Can Cannabis Help Depression?
The Endocannabinoid System
When it comes to depression, scientists have noticed that the endocannabinoid system may play an important role in the regulation of our moods. The endocannabinoid system is found throughout the human body, as well as in other mammals, and helps our body maintain homeostasis — a healthy state of internal balance.
The endocannabinoid system consists of a few different parts. First, natural chemicals called endocannabinoids are produced by the human body. These then bind with CB1 and CB2 receptors to activate and modulate a variety of different functions, like:
- muscle control
- stress response
- memory building
- and mood
Enzymes, the last piece in this important system, then break down the endocannabinoids so they can be cleared from your body, avoiding building up.
While this internal system is completely functional on it’s own in healthy humans and other mammals, it can also be stimulated by some of the active chemicals in cannabis — specifically cannabinoids like THC or CBD. These chemicals bear a striking resemblance to our natural endocannabinoids when it comes to their chemical structure. So, when ingested, these chemicals also bind with CB1 and CB2 to activate the endocannabinoid system’s effects. This is why cannabis has such a broad variety of potential medicinal uses. It is actually stimulating a natural system that modulates these effects.
Research suggests that activating these endocannabinoid receptors could be particularly helpful in relation to depression. As it turns out, the endocannabinoid system is involved with regulating our moods, and scientists believe that CB1 receptors, in particular, play a big role in the occurence of depression. There are a few reasons why researchers think this. For one thing, there are CB1 receptors distributed throughout all the parts of the brain associated with depression.
In addition, animal studies have noted that those with depression demonstrate an impairment in the functioning of the endocannabinoid system. Studies on rodent subjects, for example, found that blocking activation of the CB1 receptor leads to increased depressive symptoms.
Similar results have come out in human testing as well. Rimonabant, for example, is a drug that was marketed in Europe as an appetite suppressant. It works by blocking CB1 receptor activity. Since CB1 is associated with our hunger response, scientists hoped they could reduce appetite by blocking this receptor. Unfortunately the drug had to be pulled from the market because so many of the patients using it developed depressive and anxiety symptoms. So, blocking CB1 in both animals and humans seems to produce the same mood altering effect — increased depression.
From this, researchers have moved on to study whether stimulating CB1 might produce antidepressant like properties. One study on rodent subjects found that low doses of a CB1 activating substance did increase antidepressant activity and serotonin responses in similar ranges to an SSRI antidepressant. However, the same study found that high doses had an opposite effect. The authors of this study say that it confirms that CB1 should be a target for developing new antidepressants, and that cannabinoids from cannabis might be a helpful treatment. After all, CB1 can be stimulated by cannabinoids.
Still, given the complex, dose-dependant relationship between CB1 activation and depression, much more research is needed to confirm the theory that cannabis can help with depression.
The evidence is strong that mood and depression is at least partly regulated via the endocannabinoid system. Still, we need to look deeper into the research to see how cannabis treatments might actually impact those with depression — both in the short term and the long term.
To begin with, it’s clear that many patients are already using cannabis to treat their depression. For example, a 2002 United Kingdom survey of cannabis use found that 22% of those with depression were using cannabis. Another study of medical cannabis patients from 2016 in Washington State found that half of the respondents reported using cannabis for depression. In general, these patients indicated that cannabis was helping with their depressive symptoms.
While patients using cannabis report improvement in their depression, scientific research into this topic is in very early stages and so far has been fairly inconclusive. Still, there have certainly been some studies that support the idea that cannabis can help those with depression.
One study of cannabis using heterosexual couples found that those who use cannabis were more likely to do so in the morning if they started the day in a worse mood. Using cannabis improved their mood, resulting in more positive affect immediately after use. This suggests that using cannabis might help those who need a short term boost of positive mood, when stuck in a depressive state.
Another study specifically looking at CBD suggested that it might be a particularly helpful aid for depression. This study looked at the depression fighting effects of CBD in rodent subjects and found that a single dose could induce fast and sustained antidepressant-like effects.
A 2016 review of the literature for using cannabis with depression also reported positive results. These researchers found nine studies on using cannabis for depression and seven of these studies showed the cannabis use led to improvements in depression symptoms. Still, the authors noted that these improvements were primarily seen in studies of patients with other medical conditions in which depression was comorbid, rather than looking at depression directly. So it’s unclear whether these improvements in depression might be related to improvements in other medical conditions, rather than directly improving depression.
Another study looked at data from an app designed to help patients track the effects from their cannabis treatment. Using data from 3,151 sessions tracking cannabis use and depression, the authors found that cannabis users perceived a 50% reduction in depression symptoms. Just two puffs of cannabis was sufficient to produce depression relief, and the effect was more pronounced in patients using high-CBD/low-THC cannabis. These perceived effects did not lessen with continued use over time.
Still, despite these positive results, researchers also found that depressive symptoms tended to worsen over time with cannabis use. This result has been seen in other studies as well, with long term use of cannabis being associated with worsening depressive symptoms. In addition, one clinical study found that reducing cannabis use could result in less depression symptoms.
But not all studies show this correlation, a large Swedish study found that the association between cannabis and depression disappeared when confounding factors were accounted for. An Israeli study found similar results, reporting that this association may be due more to sociodemographic and clinical factors than to cannabis use itself.
In addition, research suggests that cannabis using patients do better than those using opiods when it comes to depression. For those treating both depression and chronic pain, cannabis seems to be the option with less depressive side effects.
Given the research above, there is a good chance that using cannabinoids to activate your endocannabinoid system can help to temporarily alleviate depression symptoms. High CBD options may be particularly helpful for this, but both THC and CBD seem to offer short term boosts in positivity and relief from depression symptoms. Still, it is important to note that research suggests these effects are dose dependant. Low doses may improve depression while high doses may exacerbate it.
In addition, some research points to the possibility that long term use of cannabis can lead to worsening symptoms of depression. While these results were inconsistent between studies, and may be related to other factors, rather than cannabis directly, it is too early to say with confidence that cannabis use won’t lead to these worsening depression symptoms.
Still, if you have other medical conditions related to your depression, cannabis may be a better treatment option than alternatives. Chronic pain patients, for example, can expect to have better outcomes in terms of depression using cannabis rather than opiods.
Clinical depression, also called Major Depressive Disorder, is a common and disabling condition that affects how you feel, the way you think, and how you act and practically every other aspect of your life.
Many people think that depression is another word for feeling sad or low, but clinical depression goes beyond mere sadness. It’s important to know that depression isn’t something that you can just “snap out of” or cure just by wanting to hard enough, although it can be treated.
There are several different types of clinical depression:
- Persistent depressive disorder, or dysthymia, is a type of depression that lasts for more than two years, although sometimes you might feel that your symptoms are less severe.
- Postpartum depression (PPD) is a major depressive attack experienced by women after giving birth. People with PPD feel far more sad, anxious, and exhausted than women with regular “baby blues,” and unlike the “baby blues,” PPD may not clear up on its own.
- Psychotic depression is a form of depression that comes together with psychotic symptoms like delusions or hallucinations.
- Seasonal affective disorder (SAD) is a type of depression that affects you only during part of the year. Most people with SAD only feel symptoms in the winter, due to a lack of sunlight.
It’s estimated that more than 250 million people around the world suffer from depression, and that 1 out of every 6 people will have a depressive episode at some point in their lives. Generally, most people who feel depressed have their first experience of depression some time between their late teens and their mid-20s.
Anyone can experience depression, but it affects women more than men. According to some studies, 1 out of every 3 women will feel depression at some point.
When you have depression, you’ll feel some or all of these symptoms every day, and for most of the day. It’s important to know that a person who has depression can have several episodes of depression. During an episode of depression, you’ll feel more severe symptoms, but in between episodes, the symptoms may still be present though milder or barely noticeable.
Symptoms of depression can include:
- Feeling sad and tearful
- Feeling anxious and restless
- Feeling empty, worthless, and without hope
- Irritability and getting angry over small things
- No longer taking pleasure in the things you used to enjoy
- Moving, talking, and thinking more slowly than usual
- Sleep issues, whether it’s sleeping too much or having trouble sleeping
- Tiredness and lack of energy, even when you’ve been sleeping a lot
- Weight loss and a lack of appetite
- Having trouble concentrating, focusing on your work, or making decisions
- Memory problems
- Thinking about death or suicide, or a suicide attempt
You might also feel physical symptoms when you have depression, like joint pain, back pain, and digestive issues.
Note: Depression is not the same as the grief you feel after a bereavement, losing your job, or ending a relationship, even though people might say that they feel depressed. If you’re feeling grief, your sadness and painful feelings generally come in waves, mixed together with happy memories and positive thoughts. With grief, you also don’t usually feel a lack of self-esteem, which tends to accompany depression.
However, grief can trigger and overlap with depression, which makes it important to pay attention to your symptoms and to go to the doctor if you or someone you’re close to feels that your sadness is leading to depression.
Children and teenagers could show slightly different symptoms, including:
- Refusing to go to school and/or performing badly at school
- Losing or not gaining weight
- Being irritable, clingy, and anxious
- Complaining of general aches and pains
- Eating or sleeping too much or not enough
- Drug or alcohol abuse
- Avoiding socializing and other normal activities
Depression is often missed in older adults because the symptoms can be less obvious. Symptoms of depression in elderly people include:
- Personality changes
- Difficulty remembering things
- Excessive tiredness
- Loss of appetite
- Insomnia and generally having trouble sleeping
- Losing interest in sex
- Becoming reclusive and avoiding socializing or going out of the house
- Suicidal thoughts
When to see a doctor
Feeling sad and low is a normal part of life, so it can be difficult to know when to see a doctor. What’s more, someone with depression might not realize that their feelings of sadness, anger, or low self-worth aren’t reasonable, making it important for friends and family to pick up on these symptoms. Generally, you should go to the doctor if you feel at least 5 of the symptoms listed above, and they last for 2 weeks or more. If you feel the urge to commit suicide, you should seek help immediately.
To diagnose depression, your doctor will generally talk to you about your symptoms, and carry out tests to rule out any other causes or underlying physical issues. You can expect to undergo:
- A physical examination, to check that you don’t have any underlying physical problem
- Blood tests, to check for other conditions that may also present with similar symptoms such as thyroid issues, or vitamin deficiencies.
Assessments—questionnaires that may check if you are experiencing symptoms as per above that may indicate depression or anxiety.
It’s almost impossible to pinpoint specific causes of depression. It can affect anyone and at any time, but there are certain risk factors that make it more likely that you’ll experience it.
- Biochemistry and other biological differences. Research has discovered that people who have depression have differences in the chemicals in the brain that are in control of your mood.
- Genetics and heredity. Depression tends to run in the family. If you have a family member(s) who have had depression, alcoholism, bipolar disorder, or have a history of suicide attempts, you’re more likely to experience depression yourself.
- Hormones. Changes in your hormones, like those felt after giving birth, after menopause, or due to thyroid issues, can bring on an episode of depression.
- Personality. People who are pessimistic, have trouble coping with stress, have low self-esteem, and/or are highly dependent or self-critical are more likely to become depressed.
- Environment. People who live with violence, abuse, neglect, or in severe poverty are more likely to develop depression.
- Trauma. Traumatic incidents like a bereavement, abuse, losing your job, or serious financial troubles can trigger depression.
- A separate mental health disorder. This includes eating disorders, anxiety disorders, or post-traumatic stress disorder (PTSD).
- Some medications. Medications like blood pressure pills and sleeping pills, can sometimes cause depression.
- Alcohol and drug abuse. People who abuse alcohol and drugs frequently also suffer from depression.
- Serious chronic illness. Cancer, heart disease, chronic pain, or strokes can lead to depression.
- Struggling with being lesbian, gay, bi-sexual, transgender, or intersex. Lack of support and compassion can lead members of the LGBTQ community to depression.
The good news is that depression is one of the most treatable mental health disorders. Some 80-90% of people with depression respond well to treatment, and almost everyone feels some level of relief from their symptoms. Treatment for depression includes medication, psychotherapy and brain stimulation therapies, and self-help through lifestyle changes.
Generally, your doctor will prescribe you antidepressants. There are a few different types of antidepressants, including SSRIs like Prozac, SNRIs like Cymbalta, and other medications like Wellbutrin. These medications have fewer side effects, so they are the first ones that your doctor will suggest.
If these medications don’t work, your doctor may prescribe atypical antipsychotics like Abilify, tricyclic antidepressants like Elavil or Norpramin, or monoamine oxidase inhibitors (MAOIs) like Nardil or Marplan. These medications have more serious side effects, and some MAOIs can even be fatal if you eat certain foods or combine them with certain other medicines.
It takes time for antidepressants to work, usually between 3 and 6 weeks, and only at the right dose, so it’s important to give them enough time to work. You’ll typically find that symptoms like sleep and appetite issues and difficulty concentrating improve before your mood does.
Once you’ve found a medication that works for you, it’s best to continue taking it even after your symptoms have improved, like another 6 or 12 months. You should never abruptly stop taking antidepressants, since that can cause serious withdrawal issues. Instead, you need to slowly decrease the dose with the advice of your doctor.
Herbal medicines and supplements
Some herbal medicines and supplements, like St John’s Wort, omega-3 fatty acids, and S-adenosylmethionine (SAMe) have become popular for treating depression. Although some people find that they’re effective, they haven’t been approved for treatment by the FDA, so it’s important to be very careful when taking them, and to always consult your doctor. St John’s Wort, in particular, can interact badly with certain medications.
Psychotherapy, or talk therapy, can be effective against depression, either on its own or together with medication. There are a few psychotherapies used for depression, including cognitive behavioral therapy (CBT), interpersonal therapy, and problem-solving therapy. Psychotherapy can be for individuals or in a group, and it can include family therapy and couples therapy. Most people find that psychotherapy improves their depression within 10 to 15 sessions, but it can take much longer.
ECT and Neuromodulatory therapy
If you’ve had severe depression, and it hasn’t improved with medication or psychotherapy, your doctor might suggest some type of brain stimulation therapy. These include electroconvulsive therapy (ECT), or repetitive transcranial magnetic stimulation (rTMS) or vagus nerve stimulation (VNS).
ECT is not painful and it is actually quite safe. In fact, you often don’t feel anything. You could expect to get ECT two or three times a week, for up to 4 weeks. It may have some side effects, like memory issues, disorientation, and confusion, but they generally resolve quite quickly.
Self-help and lifestyle changes
Lifestyle changes play a central and important part in the treatment of depression. For instance, aerobic exercise alone can increase many of the neurotransmitters such as serotonin that are lacking in sufferers of depression. Stress reduction, relaxation techniques, adequate sleep, healthy diet, engaging in stimulating activities, and having a support network are critical in the treatment of depression.