Cannabis Treats Depression

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Isn’t cannabis approved for mental health conditions like depression? 

Cannabis and related products don’t have FDA-approval for use in psychiatry.  Pooled data found cannabis usage was highest in people with depression and anxiety.  Despite any subjective, temporary symptom relief, cannabis use¹:

• Worsened symptoms of depression and PTSD. 
• Contributed to that start of bipolar and PTSD and worsening their disease course. 
• Worsened severity, persistence, and frequency of manic and psychotic episodes in bipolar.  

How can I use cannabis safely? 

The National Academy of Medicine concluded there “is insufficient information on the health implications of cannabis use” and that “no accepted standards exist to help guide individuals as they make choices regarding if, when, where, and how to use cannabis safely and, in regard to therapeutic uses, effectively.” The Academy also expressed public health concerns about adolescents, pregnant women, and those with mental health conditions using cannabis.²

Alcohol, tobacco and cannabis use were independently associated with job loss in the short- term, with higher risks associated with higher dosages. Even moderate use, defined as 2-4 alcoholic drinks monthly,  1/2 to 1 pack of cigarettes daily, or cannabis use once monthly, was associated with job loss, regardless of job grade, age, gender, income, and education level.³

Doesn’t everyone use cannabis? 

Cannabis continues to be the most widely used drug worldwide with 3.8% of the world’s population using compared to 0.2% for cocaine and 0.2% for opiates. Use is highest in North America (13.8%) followed by Oceania (10.9%) and West and Central Africa (10%).⁴ In 2108 in the US, 15% of 12-17-year-olds (13.9% of 8^th graders, 32.6% of 10^th graders, and 43.6% of 12^th graders) ⁵, 15.5% of 18-25-year-olds, and 47.8% of those 26 and older have used cannabis in their lifetime. 1 in 17 of college students use cannabis daily compared to 1 in 9 for their non-college peers.⁶  

Is cannabis really that bad? 

Scientific evidence clearly indicates that cannabis use leads to both short and long-term adverse effects.  Short-term effects include, impairment of learning and attention, retention of information, short-term memory, coordination, and judgment, all of which can lead to injuries, car accidents, and risky sexual behaviors.  Long-term and heavy use leads to addiction (9% in adult users, 17% in teenagers, and up to 25-50% if use is daily and began as a teen), addiction to other substances, impaired cognition, altered brain development, chronic bronchitis, higher risk of paranoia and schizophrenia, and diminished lifetime earning potential, educational achievement, and life satisfaction. ⁷

In Colorado between 2000-2015, marijuana-related hospitalizations and emergency room (ER) visits increased by 116%. Cannabis-positive drug tests have increased for teens and young adults with the majority requiring psychiatric evaluations. The prevalence of mental illnesses was 5-times higher for ER visits.⁸

Young people don’t need to worry about cannabis until they’re older, right? 

Cannabis exposure during brain development, beginning in the prenatal period and ending in our early twenties, is a huge public health concern.  A growing brain is more susceptible than a mature brain to environmental toxins, such as tetrahydrocannabinol (THC), the primary active ingredient in cannabis.  THC exposure in adolescence can alter the sensitivity of the brain’s reward system to other drugs, like alcohol, opioids, etc. and prenatal exposure adversely changes brain cells by affecting their function, and how they communicate and work with one other cells.⁷  

I don’t use that much. Will my health really improve if I give it up? 

Studies have shown that long-term exposure to THC strengthens the emotional and reactive parts of your brain while weakening the rationale and self-control parts of the brain.  Scientist believe the effects of THC on these parts of the brain likely contribute to the cognitive and psychiatric dysfunction discussed earlier.⁹

Airway inflammation and bronchitis are largely reversible when cannabis usage stops. Cough, mucus production, and wheezing reduce to levels seen in non-cannabis users.¹⁰ 

Aren’t CBD-only products okay? 

Cannabidiols (CBD) has become quite ubiquitous.  CBD is only FDA-approved in children for specific forms of epilepsy as Epidiolex and in adults for chemotherapy-induced nausea and vomiting as Cesamet. The therapeutic potential of CBD in treating mental health conditions from anxiety, depression, bipolar to PTSD has not been well‐studied.¹ The FDA recently published a consumer update warning Americans that CBD can cause liver toxicity and are being marketed with unproven medical claims.¹¹

While studies have shown anti-anxiety, anti-seizure, and anti-psychotic properties of CBD, the consensus in the scientific and medical community is that we need a better understanding of:

• the human endocannabinoid system, which keeps our internal body environment stable and optimal.  
• The properties of CBD, including safety, applications, and precise dosing for treating psychiatric conditions with more clinical trials.¹²

References:

1. Botsford, S. L., Yang, S. and George, T. P. (2019), Cannabis and Cannabinoids in Mood and Anxiety Disorders: Impact on Illness Onset and Course, and Assessment of Therapeutic Potential. Am J Addict. doi:10.1111/ajad.12963
2. National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. https://doi.org/10.17226/24625.
3. Airagnes G, Lemogne C, Meneton P, Plessz M, Goldberg M, Hoertel N, et al. (2019) Alcohol, tobacco and cannabis use are associated with job loss at follow-up: Findings from the CONSTANCES cohort. PLoS ONE 14(9): e0222361. https://doi.org/10.1371/journal.pone.0222361
4. World Health Organization https://www.who.int/substance_abuse/facts/cannabis/en/
5. https://www.drugabuse.gov/drugs-abuse/marijuana
6. https://www.drugabuse.gov/related-topics/trends-statistics/infographics/drug-alcohol-use-in-college-age-adults-in-2018
7. Volkow, N. D., Baler, R. D., Compton, W. M., & Weiss, S. R. (2014). Adverse health effects of marijuana use. The New England journal of medicine, 370(23), 2219–2227. doi:10.1056/NEJMra1402309
8. Roberts B. A. (2019). Legalized Cannabis in Colorado Emergency Departments: A Cautionary Review of Negative Health and Safety Effects. The western journal of emergency medicine, 20(4), 557–572. doi:10.5811/westjem.2019.4.39935
9. Hwang E-K, Lupica CR. Altered Corticolimbic Control of the Nucleus Accumbens by Long-term Δ9-Tetrahydrocannabinol Exposure. Biological psychiatry. doi:10.1016/j.biopsych.2019.07.024.
10. Hancox, R. J., Shin, H. H., Gray, A. R., Poulton, R., & Sears, M. R. (2015). Effects of quitting cannabis on respiratory symptoms. The European respiratory journal, 46(1), 80–87. doi:10.1183/09031936.00228914
11. https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis
12. Crippa JA, Guimarães FS, Campos AC, Zuardi AW. Translational Investigation of the Therapeutic Potential of Cannabidiol (CBD): Toward a New Age. Frontiers in immunology. 2018;9. doi:10.3389/fimmu.2018.02009.