The relationship between cannabis and depression has received less attention than the relationship between cannabis and psychosis. Possible reasons for this are that with cannabis use, patients with depression have fewer hospital admissions than patients with psychosis and that some cannabis use disorder symptoms may mimic those of depression. Thus, the accompanying depression may not be diagnosed. In addition, due to the illegality of cannabis use, patients presenting with depression may not report cannabis use. So, what do you think is the relationship between cannabis and depression?
There are studies showing that cannabis use increases the risk of developing depression. The increasing use of cannabis in recent years, and the increase in suicide attempts and depression, especially in adolescents, have drawn attention to the relationship between the two. A higher rate of cannabis use was found in adolescents with major depressive disorder than in those without a major depressive disorder. Major depressive disorder is the third most common reason individuals seek medical marijuana after pain and sleep disturbances.
While stimulation of the CB1 receptor may have antidepressant-like effects, receptor blockade may cause anxiety-increasing and depression-like effects. In some transgenic mice, the CB1 receptor was destroyed and these mice showed signs of anxiety and depression. Rimonabant, produced as the first CB1 receptor antagonist drug, was removed from the market due to its psychiatric side effects. It has been the most realistic evidence of an increased risk of depression and anxiety when the effects on CB1 are blocked.
The Relationship Between Cannabis and Depression
Researchers from Canada and the University of Oxford conducted the most comprehensive study to date on the relationship between cannabis and depression. According to the study’s findings, teens trying cannabis before age 18 are more likely to become depressed and develop suicidal thoughts in their adulthood. Widespread use of the drug among young people is unlikely to change, but with the increasing potential, much more work is needed to educate young people about these risks, the researchers said.
If cannabis use had been prevented, the number of people with depression in the population would have decreased by 7 percent. This equates to around 400,000 cases of depression in the US, 25,000 in Canada, or around 60,000 cases of depression in the UK that would be avoided if adolescents no longer used it. In the meta-analysis published in JAMA Psychiatry, an influential and prestigious peer-reviewed journal, 11 different studies were examined; The mental health data of 23,000 people from their first cannabis use to the age of 34 were compiled.
The researchers found no significant link between anxiety and cannabis use, but the correlation between depression and cannabis use before age 18 was 37 percent. Experts emphasized that individual factors such as family history and other life stressors still play a larger role in depression. Canada legalized cannabis for those over the age of 18 last October. Some teens think that cannabis is harmless because it’s a plant, so it’s important to inform teens about the types of cannabis they use and the risks involved.
Experts stated that the findings may worsen with the increase in the concentrations of THC, the main psychoactive (head-raising) component of cannabis, and emphasized that: “Today, unlike the 1980s and 1990s, when the THC concentration was around 6 percent, we now have 10-15 percent.”
It is not possible to guarantee that young people will never use drugs. They will, but it is possible to regulate the market to protect young people, including age, content, and influence restrictions. Any parent who does not prefer their children to drink will still prefer them to drink a known brand with certain alcohol content, rather than a fake with unknown ingredients.
Using Cannabis as a Teenager Increases the Risk of Depression
According to a study by scientists from the UK and Canada, using cannabis as a teenager increases the risk of depression in adulthood by 37 percent. According to a study by a team from Oxford University in England and McGill University in Canada, it is of great importance that families do not see cannabis use as a part of the adolescence process and take precautions in this regard.
In a meta-analysis, 11 studies in which 23,317 people participated were examined, and it was seen that cannabis use during adolescence increases depression and suicidality for the rest of life. In the article, which stated that the increase in the use of cannabis by young people is dangerous, it was emphasized that public health authorities and governments should take precautions in this regard.
Smoking cannabis at least once a week before age 18 increases the risk of becoming depressed by 37 percent by age 32, according to the study. Young people who already have symptoms of depression or have a family history of depression were excluded from the cases. It is stated that approximately 400,000 cases of depression in the USA may be related to the use of cannabis as a teenager.
It is also reported that those who used cannabis as a teenager are three times more likely to commit suicide, although it cannot be proven statistically very strongly. No correlation was found between cannabis use and anxiety. However, it was emphasized that it is not possible to say for sure that cannabis use causes depression, but there is a strong link between the two. With the legalization of recreational cannabis use, production, and sale in Canada last October, stocks were exhausted within a week.
People With Depression Tend to Use Cannabis
In a study conducted in the USA, it was revealed that regular cannabis use increased faster in depressed people, and these people perceived this as a lower risk than non-depressed people. According to the related article, researchers analyzed data from 729 thousand people aged 12 and over between 2005 and 2017. These data also included whether these people had used cannabis in the previous months and whether they had been depressed during the previous year.
In the last year of the study (2017), 19 percent of depressed people stated that they used cannabis at least once, while the rate of using cannabis at least once in people who had not been depressed recently was 8.7 percent. In 2005, 10.2 percent of depressed people declared that they used cannabis at least once, while the rate of using cannabis at least once in non-depressed people was 5.7 percent.
During the study period, the proportion of depressed people who viewed cannabis use as risky behavior decreased from 41 percent to 17 percent, while the proportion of non-depressed people who viewed cannabis use as risky behavior decreased from 52 percent to 33 percent. The decline in risk perception is faster in those with depression. Cannabis use is more common in depressed people who see low or no risk in cannabis use, compared to those with a higher perception of risk.
The study revealed that current cannabis use is highest among young people aged 18-25, with about 30 percent. Cannabis use was also more common among depressed men, depressed blacks, and depressed singles. The study did not focus on whether and how depression affects people’s use of cannabis, or what they think about the risks of regular cannabis use.
One of the limitations of the study was that the researchers relied on participants’ statements about depression and cannabis use. Because the participants were not requested to have a medical test on whether they used drugs or not or any health record regarding their mental health.
There are those who think that marijuana use is a form of self-healing for depression. There is evidence that some people consider cannabis to be less risky than psychiatric drugs. However, there is no evidence that cannabis use will relieve symptoms of depression except temporarily. On the contrary, there are data showing that cannabis use prolongs or worsens depression. Traditionally, patients are advised to avoid marijuana use during treatment for depression.
Medical Cannabis To Treat Psychiatric Diseases Like Depression
Cannabis, which is obtained as a result of processing the leaves and powders of the Cannabis Sativa plant, is the most widely produced, most trafficked, and most consumed illegal drug in the world. The United Nations reported in 2008 that approximately 2.9-4.3% of the world’s adult population uses cannabis and 0.6% uses cannabis daily.
The widespread use of cannabis is primarily due to the fact that this Asian cannabis Sativa plant has the ability to grow in almost every part of the world and its climate, as well as the easy availability of cannabis in many places. Almost every country produces cannabis. Cannabis production for international illicit trade is concentrated in Southeast and Southwest Asian countries, as well as in Morocco, Tunisia, Sudan, Albania, and Macedonia.
Another reason for the widespread use of marijuana is the belief that marijuana is safer or less harmful than cigarettes or alcohol. Due to its herbal origin, cannabis is considered more “safe” than drugs that are chemical substances produced in factories (“it is a weed, it is not harmful”). This belief has also been supported by some medical authorities.
In one study, addictive substances were compared in two main categories: “harm to users” (such as addiction, mortality, and mental dysfunction) and “harm to others” (such as crime, environmental damage, and international damage). Substances such as alcohol, heroin, and cocaine were in the first place, while cannabis was lower, next to drugs such as benzodiazepine and methadone in clinical use.
Cannabis has been used around the world for hundreds of years, both for recreational and medicinal purposes. The plates obtained by sieving the dried leaves of the cannabis plant and the powders in the flowers formed on the top of the plant and pressing them under heat are usually wrapped with tobacco and smoked like cigarettes. According to the World Health Organization (WHO), even just 2-3 milligrams of cannabis when burned is sufficient to produce the desired effect in most people. Accordingly, an average single cannabis cigarette can provide enough cannabis to satisfy 2-10 people.
This may explain why cannabis is smoked in groups and shared. As an alternative to smoking, cannabis is consumed in Western countries by being placed in cookies, cakes, or other foods. Some users claim that ingested cannabis produces a different effect than cigarettes, often producing a stronger and longer-lasting body lightness.
The active main ingredient responsible for the pharmacological effects of cannabis is Δ9-THC /Δ9-tetrahydrocannabinol (THC). THC is a fat-soluble substance and passes quickly to the brain and other organs. THC changes the activity of CB1 and CB2 cannabinoid receptors on nerve cells, which are also affected by endogenous cannabinoid substances (endocannabinoids) in the body. The endogenous cannabinoid system is thought to play a role mainly in brain neuromodulation.
After the endocannabinoid precursors are synthesized from the membranes of the postsynaptic neurons, they become active due to the activation of the glutamate, dopamine, and Gamma-aminobutyric acid (GABA) cells on which they are located. Endocannabinoids prevent membrane depolarization and exocytosis by binding to presynaptic CB1 cannabinoid receptors as retrograde messengers, creating voltage-sensitive Ca++ channel inhibition and K+ channel activation. As a result, neurotransmitter release is suppressed in the affected nerve cell.
It has been shown that cannabinoid receptors are more concentrated in the regions of the brain responsible for functions such as pleasure, memory, thought, concentration, sense and time, perception, and coordinated movement. The cannabinoid system is thought to play a role in substance addiction, as well as metabolic regulation, pain, anxiety, bone growth, and immune system functions. It has been suggested that cannabinoid system disorders play a role in obesity, some cardiovascular diseases, and neurological disorders.
Within a few minutes of smoking cannabis, it causes an increase in heart rate, a decrease in blood pressure, and relaxation in the muscles. These effects are accompanied by eye redness, decreased intraocular pressure, dry mouth, and a feeling of heat or cold. After a while, disturbances in the perception of time, touch, sound, and vision occur. Memory and learning weaken, thinking and problem-solving slows down, and loss of coordination occurs. Sometimes cannabis use can also lead to symptoms such as anxiety, fear, insecurity, or panic. The frequency and magnitude of these events show individual differences depending on the dose. The central nervous system effects of cannabis can be grouped into four main groups:
- Emotional (euphoria and laughing for no reason)
- Sensory (temporal and spatial perception and disorientation)
- Somatic (drowsiness, dizziness, and motor coordination)
- Cognitive (confusion, memory problems, and concentration difficulties)
It has been reported that long-term use of cannabis may cause health problems such as various lung diseases, head and neck cancers, immune system disorders, depression, social withdrawal, other mental health problems, substance abuse, increase in other addictive substance use, and motivation deprivation syndrome. Because of all these features and risks, cannabis and drugs containing cannabis are included in the Schedule 1 group of controlled drugs, that is, “with high abuse potential, not accepted for medical use”, and their sale is prohibited.
Potential Medical Effects of Cannabis on Depression
The euphoria (joy, pleasure) effect of cannabis has been known for thousands of years. In the writings of the Chinese Emperor Shen Nung dated 2737 BC, cannabis tea was recommended as a medicine for rheumatism, gout, malaria, and memory disorders; In case of excessive consumption, it has been recorded that it causes impotence, blindness, and “seeing demons”. In the medical field, cannabis was used in the 19th and 20th centuries for its analgesic and sleep-inducing effects.
Various sources mention that cannabis was recommended as a medicine for complaints such as headache, stagnation, loss of appetite, weakness, some bleeding, and epilepsy during the First World War. Cannabis has been recommended for painless delivery in the last century. French doctor Louis Aubert-Roche, in his medical observations in North Africa, observed that Egyptians who used cannabis were less susceptible to diseases such as plague and typhoid that afflicted Europe.
In 1890, Queen Victoria’s physician, Sir John Russell Reynolds, declared that cannabis is “the most useful medicine for the treatment of painful diseases such as dysmenorrhea, migraine, neuralgia, and also for convulsions and insomnia.” Sir William Osler, known as the father of modern medicine, used the phrase “the best cure for migraine” for cannabis in his medical textbook written in 1915.
The use of cannabis in pain treatment is a frequently used “self-treatment” option among patients who have to live with chronic pain. Although the mechanism of the pain-relieving effect of cannabinoids is not fully known, there is preliminary evidence that these substances are safe and effective for the treatment of neuropathic pain (especially fibromyalgia and rheumatoid arthritis).
It is thought that THC produces mild and moderate analgesic effects by changing neurotransmitter release in the dorsal root ganglia and periaqueductal gray areas of the spinal cord. In a systematic review of randomized controlled trials using cannabinoids in the treatment of chronic non-cancer pain, it was reported that cannabinoids showed a significant analgesic effect compared to placebo, and even improved sleep disorders.
Cannabinoids are also used by cancer patients for their anti-nausea effect due to chemotherapy, as well as for their pain-inhibiting and appetite-enhancing effects. Similarly, publications have been made that it can be used as an anti-nausea and appetite enhancer in diseases such as AIDS that do not have a definite cure. Current treatments for multiple sclerosis (MS), a demyelinating disease of the central nervous system, are ineffective or cause serious side effects in some patients.
It has been suggested that marijuana may be useful in the treatment of conditions such as spasticity, pain, chills, and bladder dysfunction in MS. Two synthetic drugs that are derivatives of Δ9-THC, the active ingredient of cannabis, are in medical use in the USA: Dronabi-nol (Merinol®) and nabilone (Cesamet®). These drugs can be prescribed to treat chemotherapy-induced nausea and vomiting in patients who do not respond adequately to conventional antiemetic treatments.
In a randomized, double-core placebo-controlled clinical study in individuals with Acquired Immunodeficiency Syndrome (AIDS), the appetite-stimulating effect of dronabinol, measured by a visual analog scale, at doses ranging from 2.5-20 mg/day, was found to be statistically significant. In the same study, it was reported that nausea decreased and improvement in body weight and the mood was observed. The issue that marijuana may be a safe and effective treatment medically for cancer and AIDS, as well as multiple sclerosis, pain, glaucoma, epilepsy, and some other diseases, arouses the interest of both scientists and patients.
Potential Use of Cannabis in Psychiatric Diseases
It is a matter of debate whether cannabis is an effective treatment for psychiatric diseases such as depression, bipolar disorders, anxiety, and similar mood disorders, as well as its use in biological diseases. Some depressive patients claim that thanks to cannabis use, their mood improves, they become connected to life, they start walking and cycling, they have regular food and sleep, and they can do things they never thought of doing in a depressed state.
In the Medical Marijuana Handbook, the first edition of which was published in 1997, it was mentioned that cannabis has a “fighting depression” feature. In a study published by Denson in 2006, among 4,400 adults who answered questions asked on the internet, daily cannabis users regularly reported less depressed mood and more positive affect than non-users.
In a study conducted among AIDS patients, more than half of the patients who used cannabis reported that cannabis had positive effects on anxiety, depression, pain, and appetite, and improved their health status and general well-being. In premenstrual syndrome (PMS), it has also been reported that some women use cannabis to improve their symptoms. Many anecdotal reports like these and the experiences of doctors from their patients indicate that cannabis (and its active substance, THC) may also have potential uses in psychiatric diseases.
In some publications, it has been reported that cannabis may be beneficial in improving symptoms or reducing the side effects of drugs in some patients who do not benefit from conventional treatment. In addition to these, another important point advocated is that it may be possible to reduce or eliminate the use of opiates, stimulants (Ritalin), tranquilizers, sleeping pills, antidepressants, and other psychiatric drugs with the use of medical cannabis. However, adequate and controlled studies have not yet been conducted on any of these issues.
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