Cannabis for depression
While feeling anxious, sluggish and in a low mood or state at times is normal, depression can be a serious medical condition. According to Beyond Blue, 1 in 16 Australians are currently experiencing depression. There are a wide range of treatments for depression. An increasing number of doctors and individuals are using cannabis to treat depression.
In this article Dr Jim will help answer the question, “Can cannabis (marijuana) be used to treat depression?” It’s important to note that while depression and anxiety treatments are similar, the conditions can be mutually exclusive. Just because you are experiencing one does not mean you have the other. If you’d like to learn about cannabis and anxiety, you can read our cannabis for anxiety article.
- What are the signs of depression? | 00:27
- When should individuals seek a doctor’s help for depression? | 01:43
- How is depression diagnosed? | 02:22
- Can cannabis help treat depression? | 05:51
- Is medical cannabis prescribed for depression in Australia?
- How does THC help with depression? | 06:50
- Can THC make depression worse? | 07:38
- How does CBD help with depression? | 08:39
- Which terpenes help with depression? | 09:15
- Are there side effects specific to cannabis and depression? | 09:47
- Traditional medication can impact sleep. How does cannabis medicine impact sleep? | 10:58
- What type of cannabis is normally prescribed for anxiety and depression? | 12:06
- Is there a typical cannabis dosage for treating depression? | 13:11
- What are the traditional (non-cannabinoid) treatments for depression? | 03:16
- What are some of the side effects of traditional treatments for depression? | 04:39
- What does the research say about cannabis and depression? | 13:55
What are the signs of depression?
Depression can be debilitating depending on the severity of the condition. There are a number of types and subcategories of depression. There are major depressive disorders. People also experience dysphonia, which is chronic low mood. There can be situational stressors which can lead to a depressive disorder, for example, postnatal depression.
However, all of these conditions have similar features. The main features for depression include pervasive low mood and anhedonia, which is the lack of ability to enjoy previously pleasurable or enjoyable experiences.
Depression can also cause changes in sleep. This can present as difficulty getting to sleep or as hyper-somnolence, wanting to sleep all of the time. A change in appetite can also be a symptom of depression. Some individuals put on weight and other people will have no appetite whatsoever.
Finally, changes in self worth including feelings of worthlessness and guilt or thoughts of death and dying or increased suicidal ideation. All of these feelings can lead to fatigue and mental and physical slowing, so that everything becomes an effort in someone’s life as well.
When should individuals seek a doctor’s help for depression?
Sad days and depression are a normal part of life. Healthy people go through periods of low mood, low energy and sadness. When these symptoms become chronic or you begin to feel that everything is an effort it’s time to see a doctor. Negative feelings shouldn’t have a major impact on your life.
So, if you feel that your negative thoughts, moods or feelings are consistently impacting your quality of life or relationships, it’s important to seek help.
How is depression diagnosed?
Depression is a clinical diagnosis. This means that there are no blood tests or other physical tests you can do to diagnose depression. There are also lots of overlaps with anxiety disorders.
In order to diagnose depression, doctors use questions and tools from the DSM-5, which is a manual for mental health disorders. A diagnosis of depression means that it needs to be stand alone; so it’s not related to other conditions like thyroid dysfunction or endocrine disorders. Finally, the feelings need to cause dysfunction in the individual’s life.
Can cannabis be used to treat depression?
Yes, cannabis medicines can be a very valuable treatment option for depression. Cannabis can be used independently of other medications, or with other conventional pharmacological agents. Cannabis medicine should always be used in conjunction with things like exercise, healthy diet, sleep hygiene, meditation, and mindfulness and psychological strategies.
Cannabis works by acting upon and upregulating the endocannabinoid system. The endocannabinoid system (ECS) is extremely important for maintaining balance and homeostasis within the body. Scientists talk about the ECS’s main functions as eat, sleep, relax, forget, and protect. With that in mind, you can see how the ECS would be important for mental health disorders.
Can medical cannabis/marijuana be prescribed for depression?
Yes, in Australia medical cannabis can be prescribed for depression. Mental health disorders are the second largest category of medical cannabis approvals countrywide.
While reports state that depression is still one of the smaller categories of approval, there are known approvals. GPs can prescribe medical cannabis Australia-wide with few exceptions, including Tasmania where patients need specialist approval.
You can learn about eligibility and how your doctor can prescribe cannabis in our cannabis access article.
How does cannabis affect depression?
How does THC help with depression?
THC itself can be a beneficial treatment for depression as THC directly stimulates the body’s own cannabinoid receptors. THC when used correctly, it has similar effects to our own internal, or endogenous, cannabinoid Anandamide.
Anandamide is the body’s naturally occurring cannabinoid-like molecule, which can be linked to the boost in energy or euphoric state we think of as ‘runner’s high’. Anandamide means bliss in Sanskrit. So, THC can help with improving mood. THC can help break down ruminating thoughts and negative thought spirals.
THC can also help regulate sleep. Research has also shown that THC may help reduce the impact of or replaying of traumatic memory. So THC can be very beneficial in other, other mental health disorders, like a post traumatic stress disorder (PTSD).
Can THC make depression worse?
Possibly yes, depending on the individual and dose. Cannabis and cannabinoids don’t work the same for everyone. For certain individuals, under certain circumstances, THC can cause dysphoria which is a worsening of mood.
Most people experience an uplifting of their mood or more of a euphoria, which is beneficial for depression. Some people are not able to tolerate THC, and for others, high doses can actually down-regulate the body’s own endocannabinoid function. Because the ECS is so important in mood regulation, causing a down-regulation can lead to worsening mental health.
Those who get a worsening of mood are the minority. But it’s important when starting cannabis treatment, to be careful with your THC dose. Too much THC or too regular use of THC can negatively affect the ECS.
Can CBD help with depression?
Yes, cannabidiol (CBD) can be a very beneficial treatment for depression. CBD is a cannabinoid that works on about 60 different receptors, enzymes and neurotransmitters. It also can activate adenosine pathways which help with relaxation and serotonin pathways which can help boost mood.
As low dopamine and serotonin can cause certain symptoms of depression, regulation of these chemicals is important. CBD can help block the reuptake of neurotransmitters like serotonin, dopamine and GABA which means that your body can use those chemicals for longer periods.
Which terpenes help with depression?
Terpenes can be useful in treating depression. Terpenes are the essential oils in cannabis and give the different breeds their aromas. Unfortunately most of the research that’s been done is on mice, not humans. Some of the terpenes that are good for anxiety and depression are:
- Limonene – research shows it may reduce stress and anxiety.
- Pinene – research shows that pinene has an anxiolytic effect (anxiety-reducing).
- Linalool – research shows that linalool odour can have anxiolytic effects.
- Mercene – research shows Mercene to have a sedative effect.
Are there side effects specific to cannabis and depression?
Most medications can have side effects and cannabis is no different. The side effects of cannabis are quite mild and generally well tolerated.
THC can cause some dysphoria and a worsening in mood for certain people who aren’t used to THC or are intolerant of THC. It can also increase fatigue or slow down mental processing. So, if an individual is having issues with fatigue and difficulty thinking, then THC can have an additive effect to those symptoms.
CBD on the other hand is generally very well tolerated. CBD, at higher doses, can cause a bit of a hyperarousal, which can lead to further difficulties in sleep. And, if people are taking high dose CBD before bed, it can actually disrupt some of the sleep architecture and affect REM sleep.
The important thing to remember is that everyone is different and so side effects may vary. Cannabis doesn’t work for everyone.
Traditional anti-depression medications can impact sleep. How does cannabis medicine impact sleep?
So there are many studies that show the positive influence of cannabis medicines on sleep. For some people, high dose CBD can actually be quite stimulating and affect sleep architecture. For many people, however, CBD improves sleep because it can alleviate many of the symptoms keeping them up at night.
THC, when used at appropriate doses, is a great sleeping aid because it doesn’t actually affect the sleep architecture. Many people don’t remember their dreams but still go through REM and the dreaming phase. This is one of the reasons THC can be really beneficial for individuals with PTSD or those with recurrent nightmares. At very high doses, THC can disrupt sleep architecture.
So, this is why it’s important you use THC in an appropriate manner, starting low and going slow and seeing how your body reacts.
What type of cannabis is normally prescribed for anxiety and depression?
Both CBD and THC formulations can be really beneficial for depression. Dr Jim said that he normally starts with a CBD dominant treatment to be used throughout the day because it’s the safest, and often a very effective treatment for depression.
If a patient is having ongoing issues with mood disorders, then he may start to add low doses of THC throughout the day as well.
At night, if a patient is having sleep disturbance or trouble getting to sleep a THC formulation might be necessary as well. The goal is to give patients good quality sleep.
Oil based medications are generally prescribed because of their duration of action, or the time that the effects last. With all treatments, you want to have relief of symptoms throughout the day. However, if there are breakthrough symptoms or conditions that need rapid onset, flower consumed via a vaporiser can be beneficial as well.
One other thing to note is that if you have to drive, THC may not be an option for you. Current laws state that it’s illegal to drive with any THC in your system. If you want to learn more about when you can drive. Please view our cannabis and driving article.
Is there a typical cannabis dosage for treating depression?
Not really. When using cannabis for a medical condition you want to find the lowest effective dose to treat the symptoms. Your doctor should do this by starting low and going slow.
Dr Jim said, “We get people to monitor their symptoms and we change their doses of cannabis medicine to find out when they’re at their most effective dose.” Patients will titrate their medicine up, meaning they increase in small amounts over time to find the right amount.
In general, with regard to CBD, most people use probably between 20 and 40 milligrams of CBD a day. And with THC, it’s a much lower dose. It’s around five to 10 milligrams a day, but this varies depending on people’s needs.
Again, it’s important to remember that cannabis is not right for everyone and it doesn’t work for everyone. Your dosage will be unique to you.
What are the traditional (non-cannabinoid) treatments for depression?
The traditional treatments for depression are divided into non-pharmacological treatments and pharmacological treatments.
These are the treatments that doctors will often recommend first. They are things you can do on your own to help with your mental health. These treatments are exercise, sleep hygiene, healthy nutrition, psychology, meditation, and mindfulness strategies.
While they can be treatments in and of themselves, they are very important to incorporate into any treatment plan. The challenge for some individuals battling depression is that they lack the motivation to engage in these activities.
After non-pharmacological treatments, the first line therapies prescribed for depression are antidepressant medications and things like SSRIs or SNRIs.
Second line treatments are older antidepressants like tricyclic antidepressants, and monoamine oxidase inhibitors. Doctors may also prescribe some newer drugs like reboxetine and agomelatine and these have less clinical evidence.
For individuals having trouble sleeping, doctors may also prescribe benzodiazepines, but these can actually make people’s mood disorders a lot worse in the long run and may be associated with more harm than good.
What are some of the side effects of traditional treatments for depression?
All medications have side effects and may be mild in some individuals and pronounced in others. Side effects are often why people discontinue medications or look for other solutions like medical cannabis. Side effects for the antidepressants may include:
- Weight gain
- Sexual dysfunction
- Dry mouth
- Changes in blood pressure
And, changes in blood pressure can lead to an increased risk in falls. The other challenge with antidepressants is that they have a delay in their effectiveness. It can take four to six weeks before they start working. So, if someone is in a critical situation, the delay can feel like an eternity. Because the drugs can increase motivation before improving mood, those who are experiencing suicidal thoughts have to be very careful because it may make them more likely to act on those impulses.
Tranquilisers can actually worsen some mental health disorders due to an increased downturn in mood.
What does the research say about cannabis and depression?
There’s a lack of good quality clinical trials specifically looking at depression or improvements in depression as their major outcome. There are some mouse trials which indicate that cannabis can help with depression. Other studies like the Sativex trials have shown significant improvement in wellbeing for people using cannabis medicines.
There is also a lot of case based information, meaning individual doctor-patient cases where cannabis is helping with depression. Finally, there have been studies that show the endocannabinoid system’s role in depression which shows there is a link between endocannabinoid dysfunction and depression. The TGA has been known to approve cannabis for patients with depression which also shows that there is a role for cannabis in treating depression.
Cannabis is not a first or second line treatment in Australia and does not work for everyone. If you think cannabis medicine might be right for you, please consult with your doctor.