Weed can be relaxing. It can make you feel good. It’s cheaper than therapy. And it’s now legal for recreational use in 19 states. So it’s not surprising that my patients keep asking me, “A little pot can’t hurt, right?” Nobody ever wants to hear a pause right after they drop that question—especially when there’s some legit research into weed as a treatment for anxiety, PTSD, and insomnia. But the fact is, when it comes to mental health, cannabis is a little squishy.
It’s been ten years since the first states legalized recreational weed, and a big research report by the National Academies of Sciences, Engineering, and Medicine says there’s conclusive evidence that it gets you more than high. Cannabis and the cannabinoids in it (compounds that interact with receptors that control sleep, pain management, eating, emotional processing, and other functions) have medical effects on your body, particularly for chronic pain, muscle spasticity from MS, and nausea from chemotherapy.
Yet there are so many questions to tackle and so many intricacies and so many cannabinoids being studied that there’s no standardized playbook yet. The FDA hasn’t approved cannabis for any mental-health conditions, and the American Psychiatric Association doesn’t recommend it, either. Of course, nobody’s waiting for official approval before testing whether it can take the edge off the Sunday Scaries or other issues, so I make sure my patients know these things:
Weed can improve anxiety. Weed can also make it worse.
To cut through the complexities, I checked in with one of the most informed weed scientists today, Staci Gruber, Ph.D., director of the Marijuana Investigations for Neuroscientific Discovery (MIND) program at McLean Hospital. She confirmed that cannabis with a low concentration of THC, the ingredient that makes you high, but with high concentrations of other, nonintoxicating cannabinoids can improve anxiety. The high-THC stuff—often considered to be anything over 10 percent THC—can worsen anxiety for some.
Unless you’re going to a dispensary, it’s hard to know how much THC, or any of the other 400 chemically active ingredients in cannabis, you’re getting. Right now, the best you can do—other than buy it from a reputable source and “start low and go slow”—is pay attention to its effects. If you always get paranoid or have mood swings, maybe high-THC cannabis is the cause. Or maybe there’s something more useful for your anxiety, like therapy, meditation, talking with supportive people, or those things plus cannabis.
Weed can put you to sleep, but so can figuring out why you’re not sleeping.
The problem with using cannabis products for sleep is that there’s probably a reason you’re not sleeping and it’s better to treat that than to soothe your racing mind with THC. Consider a patient I’ll call Jackson, a guy in his 40s who worked in sales. “I’m not doing well at work, and worrying keeps me up at night,” he told me. Jackson enjoyed weed socially, but over the previous couple months it had turned into a nightly habit. “It’s the only thing that helps me sleep,” he said. When it comes to sleep, Gruber confirms that some cannabinoids, including THC, CBD, and one called CBN, do help some people. But Jackson had other symptoms—like being unfocused at work, feeling down most days, and not having much of an appetite—that led me to diagnose him with major depressive disorder and prescribe an antidepressant. Within a few weeks, he was sleeping better, feeling more upbeat, and smoking less.
It’s also worth noting that for both sleep and anxiety, often “products with little to no THC and higher levels of nonintoxicating cannabinoids like CBD are very helpful,” Gruber says.
It’s important to tap into why you’re taking cannabis.
I ask patients what’s driving them to cannabis. As with any other drug, relying on it can become an unhealthy coping strategy. I’m not against using something to change your mood. But with prescription meds, for instance, they’re usually combined with talk therapy and monitoring by a mental-health professional. Cannabis can be one of the many factors related to the manifestation of psychosis, and people with a family history of psychosis may be at higher risk. THC may also exacerbate symptoms if you have schizophrenia or bipolar disorder.
So when my patients say, “A little pot can’t hurt, right?” I explain all this, as well as why it’s important for them to be up-front with themselves about whether it’s helping or masking their issues and if another approach might work better.
This story originally appeared in the November 2022 issue of Men’s Health.
Gregory Scott Brown MD is a board-certified psychiatrist and Men’s Health advisor. He is an affiliate faculty member at the University of Texas Dell Medical School and author of The Self-Healing Mind: An Essential Five-Step Practice to Overcoming Anxiety and Depression, and Revitalizing Your Life.