HomeAnswersPsychiatrycannabisWill Cannabis trigger anxiety and cause seizures when taken to reduce pain?

I took Cannabis to reduces pain with acute gastritis, but it increased my anxiety and caused a seizure. Why?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. K. Shobana

Published At September 5, 2021
Reviewed AtSeptember 5, 2021

Patient's Query

Hi doctor,

Initially had acute gastritis that produced a lot of mental strain (anxiety) and physical pain. Cannabis was taken to help with the pain. It instead increased the anxiety to the point I had a seizure. Since that seizure, I have been dealing with chronic anxiety that manifests itself mainly physically like chest pain, tinnitus, stomach problems or indigestion and pain, tension headaches, eye floaters, etc. It has been seven months since that event. I have a previous history of anxiety, but nothing as chronic as now. I have been taking Escitalopram 10 mg for three months. The brain MRI is normal, EEG is normal, gastric tests performed, and gastritis no longer present. Anxiety is the source of stomach problems. What would be the treatment of Cannabis-induced or triggered anxiety disorder? Kindly help me.

Hi,

Welcome to icliniq.com.

I can understand your problem. Cannabis (Dronabinol) use results in precipitation of acute psychosis, and sometimes this results in precipitation of severe anxiety, which might persist for long. You had an episode of seizure and then developed anxiety. If we consider treatment, then the treatment line is the same for anxiety and anxiety precipitated by Cannabis. You are taking Escitalopram 10 mg for anxiety, which is a good drug for anxiety control. If the anxiety persists, then the dose of this drug should be increased to 15 mg and, if needed, even to 20 mg per day. For episodic control of anxiety, drugs like Etizolam can be used as and when needed. A combination of Etizolam and Propranolol has been found to be very useful in episodic control of anxiety. This will help in your other somatic symptoms like chest pain, headache and tinnitus too.

I would also suggest you take supplements containing Vitamin-B12. This will help in alleviating somatic symptoms and also will help in controlling anxiety. Avoid smoking, excessive use of alcohol while you are on medication. Also, avoid excessive coffee or any energy drinks. This will also increase the risk of anxiety. I hope this was helpful.

Patient's Query

Hi doctor,

Thank you.

I will go on with the same treatment plan as you recommended. However, I have a few queries which I hope you could answer:

1) Will the anxiety ease off with time, and how long would it take for me to be symptom-free? (no tinnitus, stomach problems, chest pain, head pressures, eye floaters, etc.).

2) For how long should I take the medication? (been three months already).

3) Did I trigger an anxiety disorder that was dormant by using Cannabis in a moment of acute distress that is my acute gastritis? What would be the pathogenesis of my condition? As I had a seizure that precipitated everything, and according to information online, it is atypical and very rare. Was that an anxiety seizure?

4) The last time I consumed, which led to quitting completely, I felt dissociated, and everything around me looked distorted. It was not psychosis, but could it be depersonalization or derealization? I went to sleep and woke up fine, and never touched Cannabis again.

5) Will I ever be able to smoke Cannabis again?

Kindly give your opinion.

Hello,

Welcome back to icliniq.com

1) Yes, absolutely, the anxiety will ease off with time. If you take the drugs regularly, I think you should see great improvement in core symptoms in around four to six weeks.

2) Since you have been on medicine at a 10 mg dose for three months now, in my opinion, you should consider increasing the dose as I have mentioned. In the coming weeks, you should see improvement. However, you should continue medicines for at least three more months once you see improvement in symptoms.

3) As such, no classification system identifies anxiety seizures. But yes, there are dissociative or PNES which are psychogenic non-epileptic seizures. These can be triggered with Cannabis use. But true seizures too can be precipitated by Cannabis use. The trigger for your anxiety was Cannabis, but whether it was dormant anxiety cannot be ascertained.

4) This could be severe anxiety or even an episode of mild psychosis. Both are seen with Cannabis use. This is good that you have quit Cannabis completely.

5) Please avoid Cannabis totally in the future. I have seen many patients who developed mild symptoms with Cannabis while in recurrent use they developed frank psychotic episodes, which sometimes progress into chronic psychosis. So please avoid Cannabis completely in the future. I hope this was helpful.

Patient's Query

Thank you doctor,

1. I followed your advice to increase the dose of Escitalopram 10 mg to 15 mg, I am on day 6 currently. Since that, I feel that the anxiety has worsened a bit. I have skin burns hot and itches all around my body, digestive problems starting to return with constipation, eye floater, tinnitus, and headaches still present. Are these side effects occur due to increasing the dose? Should I keep taking 15 mg?

2. When I increased the dose from 5 to 10 mg, I had immediate relief within two days. I found myself better. Why is it different now?

3. Why does this anxiety manifests itself only physically? Mentally I am still myself, not worried or dreading about anything. It just feels like my body is in overdrive.

4. I need to get back to myself as soon as possible as I have many responsibilities. I am a young male with an age of 21 years. I had a seizure seven and a half months ago. Now, the anxiety still persists. Have you had seen similar cases like mine? What is the prognosis of cannabis-induced anxiety? Will this be a lifelong condition? Will I ever be normal again and medication-free?

5. Would exercise help in my case? What else would you recommend to speed up my recovery? I have been taking the B12 supplements as you recommended.

Hi,

Welcome back to icliniq.com.

Thanks for asking again. I am sorry for replying late.

1) It is common to see worsening of anxiety especially from few days of starting an SSRI like Escitalopram or when the dose of the drug is increased. It is absolutely normal. This worsening of anxiety and restlessness will go away in few days on its own and you will see improvement in symptoms. Your symptoms are a part of this worsening only. So please continue to take the drug as per advice and you will see improvement.

2) Dose of 15 mg is a little on the higher side and this could be the probable reason for your symptoms. But just remain stress-free on some days. You will see improvement.

3) Anxiety presents with both physical and psychological symptoms. Psychological symptoms like fear, fear of unknown things, mental fog, anticipation, and physical symptoms like choking in the chest, epigastric distress, altered bowel habits, pain in the body, palpitations can present in anxiety. You have predominant physical symptoms.

4) Yes, it is very common in the place where is practice. We see a lot of patients with cannabis-induced psychosis. But fortunately, this can be treated. Please continue taking drugs and you will be alright. Just remain confident. You are young and it is easy to recover. This is not a lifelong condition. You will be normal and medicines will be stopped. Do not get stressed about that.

5) Yes exercise will help. If you can run then running shall definitely help. Meditation for five minutes daily will help. Fix your time to go to bed and sleep for at least seven hours a day and you will be alright. Avoid any excessive caffeine drinks like energy drinks. In some time you will be alright. Thanks.

Patient's Query

Thank you doctor,

I am back for a review.

1) It has been four weeks now since I increased the dose from 10 mg to 15 mg. I do not have relief in my constant tension headaches and chest pain. Should I continue on the same dose or what else do you recommend? The other symptoms such as eye floaters are very rare now. Digestive or bowel problems and stomach aches are pretty much over. Will all my symptoms subside soon? I have tinnitus still prominent.

2) I have started smoking cigarettes again the last week just to see whether it helps with the headaches. It did not really and it have made it worse actually. I am quitting it as of today. I was wondering why you discouraged cigarette smoking and I just came upon this while reviewing your last answers to my queries.

3) I have also been taking Seroquel (Quetiapine) 25 mg for the last five months to help me sleep. I feel that I do not need them anymore as I sleep well without any disturbances. However, I need them to go to bed otherwise I will not fall asleep. How do you recommend me discontinuing this drug? Many thanks and kind regards.

Hi,

Welcome back to icliniq.com.

Thanks for asking again.

1) Yes, you will see improvement in the coming days. There is nothing to get worried. Continue taking Escitalopram in the same dose. The symptoms like chest heaviness and headaches will go away with time. The drug will definitely control these symptoms.

2) Please stop smoking completely. Smoking tobacco even increases the risk of headaches. Even this worsens anxiety. So while on medicines avoid smoking completely.

3) The dose of Quetiapine is very low. You can make the tablet half that is 12.5 mg for few days and then stop taking it completely. This will help in preventing withdrawal and you will be able to sleep properly. Thanks.

Patient's Query

Thank you doctor,

I am back for another review. I have increased the dose of Escitalopram to 15 mg as recommended. It has been a couple of weeks.

1) The headaches and chest pain initially decreased and now I feel like it has worsened over the past few days. There are some symptoms I still have now. The symptoms are tension headaches (top of the head, forehead, sometimes back of the head), tinnitus, chest pain, occasional eye floaters, and occasional burning skin all over the body. Rarely, I have digestive issues nowadays, which was the worse symptom before few days. I am wondering why am I still symptomatic even after increasing the dose? Would you recommend increasing to 20 mg? I want to become hundred percent symptom-free as soon as possible.

2) Now, I have been taking the drug for seven months. I was told that the treatment is usually six months. But now, I am not able to wean off the medicines completely. I have to be symptom-free which I am not as it is still persisting. For how long should I keep taking the medications?

3) After starting my medications, I have not touched alcohol. But I want to know whether it is good to have a beer once in a while. If it is fine to resume alcohol, can I start drinking it? What would be the consequences of it?

4) I have kept smoking cigarettes unfortunately since our last chat, I am finding it hard to quit now. Could it worsen the anxiety drastically if I quit considering that I am taking medications? Even after a seizure, I kept smoking cigarettes for a while. When I stopped, everything got worse. The somatic anxiety became very severe and persistent and I continued taking Escitalopram. I do not want to go through this again and I hope it will not be the case considering that I am on medications.

5) Why is my recovery taking long? Does my nervous system got damaged in some way? As I have somatic anxiety without any reason to be stressed and anxious. I mentioned everything started from that seizure and I am sure that I was smoking cannabis and nothing else.

6). How will the SSRI help me completely to become symptom-free? I do not want to go through all of this again. Will my somatic anxiety completely go away? Will I be medication-free at some point? Once again thank you and kind regards. Kindly waiting for your response. Thanks.

Hi,

Welcome back to icliniq.com.

I am sorry for replying late because of my busy schedule.

1) Sometimes these symptoms persist even on optimal doses of medicines. But that does not mean that these will remain for life. Apart from medicine, I suggest you make lifestyle changes in yourself. Try to cut down alcohol, tobacco use, reduce tea coffee intake, exercise daily for at least half an hour. Fix time to go to sleep and time of waking up. These minor changes will help in improving your symptoms. As of now, you should continue with the 15 mg dose. We will wait for about a couple of weeks and if symptoms persist then we can think of increasing the dose to 20 mg

2) As your symptoms are persistent, you should continue to take drugs for some more months. We cannot abruptly stop the drug as this might worsen the symptoms.

3) You can take alcohol in low amounts occasionally. But try to have it in a moderate amount only.

4) Reduce smoking gradually and try to stop completely over a month. Smoking results in an increase in headaches or anxiety too.

5) No, your nervous system is not damaged. This is anxiety and mood disturbances only. With time, you will be alright.

6) Yes, you will be alright with Escitalopram. Just have faith in yourself. As discussed earlier, please avoid cannabis totally in the future. You are at high risk and recurrent use might result in acute transient psychotic disorder. You have some symptoms of amotivational syndrome due to cannabis. It is more of an anxiety type. But this will go with time. There is no need to get worried.

Patient's Query

Thank you doctor,

It's me again. Yesterday I had just a pint of beer and a glass of whiskey. Initially, I was fine. But after three hours, I started to have an extreme headache, extreme nausea and I ended up throwing three times. I was not even drunk. This is not normal, right? Is it because of the side effects of Lexapro and combining alcohol? I will not touch alcohol again as long as I am on medications. I also woke up with very mild stomach pain. Will it subside? I am just scared. I think that I have flared up gastritis which I had months ago. On my Last EGD taken before eight months, it showed very minimal inflammation and it was not as gastritis. I am sorry this might be out of your domain but your opinion on the matter is welcomed. Thanks and kind regards. I also had yellowish watery diarrhea when I woke up this morning. I never had anything like this before. Is it because of the overwork of my liver with the medications and alcohol? Should I be worried? Thanks again.

Hi,

Welcome back to icliniq.com.

There is no serious interaction between Lexapro and alcohol. So do not get worried. The headache occurs due to alcohol and gastritis. It might also occur due to alcohol and Escitalopram too. This will subside in a day or two. Just remain relaxed. Please avoid alcohol completely in the future or if you take it, please take in a very low amount like a glass of beer or 30 ml whiskey. Thanks.

Patient's Query

Hi doctor,

Since our last chat, I feel overall at 90 %, and symptoms like tinnitus, eye floaters, chest pain, and GI distress are thankfully nearly gone. The main symptoms that remain are a constant mild tension headache around the forehead and occasional burning or itching skin.

1. Considering my history, what can you recommend? I feel at 20 mg of medicine, I would be completely symptom-free.

2. How long should I keep taking the medicines, and when should I be back for a review?

Thanks, doctor.

Hello,

Welcome back to icliniq.com.

Please continue to take in the same doses, and you will see improvement in headaches too. No need to go to 20 mg as of now. For headaches, you may use any good painkiller on an emergency basis.

Continue to take medicines in the same doses for at least one more month, and then we can think of a dose reduction. If the headache persists, I suggest drugs like Amitriptyline (antidepressant).

Thanks.

Patient's Query

Hi doctor,

Thank you for the reply.

I can gladly say since our last chat (about 3.5 months ago) I have lived feeling at about 95-99 % eveyday.

1. Symptoms like tinnitus, skin tingling/warmth, and eye floaters were completely gone. However, over the last week, they have started resurfacing, which is making me worry. Why is that so? Is it possible that the symptoms will come and go in phases until they wear off completely?

2. The only symptom that is always persistent is that band-like tension headache on the forehead. Painkillers have not helped. Why is that so? I have learned to live with it so far.

3. I have resumed my alcohol consumption without any problem, with no side effects. So that should be okay, right?

4. What would you recommend for the doses I am taking so far? Still on the 15 mg Escitalopram (since June 2021). I feel that I should be 100 % symptom-free before weaning off. Why are some symptoms still persisting or reappearing on and off?

5. I have gained a lot of weight since taking the SSRI. Fortunately, that is the only side effect I had to deal with. Any recommendations on that matter?

Hello,

Welcome back to icliniq.com.

Glad that you are doing good now. The slight tinnitus you are seeing could be due to mild anxiety. We deal with a lot of stressors in day to day routine, and this could be the result of that. Try to ignore this. This is not a thing to get bothered about. This will go on its own without making any dose adjustments.

The band-like discomfort is classically seen in tension type of headache. This is a normal thing. Try to stop thinking about minor things, and you will be alright. Painkillers should help; if one dose does not help, try to repeat the dose in four hours. Have a well balanced diet low in fats and refined carbs and high in complex carbs and proteins. Avoid excess caffeine or energy drinks.

I would suggest you avoid alcohol on a regular basis. Alcohol results in a disturbance of sleep which in turn increase the burden of headache and also anxiety.

Continue to take Escitalopram (antidepressant) in that dose only. If we consider weight gain, then alcohol causes much more weight gain than Escitalopram in normal therapeutic doses. Just improve exercise and physical activity, and you will be alright.

Thanks.

Patient's Query

Hi doctor,

Thank you for the reply.

Since our last chat, I can say I have lived 95-99 % every day. I have been taking the medicines for more than a year now, and some symptoms still persist, like chest pains or a constant band-like tension headache and tinnitus. Symptoms that i have not had in months, like upset stomach, started to appear again, and it worries me. Will I never be 100 % again? Why do the symptoms persist?

I recently traveled back home, where I spent nearly a year recovering. Do you think I am subconsciously thinking of the bad times I have had here, and this is causing my symptoms to appear again? I am looking for a reason why I am not 100 % yet and have been on 15 mg Lexapro for so long.

I felt that I had reached a point where I was ready to wean off the meds completely, but the presence of some symptoms makes me worry if I go off the meds, I will go back to the start, and I can not afford that as its been such a rough 1.5 years. Any advice on how to proceed?

Thank you and king regards.

Hi,

Welcome back to icliniq.com.

If mild symptoms like chest heaviness etc., are still persisting, then I do not think it is time to reduce the doses. You should continue with the same dose only for some more months. Do not think that you are not well completely. Just think that your anxiety came under control with an optimal dose of a drug, and you have normally been functioning for a year. Anxiety is part and parcel of our lives. This will go on its own in some time.

Try to ignore the mild symptoms like chest heaviness or tinnitus. When you are focusing on these symptoms, these are getting worse. Ignorance shall help control the residual symptoms, and you will be alright. Just remain relaxed. You are alright now, and you will be medicine free in some time too.

Avoid alcohol and smoking altogether.

Thanks.

Patient's Query

Hi doctor,

Thank you for the reply.

So for how many more months do you think I should keep taking the 15 mg Lexapro?

As I said, I feel 95 to 99 % every day since the last year, and thankfully I have come a long way since. However, will I ever be symptoms-free, or will there always be residual symptoms? Do you have an explanation for the residual symptoms, and would a higher dose give me a 100 % therapeutic effect?

I feel that since I have been on Lexapro, I tend to sleep more and am more sleep sensitive. However, I often struggle to wake up in the morning. I always wake up with a dry mouth as well. Are those side effects of the medication?

I have read that withdrawal symptoms when stopping SSRIs are very bad and last long. I am scared that when it is time to come off the medicine, I will face severe withdrawals, or the initial symptoms of my illness will come back. Do you have any insight on this that could reassure me?

Thank you again.

Hi,

Welcome back to icliniq.com.

Since you are almost well on this dose, in a couple of months, you can think of reducing the dose the 10 mg, and this should be taken for one more month. Then the dose can be reduced to 5 mg.

As we discussed in the past. You have to learn to ignore the minor symptoms. You can not just keep thinking that you are not 100 % alright. You have to ignore the symptoms totally and should consider yourself totally well. Dose increase would not cause much benefit unless there is any worsening of symptoms.

Yes, some dry mouth could be due to Lexapro (escitalopram oxalate). But the drug has not much sedation and effects on sleep. This could be due to the improvement of depression symptoms.

Yes, as I wrote in the beginning, we will gradually reduce the doses, and you will be alright. Do not anticipate any significant withdrawal. Withdrawal occurs when one stops taking drugs abruptly.

Thanks, I hope this helps you.

Patient's Query

Hi doctor,

Thank you for the reply.

Residual symptoms remaining are slight tension headache on the forehead, mild chest pain, tinnitus, and occasional eye floaters. I have, however, come to terms that the residual symptoms might be there forever. I have come a long way and can say I am 95 % plus every day. Is there an explanation for why some symptoms are still not gone?

Since I started the Lexapro 1.5 yrs ago now, I have gained an enormous 30 kg. I guess it was a sacrifice to pay for my mental health. However, I have been exercising and dieting for about two months now, and the weight on the scale just does not come down. My question is, does the SSRI alter my metabolism, therefore preventing me from losing weight even though I am in a calorie deficit?

I have been on 15 mg Lexapro for a little over a year now, and I feel that it might be time to start lowering the dose, maybe to 10 mg. I am counting on you to explain to me how to proceed. I am just worried if I lower the dose, the exacerbation of symptoms will reappear. If they do, should I go back on 15 mg?

Thank you again for your time and kind regards.

Hi,

Welcome back to icliniq.com.

These are minor symptoms, and such kinds of symptoms are seen in most individuals, and they are part and parcel of life due to day-to-day stress. The main issue is that these should be ignored and not given any attention. Your mind has learned that you have these residual symptoms. Therefore, you have to ignore these minor symptoms.

Lexapro (escitalopram oxalate) might cause a slight increase in weight, but that weight gain is not very significant. Remain persistent in your exercise and dietary schedule, and you will see a weight reduction. Just remain relaxed.

The dose can be reduced to 10 mg without worries. Just continue to exercise daily and have balanced food. You will be fine. Avoid binge alcohol intake and also avoid smoking. This will help in faster dose reduction.

Thanks.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Seikhoo Bishnui
Dr. Seikhoo Bishnui

Psychiatry

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