Help me find some new drugs
August 3, 2009 6:23 AM   Subscribe

I use to self-medicate with marijuana for my social-anxiety and low-level depression...can that fact be used to direct me towards a specific antidepressant?

Several years ago I was smoking pot very regularly - it was essentially a miracle drug for my semi-severe social anxiety. It would totally relax me around other people, even strangers, and allow me to speak, smile, and have an otherwise "normal" social life.

After a couple bad experiences, and several months of being alone and smoking by myself regularly, it completely turned on me and now I can't even smoke with my good friends without having a complete freakout of social paranoia...

I've been wondering...I have tried a number of SSRI's, with only very subtle improvements in my social anxiety and overall mood. I'm still searching for a better solution to supplement therapy. Is there any research on how cannabis acts on the brain, specifically with regards to anxiety and depression, which might point me towards a specific antidepressant to try?

Research or anecdotal information - any help would be appreciated. Thanks!
posted by anonymous to Health & Fitness (13 answers total) 1 user marked this as a favorite
Are you seeing a therapist? After having a couple of sever panic attacks resulting from social anxiety (one of these occurring after smoking pot) I saw a therapist, did some cognitive behavioural therapy (CBT) and took (IIRC) Celexa/Citolopram, to considerable success. I didn't take the pills for long though... I found the CBT the most helpful part. The pills just help you chill out a bit at first.
posted by molecicco at 6:41 AM on August 3, 2009

This is just a shot in the dark, but maybe you could try Marinol? I don't know whether your condition would warrant on-label treatment, but it seems worth a try.
posted by alms at 6:57 AM on August 3, 2009

Your doctor might be another resource for up-to-date research. I'm sure it won't be the first time a doctor's heard of someone self-medicating with pot, and they get all kinds of journals and access to research information, and such, that most non-doctors do not read.
posted by Houstonian at 6:59 AM on August 3, 2009

You should consult a professional instead of asking strangers on the internet.

Treating depression and anxiety takes patience and consistency.
posted by wfrgms at 7:00 AM on August 3, 2009 [2 favorites]

Have previously been in a relatively similar situation in life. SSRI's might not be the right path, though. Personally I had found amphetamines (Adderall) to be a wonderful mediator when it comes to controlling the range of moods and anxiety available to my brain at any given point.

Granted, IANAD, and what works for me may not necessarily work for anyone else. Speak to a doctor, of course. You may get unusual stares if inquiring about adderall in this capacity. Most doctors seem to be unaware of it's ability to assist in overall mood stabilization/control. I know mine was, but she very much understood once I described how it helps me overcome social and situational anxiety.
posted by dinx2582 at 7:15 AM on August 3, 2009 [1 favorite]

My mother, a long-time marijuana user, was completely unimpressed with therapeutic Marinol, prescribed for depression and appetite loss during cancer treatment. Additionally, I was told the going rate for her dosage was more than $700 per month. In earlier years, she'd initially had good results with Prozac, but found drinking while taking the drug caused bizarre outbursts that she had not otherwise been prone to.
posted by biggity at 7:16 AM on August 3, 2009

wfrgms nails it. Once again, AskMe is being used in place of a doctor's office.

Marijuana has complex effects on anxiety. It can act as an anti-anxiolytic, and have the exact opposite effect on other people, or even affect the same person differently under different conditions, or depending on the THC (and cannabinoid) contents in any particular strain of cannabis. Your progression sounds like the nearly canonical story of most people with severe marijuana dependency issues.

It is also possible, given the clinical evidence, that sustained marijuana use is one of the *causes* of (or a contributing factor in the emergence of) some anxiety disorders, even long after the user quits using the drug.

I say this as a very pro-marijuana person who nonetheless does not think the drug (or any drug) is "completely safe and harmless" for all people. PLEASE don't try figure this out on your own or by asking strangers without qualifications for psychiatric advice.

Please DO find a *psychiatrist* -- a prescribing MD, not a psychologist or MSW -- with psychopharmacological expertise in this subject, preferably one who treats people for marijuana dependence and abuse. There is a lot of *very* recent and high quality science on this subject emerging in the last couple of years. There are also major clinical trials on marijuana cessation going on at several major medical centers, and one of the key findings is that dependent users experience quite serious anxiety disorders after quitting, often long after quitting. It's a hot area of psychiatry and addiction medicine right now.

A clinician with expertise in this area will probably want to treat you with targeted anti-anxiolytic therapy over and above the anti-depressant therapy, just guessing from anecdotal experience. But the exact history you describe -- ramping up use to self-medicate for social anxiety (which often intensifies when you are not high if you're a heavy user), and then developing severe paranoia/anxiety reactions to the drug over time -- is terribly common. If you are in a major city, or near one, you should easily be able to find a doctor who understands all of this. It's possible I can help you with that if you'd like to send me a MeMail.
posted by fourcheesemac at 7:22 AM on August 3, 2009 [2 favorites]

Ack, just "anxiolytic" -- not "anti-anxiolytic," throughout, above.
posted by fourcheesemac at 7:45 AM on August 3, 2009

I have no specific knowledge to give you, but I can give you this story.

At my wedding my brother (who is normally rather reserved and has some depressive tendencies of his own) was drinking alcohol. He then started acting exactly the way we've been trying to get the medicine to make him act.

That being said I don't see why you couldn't go to your doctor and tell him that you've been smoking, the effects that it's had, and that you'd like to see if there is a drug (or drug combination) that could get you to act that way.

With the key part being go to your doctor and let them make the good medical decision.
posted by theichibun at 8:49 AM on August 3, 2009

Just a word of advice: I would not take this up in detail with your GP/PCP, beyond seeking a referral for anxiety. We live in an age when your medical records are increasingly less private. Once you are in therapy with a psychiatrist, you should be brutally honest, and you will be protected by a somewhat higher bar of personal privacy. Your insurance company does not need to know you are in treatment for marijuana dependence, necessarily.
posted by fourcheesemac at 9:03 AM on August 3, 2009

Your doctor might be another resource for up-to-date research. I'm sure it won't be the first time a doctor's heard of someone self-medicating with pot,

But only if you get him to solemnly vow not to put this in your records. It will haunt you the rest of your life otherwise.
posted by small_ruminant at 10:10 AM on August 3, 2009

My doctor and I discussed this just last week. In our discussion, we touched upon the fact that when I do smoke, I use sativa (known on the street as haze) rather than indica. You might do a bit of research on these two strains so you can tell your doctor what you were smoking.

... And then tell your doctor. He or she will probably ask you what your experiences were when you were stoned. It's all good. Your doctor won't eat you or turn you in to the feds. Instead, he/she will use the info to help you find a more canonical method of dealing with your anxiety and depression.

One more thing: You'll probably have to try, over the course of months or even years, a variety of different medications. Every person has a different brain chemistry, and psychiatry is one of those fields in which you find the right potion via trial and error. That makes it that much more important to have a good psychiatrist.

You should keep a medication journal for yourself, so that when your doctor prescribes a certain medication you can report both beneficial and negative effects. (This is also helpful down the road. Seven years later, you may not remember your exact negative reaction to Drug X, and your doctor may not have detailed notes on it, either. If you move or have to switch doctors for other reasons, it's always good to be able to present a thorough medication history.)

But seriously. Talk to your doctor. No one on the green is going to be able to tell you what anti-depressants or anti-anxiety meds will work for you.
posted by brina at 1:41 PM on August 3, 2009

In most cases, you cannot reliably know whether you are buying indica or sativa, unless you know enough about the appearance, smell, and psychoactive effects to tell for yourself (and I've seen experienced smokers fooled about this in blind testing, actually). But brina is quite right that the two sub-species of cannabis do produce different effects in people. I'm not so sure they are highly predictable across individual smokers however.
posted by fourcheesemac at 5:21 AM on August 4, 2009

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