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Severe depression and cannabis have a complex relationship. For years it was believed that cannabis would cause depression. This commonly held belief was formed from few facts and governments trying to find ways of justifying their anti-cannabis policies. Propaganda films like “Reefer Madness” associated cannabis use with jazz and criminality. Of course, this was madness itself, but the public largely believed these misconceptions and plain untruths.
For a number of reasons, cannabis was made illegal in the 1920’s in most of the world. Since the 60’s, it has been included with drugs like cocaine and heroin in the severity of the punishments meted out for possession and sale of this drug. This harsh regulatory environment has meant that it has faced very little proper scientific scrutiny until late. Indeed, the United States’ Federal policy still regards it as having “no medicinal value”.
The evidence suggests otherwise. Because of the recent decriminalization and legalization of cannabis in some of the United States and the increasing availability of the drug to researchers across the world, the scientific community is discovering that far from being a social menace and a drug with no medicinal value, cannabis and the constituent drugs in the plant itself can be used to treat dozens of conditions, from acne to depression, psychosis to epilepsy.
Dwelling on what could have been if it had not been prohibited for the past 90 years is a depressing prospect (millions of lives saved etc) but for now, the opportunities for using cannabis and particularly one of the cannabinoids found in the plant, CBD, are being explored like never before.
A mood disorder like severe depression is a common and hard to treat condition. Somewhere around 350 million people suffer from depression worldwide, and suicide remains the biggest killer of people between the ages of 20 and 35 in most of the developed world. Treating this type of depression is complex and often unsuccessful. Many common drugs and therapies work only as well as a placebo, or only slightly better. The reason for this are threefold;
One of the factors in some forms of depression is the endocannabinoid system (ECS). This is a system of cannabinoid receptors in the limbic system. This is part of the brain known as the “emotional” brain. The role of the ECS is to change the way that signals are sent across the body.
Initial studies have indicated that the ECS is involved intimately with anxiety and depression. The reason that this is believed is that when CB1 receptors (which respond to cannabinoids) are blocked, it has an anxiety producing effect. The opposite is also true. When the ECS is stimulated, there are anxiety reducing effects. Stimulation of the ECS also appears to have antidepressant effects, and again the opposite is true: block the CB1 receptors and depressive symptoms emerge.
Depression is much more complex and intricate than just endocannabinoid system stimulation or blockage. With nearly 100 billion neurons and trillions of connections between them, the brain is far beyond our understanding at the moment. What we do know is pointing to the ECS as being pivotal, and the use of cannabis could be a crucial part of relieving depression. However, it should never be seen as being successful in isolation.
The causes of depression are as complex as they are many, and external factors are often a major trigger or cause of depression. In many cases, solving whatever life problem or medical conditions the patient had is enough to rid them of depression. In others, it is entirely a case of the brain reacting badly to the world or itself.
How successful cannabis can be for treating severe depression is unknown. Before you seek treatment, you should obtain a clinical depression diagnosis. A psychiatrist or mental health professional will be able to interview you. They will talk to you about which symptoms of major depression that you’re experiencing, history, drug use, lifestyle and possible genetic inheritance. Then they can make a diagnosis. A major depressive disorder is not as common as someone experiencing brief periods of depression, and the two are treated very differently.
According to the diagnostic and statistical manual of mental disorders (DSM) 5, severe depression has a number of recognizable symptoms. A severe depressive episode must have:
If you think you have depression, talk to your doctor. They are there to help. The Samaritans run a confidential listening service that is free and will not appear on your phone bill. If you think you are feeling suicidal, please call the emergency services or the national suicide prevention lifeline. They are trained, experienced and know exactly how to help you.
For a long time, cannabis was believed to be a cause of depression and something that would only make things worse for someone dealing with depression. This is understandable, as cannabis use can affect the memory and active functioning of the user and clearly the drug has a sedative effect. The correlation between cannabis use and depression, bipolar disorders and schizophrenia is quite clear; people with these conditions use cannabis more than average.
However, that correlation is not as causative as people thought. Cannabis does have a small role in triggering some forms of schizophrenia in young people, but it appears to need a genetic predisposition and family history of the condition to happen. Occasionally, cannabis can trigger psychosis, but there is currently no evidence it actually causes it. Cannabis looks like it is a trigger for some conditions, not the cause of them.
That is not to say that cannabis is a good thing for mental health disorders. The picture is far more complex than that. There have been large scale studies that have related cannabis abuse to depression, which is to be expected. Cannabis is a drug and like any drug, if it is abused it can lead to severe side effects.
Because cannabis is such a widely used drug it is possible to do large studies. Unfortunately, there have not been many reliable, large scale studies on the positive effects, especially those that consider the use of cannabis as a psychiatric tool. The American Psychiatric Association is coming around to using cannabis products in a controlled fashion for treating psychiatric disorders. In particular, the use of CBD is promising, especially as it doesn’t cause the ‘high’ that people are keen to avoid.
Cannabidiol (CBD) is one of the most promising of the cannabinoids found in cannabis. It does not interact directly with ECS receptors themselves, more as a mediator of other cannabinoids’ reactions. It has been shown to have mood stabilizing, antipsychotic, antiepileptic, and tumour fighting abilities. Because the ECS is so widespread around the body, it is related to many different conditions. CBD appears to be an effective way of mediating changes to the conditions.
Cannabidiol is highly tolerable and impossible to overdose on. This is believed to be because it is easily metabolised by the body as it is naturally present there anyway. The human body already has ways of dealing with CBD, so taking the drug is extremely unlikely to land you in the emergency room.
The safety record, apparent success in treating some conditions, and the cheapness and availability of the drug make it ideal for experimentation and study. In 5 years, the picture will be much more filled in, but for now, it only looks good.
Types of Depression and their Relationship with Cannabis
Cannabis is the most commonly self-administered drug for people with bipolar disorders. Excessive use of cannabis at an early age is associated with an increased risk of developing a bipolar I or bipolar II disorder. This is likely due to the effects of large amounts of cannabinoids on the delicate endocannabinoid system during pivotal stages of emotional development.
It seems that both the sedative and stimulating effects of cannabis are useful in either the manic or depressive stages of bipolar disorder, with some patients using the drug for both. Most current drugs used with bipolar disorders have a broad flattening effect, and so reduce the severity of highs and lows. Cannabis appears to have a more nuanced effect, working as both a sedative when the brain is in a manic phase, and a stimulant when it is in a depressive phase.
Further evidence is hard to come by for bipolar and cannabis. There is currently a real need for investigation into the use of cannabis as a positive treatment for bipolar disorders. Many psychiatrists are pushing for this because anecdotal evidence shows that many sufferers of bipolar disorders report that cannabis is more effective than other prescribed drugs for relieving their symptoms.
For severe depression, cannabis is being investigated for its apparent mood stabilization and “normalization” of the ECS. If the endocannabinoid system is not regulating itself properly, or there is an outside factor that is altering how it works, the use of cannabis could help it to return to its “normal” state in a major depressive episode.
The difficulty at this point is that this is not a conclusively proven effect. There have been investigations using animals but few on humans. Chronic stress is one of the leading causes of depression, and anecdotal evidence would point to cannabis being a successful way of coping with stress. But the science cannot back this up yet. It is difficult, therefore, to make solid conclusions at this time.
It has been known for a long time that people are buying and using cannabis illegally to help them deal with mental health problems. Now psychiatrists are facing a different regulatory environment. Cannabis can be obtained legally in many states in America, and Canada has recently legalized the drug, so it looks like it could be used successfully in treatment. The problem is that psychiatrists do not have the data to be able to recommend doses, know about long term safety, which conditions it is most successful at treating, or what the real risk factors are. Other drugs they prescribe are much better understood, even if they are less effective.
Using Cannabis for Severe Depression
It is probably clear at this point that the evidence for how successful cannabis can be in treating severe depression is unknown. However, many people do use it and the anecdotal evidence points to it being at least partly successful for most people.
A significant issue with using cannabis for severe depression is its illegality. Possessing and using an illegal drug can lead to severe punishment in some parts of the world. Only use it if it is legal. This is not only because of the punishments, but also because when you are using a drug to treat your severe depression, your doctor needs to know exactly what you are taking. Cannabis bought from the street is of unknown quality and strength, so comparing doses and use is impossible unless it was obtained from a medical marijuana dispensary.
Alongside this, your doctor might be obligated to report you for illegal drug use.
There are lots of treatment options available in the primary care system for people with depression including therapy and drugs. CBD and cannabis are one of many, and if you do decide that either cannabis or CBD are the way forward for your condition, please only do so in consultation with your doctor and accordance with the law in your state.