana. Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are the main chemicals found in the medical form.
Although medical marijuana is used for many conditions (among them: multiple sclerosis (MS), cancer, seizure disorders, and glaucoma), its efficacy hasn’t been proven. “The greatest amount of evidence for the therapeutic effects of cannabis relate to its ability to reduce chronic pain, nausea and vomiting due to chemotherapy, and spasticity [tight or stiff muscles] from MS,” says Marcel Bonn-Miller, PhD, a substance abuse specialist at the University of Pennsylvania Perelman School of Medicine.
As noted above, there aren’t many studies on the relationship between marijuana use and mental illnesses, such as anxiety, depression and bipolar disorder yet. However, research done in 2017, examined marijuana use in conjunction with the depression and anxiety symptoms of 307 psychiatry outpatients who had depression (Bahorik et al., 2017). This study found that “marijuana use worsened depression and anxiety symptoms; marijuana use led to poorer mental health functioning.” In addition, the study determined that medical marijuana was associated with reduced physical health functioning.
Part of the problem with using marijuana either recreationally or medically is that there is no way to regulate the amount of THC you’re getting, because the Food and Drug Administration (FDA) doesn’t oversee the product. This means not only the ingredients, but the strength of them can differ quite a lot. “We did a study last year  in which we purchased labeled edible products, like brownies and lollipops, in California and Washington. Then we sent them to the lab,” Bonn-Miller says. “Few of the products contained anywhere near what they said they did. That’s a problem.”
Another area of concern is that, as we know from regulated psychiatric medications, one dose may affect you differently than it affects your sibling or a friend. People are unique – each person’s reaction to a medication will vary, which is why psychiatric medications are monitored by the prescribing doctor so that the dosage can be adjusted for your specific needs.
In summary, if you choose to use marijuana either medically or recreationally, be careful. Talk to the doctor who authorized it, or speak with a mental health professional if you find yourself experiencing the symptoms of depression or anxiety, or if you have panic attacks that begin or worsen while you are using pot. Additionally, be sure your doctor knows your psychiatric history before they authorize medical marijuana for you, especially if you have been diagnosed with anxiety, depression, panic attacks, bipolar disorder, or psychosis.
We can help! The mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida can answer your questions about how medical or recreational marijuana use can affect your anxiety, depression, or other condition. For more information, contact us or call us today at 561-496-1094.
Resource: Bahorik, Amber L.; Leibowitz, Amy; Sterling, Stacy A.; Travis, Adam; Weisner, Constance; Satre, Derek D. (2017). Patterns of marijuana use among psychiatry patients with depression and its impact on recovery. Journal of Affective Disorders, 213, 168-171.
Dr. Andrew Rosen, Board Certified Psychologist, founder and director of the Center for Treatment of Anxiety and Mood Disorders and Dr. David Gross, Board Certified Psychiatrist, and medical director of the Center recently held a webinar on using medication versus therapy for anxiety and depression with The Anxiety and Depression Association of America. Some of the topics covered in the webinar include: What are the roles of medication and therapy? How can my psychiatrist (or primary care doctor) and my therapist work together as a team? How soon can I expect to see results from medication? How soon can I expect to see results from cognitive-behavioral therapy (CBT)? Are there situations where medication and CBT can work great together?
Watch the webinar here:
Recorded on April 21, 2017 for the Anxiety and Depression Association of America (www.adaa.org) © ADAA 2017
If you’re like most people, you don’t exactly love visiting the doctor. But for some, the anxiety they experience is so overwhelming they avoid any form of health care whatsoever – in some cases for decades.
David Yusko, clinical director at the University of Pennsylvania‘s Center for the Treatment and Study of Anxiety, treats patients with iatrophobia – the medical name for fear of doctors. He says the phobia probably affects about 3 percent of the population.
Such people can be helped by exposure therapy – in which they’re gradually confronted with medically related images, items and scenarios in rising order of fear-provoking power.
When Yusko treats these patients, he says their anxiety is obvious: “They’ll wring their hands; they’ll cross their arms or legs; or they’ll try to turn their body away from the image or hide their eyes from it. They’ll talk about their heart beating quickly, their hands getting sweaty and feeling dizzy or nauseous.”
Cascade of Fear
The biggest fear for many patients is fear of the unknown, says Andrew Rosen, director of The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida. Needle phobia is also common, Rosen says, above and beyond the distaste most people have when faced with an injection or blood draw. When he talks patients through exaggerated fears, it often turns out they’ve imagined excruciating pain that could last for hours.
“The person doesn’t know what’s going to happen to them once they step in the door. Usually a person who’s anxious fills in the blanks with bad things: ‘I’ll be hurt.’ ‘I’ll be mistreated.’ ‘I’ll be diagnosed with some terrible disease,’” Rosen says. “It’s the fear of pain, bad news, cancer, the hospital.” It’s a cascade in which a patient could go “from A to Z in two seconds,” he adds.
Anticipation Equals Dread
Doctor anxiety wasn’t an issue for Virginia Lounsbury, of Gulf Stream, Florida, until 2009, when she was hit with a debilitating illness at age 38. She underwent a barrage of treatments and multiple hospitalizations until the life-changing diagnosis – postural orthostatic tachycardia syndrome, or POTS, a rare genetic condition – came 2.5 years later.
By then, she had developed a full-blown fear of doctors and health care facilities. It reached the point where she needed help managing her anxiety, which brought her to Rosen’s center.
Rosen walks Lounsbury through scenarios in advance, starting with her rising anxiety as the car enters the parking lot and she approaches a medical center. “It’s a building – it’s concrete,” she recalls him saying. “You can’t be afraid of concrete.”
Because she’s claustrophobic, spending 90 minutes in an MRI tube is among her least favorite experiences. But for Lounsbury, the waiting room is the hardest part. “All those TVs [are] on – any doctor you go to,” she says. “And it’s all this medical news, which is never good.” She describes hearing dire cancer statistics emanating from a TV as she once waited her turn for a mammogram.
To cope with future visits, she and Rosen came up with a plan: Pack a bag with items for distraction, find a quiet waiting room corner away from the intrusive TV and read, do needlepoint or check email.
Ah, the Dentist
One underlying cause of doctor fear is the increasingly impersonal nature of health care, according to Rosen. But when it comes to dental care, the experience may be too personal.
“If I’m going to work on you as a dentist, I’m going to get pretty close,” says Matthew Messina, consumer advisor for the American Dental Association. “There’s kind of that invasion of personal space aspect. So I have to respect that in patients.”
With extremely phobic patients, he says, most have had some bad experience recently or in the past, perhaps with a dentist or while in the hospital, and the memory could be long repressed. “They may have been restrained in the emergency room,” he says. “Those kinds of things can create very deep-seated fears where dentistry and medicine all sort of get lumped together.”
Messina, who has a private practice in Fairview Park, Ohio, says he wishes dentist avoiders would put aside their fear long enough to sit down in his office – just to talk. “We have to confront the fear and name it,” he says. “Then we can have a chance at overcoming it.’”
Motivation to Change
Getting someone with extreme fear back into the health care system is a hard sell. Rosen recalls a patient in her 50s who hadn’t had a breast cancer screening or seen a gynecologist in 25 years.
For some patients, it takes a crisis like a heart attack or appendicitis to accept treatment. Others finally acknowledge the need for preventive care and routine screening. Yusko says he’s had several cases of women whose plans to eventually have children motivated them to overcome their medical fears.
Exposure Therapy in Action
With exposure therapy, Yusko says patients confront a hierarchy of anxiety in the safe, supportive environment of his center. Images – of stethoscopes or syringes, for instance – would be lower-hierarchy items. From there, therapy could move on to viewing videos or TV shows like “Grey’s Anatomy” that feature medical procedures.
Next, the patient might stand outside the hospital in the parking lot. Actually seeing a needle, or being in the same room as a needle, would be another step. And because a nurse works in the center, Yusko says patients get a chance to come face to face with a medical professional.
Other Treatment Options
Different types of talk therapy and relaxation techniques may also help. While medications can ease short-term anxiety, they don’t address the root of the doctor phobia and most often aren’t needed, physicians say.
With dentistry, the situation is somewhat different. Messina says some patients may benefit from techniques including medication, biofeedback and hypnosis. For procedures like wisdom-tooth removal, sedation may be warranted, he says, but there is a risk-benefit ratio involved, and “using sedation to clean someone’s teeth [is] probably a higher level of medical risk than we’d like to take on.”
Dealing With It
Of their patients who’ve gone through exposure therapy, the vast majority can now manage their anxiety and receive medical care, Yusko and Rosen say.
Lounsbury, who’s started a foundation to help others with her condition, says she’s coping better with her anxiety. Acupuncture works for her (for those scared of needles, laser acupuncture or acupressure are alternatives). To people who share her fears, she offers these words of encouragement: “The main point is, wherever you are, it’s only temporary. Nobody’s ever gone to the doctor forever.”