(cannabis-related psychosis is treated separately, in another section)
Panic episodes following cannabis use may be followed by persistent states of anxiety. Typically, after the acute fright of the attack, attention becomes focused on certain elements that persist, or simply on the anxiety of not returning to normal, which leads to continuous monitoring of one’s own sensations, perceptions, thoughts, and bodily functions. Given the expected effects of cannabis, it is fairly logical to think that some of these symptoms are actually part of the euphoric-dysleptic experience of cannabis, albeit in an unpleasant form (depersonalization-derealization, perceptual distortions, etc.). However, it should be considered that ordinary panic attacks include symptoms of this kind, even though they are not among the most classic or frequent ones, so it is possible that the symptoms derive not so much from cannabis as from the panic itself. Furthermore, the person’s fear is directed toward neurological-type phenomena, that is, the same thing that happens to someone experiencing panic attacks without cannabis but with those same symptoms.
If the phenomenon does not resolve within the first few days, during which symptomatic treatment may nevertheless be used, it is advisable to seek medical evaluation.
These episodes are in fact often the onset of panic disorders or obsessions focused on bodily functions or sensations (hypochondriacal obsessions) that would have appeared anyway, perhaps with different content or later in life.
In general, treatment in these cases does not differ greatly from that of disorders unrelated to cannabis, except in two respects.
The first concerns the use of medications that may be selected from among those that, in the immediate term, attenuate some of the key perceptions that contribute to sustaining the patient’s concern. It should nevertheless be kept in mind, as in other cases, that improvement occurs with a delay of 2–4 weeks, following an initial neutral phase that may be beneficial but may also involve a transient worsening.
The second is that substance use tends to be associated with mood disorders which, particularly in younger individuals, may not yet have manifested themselves but nevertheless need to be assessed. They may emerge during antidepressant treatment, or as a subsequent (excited) phase following an initial depressive-anxious phase. It is also possible that the very phase in which the anxiety symptoms appear represents a “down” phase following a period of very elevated mood and disinhibition, during which the person used substances without concern and without experiencing unpleasant effects.
Persistent abnormal perceptions are rare. Cases of persistent perceptual disturbances have been described both with classical hallucinogens and with minor dysleptics, but in these cases self-diagnosis should be avoided. Concern about having suffered permanent neurological damage, in fact, influences the way symptoms are presented: a worried person may suggest to the physician the diagnosis they fear, in order to obtain two things. The first is reassurance that the condition does not represent permanent damage; the second is to obtain treatment for what they are convinced is permanent damage. In both cases, however, the presentation of symptoms may point toward a specific diagnosis that has nothing to do with persistent perceptual disturbance (PPD) or similar syndromes.
If your doctor does not prescribe medication for hallucinations, there is nothing unusual about this. The first step is to determine whether the disorder is actually a common form of panic, obsessive hypochondriasis, or depression.
Depressive phases that develop after cannabis use, often preceded by a panic attack that interrupts the positive part of the experience, are then characterized by a duration of weeks to months and—unlike a simple panic reaction—by concern about incurable damage, with a central idea that is more one of probability than of intrusive doubt concerning the possibility of having “ruined” one’s brain. These individuals therefore tend, rather than to seek reassurance, to hope that there are ways to repair the damage or at least mitigate it. This thought essentially constitutes a core of depressive ideation with a hypochondriacal component.
Treatment of these phases should assess certain characteristics, such as bipolarity. Once cannabis use has ceased, there do not appear to be major differences in the treatment of these syndromes.