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"  A thimbleful is all it takes. After a day&amp;#039;s work, I pinch off a small amount of marijuana and put it in a steel-tooth grinder. The flowers, covered in tiny white diamonds of THC, release a piney scent when crushed. I turn on the TV, and instead of taking a glass of wine with my evening news, I take out my vaporizer and set it on the coffee table. Outside the walls of my bungalow in Oakland, California, I can hear the rush-hour traffic, but I&amp;#039;ve already changed into my Big Lebowski\u2013style robe and slippers. I tap the ground flakes into a canister that I attach to another piece, this one with a bag on the end, and set both on the vaporizer. I flip the switch, and the bag slowly inflates with plumes of white smoke. Once it&amp;#039;s fully clouded, I attach a mouthpiece to the canister, put this to my lips, and press. On the inhale, the cannabinoids taste like sunned grass. My prescription for anxiety disorder didn&amp;#039;t always begin and end with an herb. But I&amp;#039;ve run through enough pharmaceutical drugs to know that pot dulls my panic better than any pill. One could say I diagnosed myself in high school, when I recognized my symptoms in a psychology textbook. Finally, I had &amp;quot;generalized anxiety disorder&amp;quot; to describe the dread I felt of some future event that was overtaking my present. I usually sensed the panic attacks first in my chest. Then my vision would start to go to static, and my body would crumple to the floor. There I&amp;#039;d ride it out until the adrenaline ran its course. Soon after I started to suffer several of these episodes a day (and so often that fear of another one kept me indoors), I sought out a psychiatrist. I told her about the times I&amp;#039;d be driving and convince myself that I was about to spin off the road\u2014the looping, invented terrors. A little talk therapy and a prescription later, I discovered that Zoloft only exacerbated my panic and depression. I stopped taking the little white pills and cut out caffeine instead; I exercised and practiced meditation. For years I abstained from medication, and aside from the occasional pot smoking with friends, I swore off drugs entirely. By the time I graduated from college, I knew all about the female hysteric and how anxiety was still cast as a womanly defect. Women experience generalized anxiety disorder at twice the rate of men. Every year, as many as 4.5 million American women are diagnosed with GAD\u2014not including the several other permutations of anxiety disorders, namely social phobia, obsessive-compulsiveness, post-traumatic stress, and agoraphobia\u2014for which, as with most mental illnesses, they are prescribed medications. Thus, I resisted pills for the backward &amp;quot;rest cure&amp;quot; and institutionalization they stood for: the only thing to be done for the hysterical female. I resisted, that is, until another monsoon of panic attacks threatened my livelihood. I had a writer&amp;#039;s dream job, reviewing manuscripts and researching productions for a prominent Bay Area theater. But some mornings, I couldn&amp;#039;t step outside. I&amp;#039;d call in sick, often days in a row. Or if I showed up, I&amp;#039;d avoid contact with my boss any way I could. Eventually I had to leave that job, for reasons including my inability to concentrate. I sought out a new job and a new psychiatrist, who rediagnosed me with GAD and panic disorder and put me on Paxil. It did its job and kept me in mine, at a Berkeley bookstore, for a while. The downside came a year later, when surges of elation or rage would seize me at work while I was doing mundane tasks, like shelving. Once, I almost threw a punch at one of the regular, but by no means normal, customers: a squat man who&amp;#039;d tell the female clerks not to touch the (typically women&amp;#039;s) magazines he was buying. After a few of these episodes, it became clear that there was no peace for me in Paxil. Calm came, I found, only from pot. A hundred years ago, a doctor might have recommended marijuana for my condition\u2014or &amp;quot;nervous inquietude&amp;quot; as the U.S. Dispensatory called it in 1854\u2014and to anyone suffering from menstrual cramps, gout, cholera, or migraines. During the nineteenth century, American pharmaceutical companies freely produced cannabis for ailments. But in 1937, Congress criminalized &amp;quot;marihuana&amp;quot; with a tax act. In 1996, when California passed the first state initiative to decriminalize marijuana for treating illness, certain liberal populations, like the People&amp;#039;s Republic of Berkeley, quickly embraced cannabis as a means to ease nausea and other symptoms associated with AIDS, cancer, and treatments for both. Yet it didn&amp;#039;t get any notice in the area of anxiety and depression. As my antidepressants were failing me, though, I couldn&amp;#039;t help but pay attention to the fact that whenever I smoked pot with friends (after a soccer game, before a hike), it relaxed me\u2014and the calming effect lasted for days. I returned to marijuana in my mid-twenties as a way to level the emotional extremes Paxil induced, and to avoid talking to another listless doctor who would just give me a new pill. And at least doing business with a Cal student\u2014whose house reeked of too many animals\u2014seemed less likely to land me in jail than a visit to one of the marijuana clubs I kept hearing about. These were the sites of DEA raids, an entirely nerve-racking scenario for someone prone to panic attacks. In addition to the real possibility of federal arrest was the task of convincing a doctor that smoking pot was so far the only effective remedy for my feeling panic. Researchers are all over the map as to whether marijuana causes or reduces anxiety. One study published in a 1982 issue of Psychopharmacology found that the marijuana compound cannabidiol (CBD) muted the anxiety produced by THC\u2014marijuana&amp;#039;s main psychoactive cannabinoid. In 1999, the U.S. Institute of Medicine, an outgrowth of the National Academies, which make public-policy recommendations, issued an ambiguous report stating that &amp;quot;the psychological effects of cannabinoids, such as anxiety reduction...can influence their potential therapeutic value,&amp;quot; and also that its &amp;quot;effects are potentially undesirable for certain patients and situations and beneficial in others.&amp;quot; Cannabinoids, for example, reduce nausea. But they also impair short-term memory (hence the Dude, Where&amp;#039;sMy Car? stereotype). Also in the past decade, scientists discovered that the brain produces its own endocannabinoid compounds, which mimic plant-made cannabinoids and transmit their chemical messages through the same neural receptors. High numbers of the receptors were also found to occur in the amygdala and the hippocampus, the parts of the brain that play the biggest role in anxiety. Also significant for anxiety sufferers, scientists concluded that endocannabinoids\u2014and arguably cannabinoids\u2014may serve in the forgetting of fear. About four years ago, another psychiatrist put me on lithium for what he described as my &amp;quot;Paxil-induced hypomania.&amp;quot; When it made me violently sick, I decided I needed to replace pills altogether and turn to a regimen that relied on what was, to me, the only proven drug. I headed down to the five-block stretch of marijuana advocacy groups known as &amp;quot;Oaksterdam.&amp;quot; There, I explained to an understanding doctor, wearing Lennon glasses and cargo shorts, that marijuana eased the symptoms of what studies showed and I knew to be a genetic disorder. (My two younger brothers have been diagnosed as bipolar, and my grandmother suffered from anxiety and depression.) I also wanted more control over my medicine, the chance to find the right cocktail on my own. As the doctor thumbed my Paxil bottle, he told me, &amp;quot;I only ask that you be responsible for your illness&amp;quot; and that I see my primary-care physician at least once a year. In my case, he said, taking responsibility might mean combining pharmaceuticals and cannabis. He gave me a note recommending I use marijuana &amp;quot;on an as-needed basis,&amp;quot; and I became one of California&amp;#039;s 300,000 (and growing) number of pot patients. Each time I went to pick up my dosage at a dispensary, I weighed the costs of medicinal marijuana. While the literal cost was roughly the same as street weed (on average, $55 for the standard 3.5 grams, known colloquially as &amp;quot;an eighth&amp;quot;), I did pay a price in that all of a sudden, my pot smoking was a habit to be discussed with others. My parents resisted the idea at first; my mom handed me more than her usual share of newspaper clippings on the harm smoke inflicts on the lungs or the latest DEA dispensary raid. I got good at relaying what I&amp;#039;d read in studies\u2014that modulation of my cannabinoid system may alleviate anxiety disorder more quickly than SSRIs and with fewer side effects\u2014to the point that people usually agreed to let me go about my own business, as long as it made me feel better. When yet another psychiatrist\u2014my fifth\u2014got me off Paxil by prescribing Lexapro, I fought the drug-induced fatigue with different varieties of cannabis. In the culture of dispensaries, where scientific and clinical findings combine with toker lore to create a hybrid medical practice, I had to do the searching myself to find the strain that made for the best medicine. At my first visit to a dispensary, I was overwhelmed by the myriad strains of marijuana: There were rows of glass jars with names like Buddha Haze and Sensi Star on the labels. Not only could I take home a bottle of herb, I also could purchase cigarettes, hashish, tinctures, and edibles like Reefer&amp;#039;s peanut butter cups. I had no idea what to try, and the names seemed to change with the seasons. (One variety&amp;#039;s known impingement on motor functions moved a dispensary clerk to advise me, &amp;quot;You don&amp;#039;t want to pay your bills on this one.&amp;quot;) My friend, a user of marijuana as aspirin for his sports injuries, taught me how to recognize the difference between the main varieties, indica and sativa: Indicas have short and bushy leaves; sativas have thin leaves and fluffier buds. He explained that sativas&amp;#039; high THC content makes the buzz more cerebral, while indicas&amp;#039;, conversely (it has higher levels of CBD), has a stonier effect. I had the most success with sativa and indica blends, and I admit I&amp;#039;d finalize my selection based on scent\u2014in the end, it had more to do with aromatherapy than anything else. When someone behind the counter would hold out a mint dish full of buds, I&amp;#039;d take home the strain that smelled the most like an Oregon forest. Only after I stopped taking Lexapro, my third and last of the SSRIs, did I realize that just a little herb would suffice\u2014a few times a week, always at home, when I didn&amp;#039;t have to drive anywhere, and in the evening after a day&amp;#039;s work. I found a therapist, trained in addiction counseling, who told me that cannabinoids work similarly to SSRIs: They neither heal the brain nor work on neurochemical fragility but help you deal with symptoms. And, she advised, &amp;quot;as with SSRIs, should you decide to stop the marijuana, you&amp;#039;d want to taper off gradually.&amp;quot; Instead, I stopped taking Lexapro and, after a seven-year pill streak, gradually acclimated to a low-level anxiety similar to what I&amp;#039;d known before pharmaceuticals. I chose to stay on marijuana, the drug with the three-thousand-year history, for the firm grip it had on my panic, and managed to bring my dosage down to once a week\u2014a touch of Green Cream to soothe the nausea, sleeplessness, and jittery reflexes. I meditated every day and took more seriously my mom&amp;#039;s other cautions about eating well and exercising regularly. Yet outside Oaksterdam, my choice to medicate anxiety with marijuana puts me on contentious ground. There&amp;#039;s the basic fact that people seem to regard regular marijuana users as dim-witted, half-baked. And, more urgently, California law seems to have suffered from short-term memory loss: In January, the California Supreme Court ruled that employers could fire a medical marijuana user, even if the drug had no adverse impact on job performance. It hasn&amp;#039;t on mine, nor with my friends who self-medicate with the stuff and do all the things in life that make me proud to know them. My role as an anxious patient, then, has seemingly morphed from hysteric to herbalista\u2014an undercover clandestine marijuana user who hopes never to be seen through the smoky lens of stoner stereotypes. There&amp;#039;s been a recent progressive development in Congress, however. A bipartisan effort called the Medical Marijuana Patient Protection Act would back up initiatives like California&amp;#039;s Prop. 215, the likes of which have passed in 11 other states. If ratified, bill H.R. 5842 would take cannabis off the Schedule I list (drugs that are highly addictive and have no medical use) and upgrade it to Schedule II status (drugs that can be addictive but have medical use). This potentially paves the way for the FDA to set up a regulatory system and begin a drug-approval process for marijuana. Perhaps then the federal government will cease spending millions of taxpayer dollars on marijuana enforcement, cities can use the revenue from dispensaries to keep their libraries open, and I will be able to fill my prescription without looking over my shoulder for the DEA or continually lobbying my parents. On a recent drive to the dispensary, I wondered if I would ever go off drugs entirely\u2014and if I even count marijuana as something I want to eventually kick. My most recent physician, a former surgeon whose six-year history of referring marijuana is an eternity in the practice, told me that &amp;quot;pot simply treats anxiety so much better than the other drugs.&amp;quot; I thought about this outside, when I showed my state-issued medicinal-user ID card and driver&amp;#039;s license to a guy with a radio. He summoned security inside, and the door swung open to reveal a large room with fresh flowers on tables and bamboo mats underfoot. I hadn&amp;#039;t come for drugs that day. I&amp;#039;d made an appointment with a hypnotherapist whom I see every once in awhile to talk about my dreams; it&amp;#039;s just one of the free services that the dispensary offers. Rose greeted me at the registration desk, and we passed the jars of cataloged plant life\u2014Strawberry Cough, Witch Hazel\u2014together. When we reached her office, she turned to me and said, &amp;quot;You looked so relaxed when you came in, I didn&amp;#039;t even recognize you!&amp;quot; I took this to mean that I was onto something. Add the club kids to the pot smokers on the list of recreational users whose drugs show promise as remedies for mood disorders. Ketamine\u2014the PCP-like hallucinogen dubbed &amp;quot;Special K&amp;quot; in the &amp;#039;90s rave scene\u2014just may overcome one of the greatest obstacles to treating depression: the crucial lag time before medication takes effect. A recent National Institute of Mental Health study found that ketamine kicks in as an antidepressant within hours, rather than the weeks or months it takes for conventional treatment. And the period before an antidepressant starts working can be especially high-risk for suicide, says Husseini Manji, MD, director of mood and anxiety disorder research at NIMH. Twenty percent of women will experience at least one depressive episode in their lifetimes, and in two thirds of cases, the first drug tried is not effective. &amp;quot;We didn&amp;#039;t expect to see such a robust, rapid, and sustained effect,&amp;quot; NIMH researcher Carlos Zarate says. In a randomized, controlled trial published in the Archives of General Psychiatry in 2006, he and his colleagues found that 71 percent of subjects experienced significant reduction in symptoms and 29 percent had complete remission from depression one day after an infusion of ketamine. What&amp;#039;s more, ketamine worked for people who, on average, had tried six different drugs without relief. Researchers have found that ketamine affects the brain in a way that has them questioning prior theories of how all antidepressants work. The existing theory is that stress causes depression by releasing too much of the neurotransmitter glutamate, which can be toxic to brain cells. SSRIs enhance the nerve-growth factors that repair this neurological damage. &amp;quot;There&amp;#039;s a lot of literature supporting that, and then along comes ketamine,&amp;quot; says Lisa Monteggia, PhD, assistant professor of psychiatry at the University of Texas Southwestern Medical Center, who recently reviewed data on this nerve-growth theory of depression. Ketamine, some researchers believe, instead restores normal glutamate activity. &amp;quot;It&amp;#039;s an intriguing idea,&amp;quot; Manji says, that the drug &amp;quot;may actually be resetting the brain.&amp;quot; "^^<http://www.w3.org/2001/XMLSchema#string>
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