Depression and Medical Cannabis
Depression can range from mild to severe, and is a persistent sadness that lasts weeks, months or years rather than just a few days. Unhappiness, hopelessness, anger and anxiety are all associated with long-term depression (major depressive disorder).
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Potential Efficacy / Quality of Evidence (Low, Average, High) of Medical Marijuana for Depression
Cannabinoids, Terpenes/Terpenoids, Strains and Ratios that May Help
CBD:THC 20:1; CBD:THC 3:1; CBD:THC 1:1
Medical Cannabis Pros
Cannabinoids have antidepressant-like actions, which could help for those who are resistant to antidepressants, and possibly even reduce or replace their usage.
Cannabinoids work quicker than antidepressants, making them potentially very valuable for depressive episodes in the short-term.
Very useful for depression arising from chronic pain.
The cannabis plant contains a huge number of stress-busting compounds, such as limonene, alpha- and beta-pinene and linalool, alongside CBD and THC.
Medical Cannabis Cons
Care must be taken if the depression is comorbid with anxiety, where the person may be more sensitive to THC.
Getting the dosage right is important – too high a dose of THC could make depressive episodes worse, whilst a low dose may help alleviate depression to some extent.
In some instances, high amounts of cannabis use may be implicated in the development of depression. This seems to be the case with high-THC use during teenage years.
Contemporary antidepressants aren’t usually contraindicated by cannabis, but older ones like tricyclic antidepressants (TCAs) are.
More About the Condition
Depression could be the most common type of mental health condition in the U.S., affecting just over 26% of the population, although major depression affects around 16.1 million Americans. That is 6.7% of the population. Depression is a pernicious condition, and is often comorbid with anxiety. As depression is also a feeling that is hard to define, it is also extremely difficult to treat directly. Symptoms such as the anxiety associated with depression are treatable, but the depression itself is a much more elusive matter.
The costs of depression cannot be underestimated, and has a similar effect to that of smoking, i.e. a 7 – 11 year reduction in life expectancy. Suffering from depression can also increase the likelihood of developing another illness or disease, as the immune system is dampened. Those in chronic pain are also more likely to develop depression, which in turn can make the pain worse.
Contemporary antidepressants have a very high therapeutic index, and are not highly addictive. They work by increasing the levels of neurotransmitters like serotonin (which are selective serotonin reuptake inhibitors – SSRIs) and noradrenaline (noradrenaline and specific serotonergic antidepressants – NASSAs). The increasing levels of neurotransmitters may also disrupt pain signals, making them a mainstay in treating chronic pain conditions.
However, antidepressants can take some time to work. Figuring out which ones work can mean months or even years of trying various different pills. Cannabinoids, meanwhile, provide a more immediate effect, and so it can be seen rather quickly if the cannabinoids help. As cannabinoids such as CBD also work on serotonin receptors, amongst others, they could have antidepressant-like qualities.
However, it is important to remember that cannabinoids have biphasic effects. This means that they can have different effects at different dosages. For those with anxiety and/or depression, microdosing THC may be useful, but too high a dose may prompt anxiety and increase the feeling of being “low”. This gives a clue as to why the research into cannabis use and depression seems to return such differing results, with some claiming it helps and other studies showing a correlation between cannabis use and an increase in the rates of depression in a population.
This is certainly one area where regulation can help, as people are more easily able to shop for a product that will actually help them rather than be beholden to whatever strain or product their seller has that particular day.
There are also several other issues to be concerned about when looking at depression, which is a difficult condition to define precisely. Contemporary antidepressants may work well for anxiety and symptoms associated with depression, but not necessarily the depression itself, which is a far more nebulous condition to treat.
That antidepressants don’t work for everybody and often need to work on receptor systems other than serotonergic ones suggests that serotonin imbalances are not alone in the formation of depression. It is unlikely that a malformation in one set of genes encoding for serotonin receptors is the main cause of depression. We cannot say that modulating the endocannabinoid system is a better answer (most evidence is pre-clinical, as is the case with most studies on cannabis), but that cannabinoids work on multiple receptor targets may give us a clue as to how specific conditions with polygenetic causes arise.
Quotes from Experts
“The endocannabinoid system plays a key role in emotional responses and cognition function, and both clinical and preclinical studies suggest that dysregulation of its neuronal signaling may be involved in the pathophysiology of these disorders [anxiety, depression, schizophrenia] [27,28]. Thus, therapeutic strategies based on drugs that modulate endocannabinoid signaling may be useful in the treatment of neuropsychiatric disorders.” Source: Scherma, Maria et al. ‘New Perspectives on the Use of Cannabis in the Treatment of Psychiatric Disorders‘ Medicines (Basel, Switzerland) vol. 5,4 107. 2 Oct. 2018, doi:10.3390/medicines5040107
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