Marijuana (Cannabis) withdrawal and mental health

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

During times of stress people may become vulnerable to using cannabis as a way to cope.

Previous posts have discussed the negative impact of cannabis on memory, cognitive performance, and PTSD.

Cannabis withdrawal can cause and worsen a variety of mental health symptoms.

It is important become aware of this connection for mental health.

What are some symptoms of cannabis withdrawal syndrome (CWS)?

CWS involves 3 or more of the following symptoms within 7 days of reduced cannabis use (1):

  • Anxiety
  • Depression
  • Changes in sleep
  • Irritability, anger, or aggression
  • Appetite or weight disturbance
  • Restlessness
  • Somatic symptoms, such as headaches, sweating, nausea, vomiting, or abdominal pain.

How common is cannabis withdrawal syndrome?

A meta-analysis(2) of 47 studies including 23,518 participants, found that the prevalence of cannabis withdrawal syndrome was found to be 47% (2).

What are some factors that were associated with higher cannabis withdrawal syndrome (2)?

Researchers (2) found that Daily cannabis use, concurrent tobacco use, and use of other substances was associated with higher CWS (2).

Other thoughts:

  • It bears repeating that daily users were more likely to have cannabis withdrawal syndrome.
  • Some people may report cannabis use helping with anxiety, depression, or insomnia when it may just be masking the withdrawal symptoms caused by previous cannabis use.
  • Research shows an association between cannabis use and several medical, cognitive, functional, and psychosocial problems(3).
  • Short-term risks of cannabis use include impaired short-term memory motor dis-coordination, altered judgment, paranoia, and psychosis (4).
  • Some long-term effects of cannabis use include addiction, altered brain development, poor educational outcomes, cognitive impairment, diminished quality of life, increased risk psychotic disorders, injuries, motor vehicle collisions, and suicide (4,5).
  • Further research is needed on cannabis and mental health.

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Resources for mental health support can be found here.

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association Publishing; 2013.
  2. Bahji A, Stephenson C, Tyo R, Hawken ER, Seitz DP. Prevalence of Cannabis Withdrawal Symptoms Among People With Regular or Dependent Use of Cannabinoids: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(4):e202370. doi:10.1001/jamanetworkopen.2020.2370.
  3. Crean  RD , Tapert SF , Minassian  A , Macdonald  K , Crane  NA , Mason  BJ .  Effects of chronic, heavy cannabis use on executive functions.   J Addict Med. 2011;5(1):9-15. doi:1097/ADM.0b013e31820cdd57
  4. Volkow  ND , Baler RD , Compton  WM , Weiss  SRB .  Adverse health effects of marijuana use.   N Engl J Med. 2014;370(23):2219-2227. doi:1056/NEJMra1402309
  5. Carvalho  AF , Stubbs B , Vancampfort  D ,  et al.  Cannabis use and suicide attempts among 86,254 adolescents aged 12-15 years from 21 low- and middle-income countries.   Eur Psychiatry. 2019;56:8-13. doi:1016/j.eurpsy.2018.10.006

Coping with Loneliness and Isolation

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

Many young adults struggle with loneliness. For example, a national survey found that almost 70% of Gen-Zers and 71% of millennials are lonely vs. 50% of baby-boomers (1,2).

For some, this could be further increased by COVID 19 (Corona)related social distancing, quarantine, isolation.

Feelings of loneliness can increase symptoms of depression (3) and over time, worsen cognitive function (4).

The American Psychological Association offers the following strategies to cope with loneliness/isolation (5):

  • When possible, plan ahead by considering how you might spend your time, who you can contact for psychosocial support and how you can address any physical or mental health needs.
  • Create and follow a daily routine. This can help with a sense of order and purpose. Try to include regular daily activities, such as work, exercise or learning, and other healthy activities as needed.
  • Maintain virtual contact such as phone calls, text messages, video chat and social media to access social support networks.
  • Maintain a healthy lifestyle. Get enough sleep, eat well and exercise in your home when you are physically capable of doing so. Try to avoid using alcohol or drugs as a way to cope with the stresses of isolation and quarantine.
  • Consider telehealth or telecounseling (see  campus and surrounding resources below).
  • Limit excessive news consumption to reliable sources because too much exposure to media coverage can increase feelings of fear and anxiety.
    • Balance this time with other activities unrelated to quarantine or isolation, such as reading, listening to music or learning a new language.

Psychological strategies to manage stress and stay positive during times of loneliness/isolation (5):

  • Take a look at your worries and aim to be realistic in your assessment of the actual concern as well as your ability to cope. Keeping a dairy may help.
  • Focus on what you can do and accept the things you can’t change.
  • Keep a daily gratitude journal. This will help you appreciate the positives which can help reduce stress.
  • Practice mindfulness and relaxation exercises. There many online resources that can help, including our mental health strategies video series.
  • Focusing on the altruistic reasons for social distancing, quarantine or isolation can also help mitigate psychological distress. Remember that by taking such measures, you are reducing the possibility of transmitting COVID-19 and protecting those who are most vulnerable.

Other strategies:

  • For some, periodic isolation can be a time of solitude—an opportunity to step back from your daily life and re-focus on your priorities and longer term goals. This can help you better deal with shorter term challenges. This can also help you identify things that you could add or subtract when you return to your usual life.  What tasks or goals have you been putting off that you can now address because of this time? Can you do research on future goals?
  • Change the scene. Take a walk outside when possible. Fresh air, and seeing others even at a distance may help reduce feelings of loneliness.
  • Consider online discussion groups based on hobbies such as books, movies, shows, crafts, gaming, video games, professional interests, sports, community area, etc.
  • Consider a discussion group with your classmates.
  • Many places now offer online group fitness, yoga, and virtual races.
  • Schedule a time to virtual visits with friends or family.
  • Campus and surrounding resources related to mental health.

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Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

 References:

  1. https://www.scientificamerican.com/article/how-to-prevent-loneliness-in-a-time-of-social-distancing/
  2. https://www.cigna.com/static/www-cigna-com/docs/about-us/newsroom/studies-and-reports/combatting-loneliness/cigna-2020-loneliness-factsheet.pdf
  3. Cacioppo JT, Hawkley LC, Thisted RA. Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations Study. Psychol Aging. 2010;25(2):453–463. doi:10.1037/a0017216
  4. Cacioppo JT, Cacioppo S. Older adults reporting social isolation or loneliness show poorer cognitive function 4 years later. Evidence-Based Nursing 2014;17:59-60.
  5. https://www.apa.org/practice/programs/dmhi/research-information/social-distancing

 

Mental Health tips during Covid-19 (Coronavirus)

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

Global disease outbreaks can be stressful, especially when it starts to impact your everyday life.

While different people react differently to this type of stress, common reactions can be:

  • Anxiety
  • Fear of the unknown
  • Change in sleep, eating habits and increased use of alcohol or drugs as a way to cope.

The Center for Disease Control (CDC) recommends the following ways to support yourself (1):

  • While it’s important to educate yourself to reduce the fear of unknown, Avoid excessive exposure to media coverage of COVID-19.
    • Take breaks from watching, reading, or listening to news stories. It can be upsetting to hear about the crisis and see images repeatedly.
  • Take care of your body. Take deep breaths, stretch or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep and avoid alcohol and drugs.
  • Make time to unwind and remind yourself that strong feelings will fade. Try to do some other activities you enjoy to return to your normal life.
  • Connect with others.
    • Share your concerns and how you are feeling with a friend or family member. Maintain healthy relationships.
    • Try to plan time to communicate with those in your support system.
      • If in person interaction with others is not possible, a phone call or video chat may be an option to consider.
    • Keep social distancing in mind.  CDC recommendations for social distancing (Remaining out of places where people meet or gather, avoiding local public transportation (e.g., bus, subway, taxi, rideshare), and maintaining distance.
  • Maintain a sense of hope and positive thinking.

The following are adapted from National Library of Medicine (2):

  • Recognize and accept the things you can’t change.  This can help you let go and not get upset. For instance, you might not change rush hour traffic, but you can look for ways to relax during your commute, such as listening to a podcast or book.
  • Avoid stressful triggers when possible. For example, if your family squabbles during the holidays, give yourself a breather and go out for a walk or drive.
  • Exercise. Regular exercise or physical activity most days for about 30 minutes can help your brain release chemicals that make you feel good, and help you release built-up energy or frustration.
  • Change your outlook. Are you being too negative? Work on more positive attitude toward challenges by replacing negative thoughts with more positive ones.
  • Do something you enjoy preferably daily even if it’s just for a few minutes. Examples include reading a good book, listening to music, watching a favorite movie, or having dinner with a friend, a new hobby or class.
  • Get 7 to 9 hours of sleep per night. This can help you think more clearly, and have more energy.
  • Eat enough AND eat healthy foods. This can help fuel your body and mind. Skip the high-sugar snack foods and load up on vegetables, fruits, raw nuts, lean proteins, good fats.
  • Learn to say no. Set limits if you feel over-scheduled, cut back or defer where you can. Ask others for help when you need it.

Consider relaxation techniques:

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. https://www.cdc.gov/coronavirus/2019-ncov/about/coping.html
  2. https://emergency.cdc.gov/coping/responders.asp