Marijuana, Maureen Dowd, and Panic

Several years ago, a woman called me from out of state. She was worried about her son, who was a student in the city. She said that he had called her at 3 AM on Sunday morning, in a panic.

He told her that, a few days earlier, he had ingested marijuana for the first time. He’d gotten high--”super scary high” in his words--and even the next day, when the THC had left his system, he was worried about his state of mind. As he put it, “I feel like I’m going crazy. I just don’t think I’ll ever be the same after that experience.”

When I met with him the next day, it became clear that although he was very scared, he wasn't suffering from anything as severe as he had imagined. No psychotic break, brain tumor, or anything else that would threaten his life or sanity. Instead, he was having an anxious reaction that was beginning to develop into panic disorder and agoraphobia.

Panic disorder is caused by a hypersensitivity to symptoms of anxiety--a “fear of fear,” if you will. Here’s how it works: You suddenly feel scared, and you’re not sure why. You try to stop feeling scared, but you can’t, which makes you feel more scared. And on and on and on, until you’re in a full blown panic attack.

For this particular young guy, the feelings he interpreted as fear were all part of what you’d expect from ingesting pot: Lightheadedness, increased heartrate, derealization, distortions in time. But because these symptoms were so intense and unexpected, they spiraled into panic. And even though they went away when he sobered up, he continued to look for signs of their return, and he found himself stuck worrying that this experience might have permanently impaired his functioning.

As is always the case in panic, the problem here was not the anxiety itself, it was the interpretation of the anxiety as dangerous. I don’t know if it’s possible for a single marijuana experience to permanently change someone’s brain chemistry (strictly speaking, anything is possible), but it does seem highly unlikely.

What’s much more likely is that a person could have an intense experience with marijuana, and then interpret it through our culture's traditionally hysterical attitude toward drugs in general, and pot in particular. Since drug education and drug policy fail to differentiate between marijuana and other, riskier substances,  it’s easy to see how somebody could develop some unreasonable fears.

Now, this guy's experience is not unheard of. I’ve seen a number of other people who have experienced panic attacks after intense drug experiences. Recently Maureen Dowd wrote about how she, an infrequent marijuana user, ate pot brownies and suffered an awful night of anxiety and sickness. This earned her considerable derision, which was somewhat well-deserved (it’s the equivalent of a teetotaler who, after downing a pint of whiskey, is shocked to find the room spinning).

The bad news is that Dowd's experience is not unique, and I wouldn't be surprised to see an increase in marijuana-related panic attacks--at least in the short run--as legal and cultural strictures are loosened. I also expect this to eventually abate in the coming years, as a culture of sensible marijuana use emerges, and evolving norms allow people to openly share their cautionary experiences.

The good news is that panic disorder, whether related to drug use or not, is highly treatable. CBT is highly effective in the treatment of panic and anxiety. The young man I mentioned earlier was able to make sense of his experience and move on from it, with a newfound set of anxiety-management skills, and a healthier respect for the potential hazards of pot brownies.