  医療カナビス |
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While marihuana makes some people anxious, paradoxically it appears to help others with various kinds of anxiety disorders. The following is an account of a woman who found marihuana useful in the treatment of this chronic disorder and she is now being successfully treated with Marinol. This account is followed by a commentary by her psychotherapist, who prefers to remain anonymous. I am a 51-year-o1d woman who has suffered from post-traumatic stress disorder for as long as I can remember. It is a result of severe childhood physical, sexual, and emotional abuse and has resulted in a restricted functional life. hen in an acute state I experience physical symptoms of anxiety: shallow breathing, sweating, shaking, heart palpitations, tightness in my chest, extreme muscle tension, and heightened startle response. Mentally, I experience symptoms of confusion, dissociation, and agoraphobia. During childhood it was diagnosed as "temper tantrums" and my mother was advised to throw water in my face when the episodes occurred. During adolescence I was heated for the same symptoms with tincture of belladonna and sodium amytal. This treatment lasted until I was 21 years old and left home to get married. for several years I was productive and in remission. When I was about 30 years old, my family of origin again came into my life, and I became depressed and extremely anxious. On the advice of my husband, I saw a psychiatrist for the first time. He prescribed Stelazine, which rendered me useless and more depressed. I stopped taking Stelazine within a week or two. Shortly thereafter I began having severe back pain (sciatica), which was treated with bed rest and Valium. At this time, I experienced my first hull-blown clinical depression. I saw a second psychiatrist who diagnosed an "acute anxiety disorder with reactive depression." I was able to get through that episode without medication and made some major changes in my life to eliminate unnecessary stress. Around this time (mid-'70s) I experimented with marihuana for the first time. My first experience was negative (it was very strong). A year later, I tried marihuana again and found that it relaxed my entire body and allowed me to focus better. For the next several years I was able to live a very productive life as a wife, mother, and professional theater artist. I was taking no medication except smoked marihuana on a regular basis to alleviate my anxiety It enabled me to rise above my negative, obsessive thoughts and fears, and helped me to eliminate the physical symptoms of heart palpitations, tension, tremor, hyperventilation, and in extreme cases, incontinence In the past 12 years, I have had several acute episodes of anxiety. I was hospitalized for the first and only time in 1986, when I was diagnosed with major depression and panic disorder, stabilized on imipramine and told that I would have to take Xanax "for the rest of my life." I complied for six months, but the medication made me "spacey" and sapped the energy I needed to perform as a character actress and musical theater artist. My profession was very demanding and required me to be focused and in excellent physical condition I began smoking marihuana again PRN and was productive and able to work until 1995.At that time my son was 15 years old, and I began to feel guilty and hypocritical for partaking in something I was asking him not to. I was also tired of dealing with the people I had to deal with to get the drug. So I stopped smoking for several months, but I became profoundly anxious, agoraphobic, and depressed. My therapist suggested that I take medication to relieve the symptoms. She recommended a psychopharmacologist who prescribed Zoloft and Klonopin. I hated the way these drugs made me feel (weak and exhausted) and began doing some research to find out if there were any drugs that could relieve my symptoms without turning me into a zombie. At this point, my therapist told me she had attended one of your lectures and found it very informative. I looked you up on the Internet and read about Marinol for the first time. I called you, met with you, and was prescribed Marinol. The anxiety lifted almost immediately and my body became more relaxed than it had ever been I was able to leave the house on my own and tolerate social contact without symptoms. I felt hopeful again. For the first time in my life I had a medication that completely eliminated my symptoms and allowed me to function normally. For almost four months I have been taking Marinol and it has profoundly changed my body and my life. The physical changes were immediate. Within an hour of my first dose, I felt the muscles around my rib cage begin to relax. This immediately freed up my diaphragm and my breathing became normal again, eliminating many of the other symptoms. The next thing I noticed was the effect it had on my GI system. Within a week I was on a normal schedule and not suffering from constipation and the bloating and pain associated with it. I had no pain or spasms in my lower back or legs. The physical therapist who had been working on me for years said it was like working on "somebody else's body." I no longer have hypertension and have been taken off Vasotec. I still take a diuretic PRN. The mental changes have been less immediate, more subtle, and profoundly liberating. I am presently experiencing no depression, no dissociation, no full-blown panic attacks, no trembling, no sweating, and far fewer hot Rashes. I still avoid Stressful situations, but I'm able to live moment-to-moment and confront, deal with, and LET GO OF everyday stress like a normal person. It feels like the Marinol overrides the terror that has been programmed into my nervous system, reducing the anxiety and allowing me to think instead of react (which throws my body into panic mode). I am again able to do the simple thin& I have always enjoyed. I can focus my mind enough to read a book and write a story. I can drive to the beach and sit in the morning sun without having a panic attack. I went to the movies! I am able to go to appointments on my own and I can tolerate social situations more easily. I am not housebound. I am still not back to where I used to be- I am still bored, but I now have the presence of mind to do something about it. I am in the process of investigating colleges in my area that offer "non- traditional age programs" for women like myself who want to go back to college. My life is still not perfect. I am still overweight, still hypersensitive, still in the throes of menopause, but I have something I haven't had in a long time. I have hope. Thank God for Marinol. Her psychotherapist comments: I have been treating her since June 1991 for symptoms of anxiety That stem from posttraumatic stress disorder. She suffered multiple episodes of physical, sexual, and emotional abuse chronically throughout her childhood, some traumas occurring before the development of speech. She has two response patterns: dissociation and panic symptoms. Further, She was in abusive psychotherapy in the mid-1980s in which a therapist used hypnosis for age regression and then abruptly ended the treatment when her bill got too big for the therapist to tolerate. Although there were many boundary violations during the course of this therapy, she felt a great sense of dependence on this therapy and the therapist and become acutely symptomatic, requiring inpatient with me she described herself as chronically anxious and conflicted over how to interact with her aging mother who had been quite abusive over the years. She would become triggered to the point of dissociation when her husband would panic about issues like shortage of money. She was unable to work as an actress and she only left her house with great effort and erratically. She was resistant to medication as previous psychotropic medication made her, by her report, too “groggy.” With increased trust in me she was able to work with a psychiatric nurse with psychotropic prescribing privileges to whom I referred her and took a couple of different SSRIs and Ativan. After about a year she was able to work part time as a symptoms escalated secondary to a client at the halfway house cutting herself. During the time of our psychotherapy, she has worked adjunctively with a body-oriented practitioner who does deep tissue massage. She has often described her panic symptoms and has spoken about the working through process of dealing with her traumatic memories in somatic, kinesthetic language that is informed by this body-oriented therapy and her previous training as an actress. She also from time to time used marihuana to attain a feeling of calm when she would panic, but was highly conflicted about this, owing to wanting to parent in the best possible way her teenage son, in whom she has tremendous constructive investment. After her acquisition of a home computer, she has reported the following to me and it is consistent with what I observe since she has begun using Marinol. Her thinking can remain at a normal pace even in situation that formerly would send her into a panic state where she couldn't process the world rationally. She describes one inconvenience, that she can't drive immediately after taking the Marinol, but after an initial period of a couple of hours she can drive and use her reflexes appropriately while remaining tension-free. She eats less impulsively which she attributes to not needing to eat out of anxiety. She is greatly relieved that she feels she can breathe properly when taking the Marinol. This has a primary effect of her feeling more comfortable and a secondary effect in that breathing properly is a signal and symbol to her of well-being. This is a consequence of her meaning and belief system being so located in her experience of her body. She described neuromuscular changes of being able to do gentle stretching of her body, and being able to lower her shoulders. She is aware of time at which she feel an anxiety of panic response, but she describes being able to note it mentally and use an image of it floating through and out of her body. She reports a more regular sleep schedule and feeling more rested when she rises in the morning. Behaviorally, she has made some significant changes: she went out to a movie, tolerating the crowd and the sound system adequately; she has been able to take the car and go to the beach and sit for 15 minutes, and has started to contemplate walking on the beach. She has resisted responding to her mother's provocations and been able to set limits twice when she felt her husband was too frantic and on the verge of being degrading to her. Whether this is a primary or secondary effect of being less tortured by frequent panic attacks, she describes feeling more pleasure in activities that were formerly pleasing to her, like listening to music “and being able to feel the music.” Parenthetically, she has also been able to lower her blood pressure and reduce the antihypertensive medication she has been prescribed for the past few years. She has been able to tolerate mammograms, essential since her mother has had two episodes of breast cancer. I have taken the stance in therapy that I endorse her pursuing thing she feels are resources to her healing. I have taken a “curious observer” position with regard to her belief in Marinol, and told her my job is to help her understand the effects she experiences and to tolerate the risk and internal conflict she feels pursuing this avenue that does not meet with medical establishment and broader social approval. The difficulties in accessibility have certainly constituted a stress for this woman. However long she is able to take the Marinol, it seems constructive in giving her an experience of a more trustworthy internal and external world that is not relentlessly stormy and treacherous. |
