In 1621, British clergyman Robert Burton recommended a variety of treatments for depression (what he then referred to as the “Chaos of Melancholy”) in his book The Anatomy of Melancholy, including prayer, good company, exercise and various tinctures and herbs – including marijuana.
Today, when faced with the myriad symptoms of a depressive episode, patients and their physicians are more likely to turn to a plethora of prescription pills.
Pharmaceuticals are undoubtedly helpful for many patients. However, each comes with its own list of side effects including nightmares, fatigue, dizziness, irritability, even sexual dysfunction. Additionally, pharmaceutical treatments carry varying levels of risk for addiction and liver or kidney toxicity.
However, the expansion of access to regulated medical cannabis in the U.S. provides millions of patients an alternative to what we have come to think of as “traditional” pharmaceutical treatments. Almost 400 years after Burton recommended it, patients and health care providers are again turning to marijuana as a natural alternative to pharmaceutical antidepressants, and part of a holistic approach to mental health care.
In 1988, researchers discovered a complex receptor system in humans, the endocannabinoid system. These receptors are found throughout our bodies, and interact both with the active compounds in the cannabis plant and with analogues of these compounds which our bodies produce naturally. We know that in our brains, these receptors play an important role in modulating mood and emotion, including both anxiety and depression. Genetically engineered mice whose CB1 receptors have been “knocked out” may soon be used as models in preclinical studies of depression. Furthermore, the scarcity of cannabinoid receptors in the brain stem means that lethal overdose is essentially impossible with marijuana.
Can I use cannabis for depression in Maine?
It is important to remember that depression itself is not a qualifying condition for the medical use of marijuana in Maine. Maine recently added Post Traumatic Stress Disorder (PTSD) to our list of qualifying conditions; in the summer of 2014, the Wellness Connection of Maine surveyed 526 of our members, and nearly 25 percent of respondents listed PTSD as one of their qualifying conditions.
The same survey asked members if they had also found that their cannabis use for a qualifying condition also helped them with another condition that is not currently approved in Maine. 19.6 percent of respondents agreed that it had, and depression was among the most frequently listed of these conditions. Because depression so often accompanies serious illness, we frequently hear anecdotal evidence that patients who use cannabis for a “qualifying” ailment also find that it improves their co-morbid depression.
But doesn’t cannabis cause depression?
There is no conclusive evidence that marijuana use alone causes depression. This does not preclude the existence of competing studies and various interpretations of data on the part of the scientific community. Dr. Daniel Hall-Flavin of the Mayo Clinic summarizes the topic thus: “Marijuana use and depression accompany each other more often than you might expect by chance, but there’s no clear evidence that marijuana directly causes depression.” In other words, correlation does not prove causation.
Some of the correlation may be due to the fact that people with depression sometimes turn to cannabis to self-medicate. Certain strains or varietals of the plant can provide mental and physical stimulation and focus, temporarily alleviating feelings of apathy or sadness and allowing the user to function effectively in society.
A 2005 survey of 4,400 respondents by Denson and Earlywine (“Decreased depression in marijuana users,” Addictive Behaviors Vol. 31, Issue 4, Pages 738-742) revealed interesting conclusions. The research team grouped respondents into those who had never used marijuana, those who used once a week or less, and those who consumed daily. All took The Epidemiologic Studies Depression scale and responded to a series of questions about their marijuana use. The researchers point out that they chose to use an online format in hopes of attracting more-depressed participants, including those whose condition would have made it difficult to go to a public clinic or even to talk on the phone.
Those in the once-a-week or less group reported “less depressed mood, more positive affect, and fewer somatic complaints” than the cannabis-naïve group. Daily users reported less depressed mood and more positive affect than the non-using group. This study also separated out medical and non-medical consumers, and found that the medical users “reported more depressed mood and somatic complaints than recreational users.”
Researchers at McGill University discovered in 2007 that low doses of dronabinol function as a potent anti-depressant. Dronabinol (also known as Marinol) is the synthetic form of the THC molecule, which is responsible for the “high” associated with marijuana. However, at higher doses, dronabinol worsened depression. This makes sense—THC is known to cause psychoactive effects and in high doses of whole-plant medicine it can also cause anxiety, agitation, paranoia and floating fear.
The McGill findings underscore the need for whole-plant users to consume responsibly, and in moderation. They also implicitly highlight the benefits of using the whole plant. There are dozens of therapeutically valuable compounds in marijuana, including cannabidiol (CBD). Recent research indicates that CBD acts to moderate the psychoactive high of THC.
While Western medicine tends to analyze and break apart the constituent parts of medicinal plants (think willow bark tea vs. aspirin), the active compounds in whole-plant cannabis interact with one another in complex ways to provide relief. And studies have shown that patients prefer whole plant medicine over dronabinol by wide margins.
Cannabis as an empowering, engaging treatment option
In the survey of our members, 72 percent of respondents reported being more able to work or attend school since starting cannabis therapy. These patients did not all identify as suffering from depression, but withdrawal from one’s usual activities is certainly a symptom of depressive disorders. 77 percent were able to reduce by at least one the number of prescription medications they were taking after starting medical marijuana—and 30 percent of these prescriptions had been prescribed to alleviate side effects of another prescription medication.
Beyond improving mood and social functioning, and reducing pharmaceutical intake, there is an often-overlooked benefit to patients with depression who choose therapeutic cannabis: personal empowerment. Unlike pharmaceuticals, whole-plant cannabis can be self-titrated; the patient determines the optimum amount and frequency of dosing. The empowerment that comes from identifying and controlling this aspect of treatment may itself be beneficial to those living with depression.
Responsible cannabis use can help patients with depression feel more engaged and participate more fully in life, especially in combination with other complementary therapies such as cognitive behavioral counseling, or the physical exercise that Burton recommended four centuries ago.
Faced with the “Chaos of Melancholy,” contemporary patients, physicians and therapists should communicate openly and objectively about how this traditional therapeutic herb may fit into a successful treatment regime.