‘These are weak studies’ more needed to understand cannabis and depression

cannabis and depression: image of person in distress with cannabis plant superimposed over

Anxiety and depression often coexist, which is wild since they have seemingly opposing effects. Throw cannabis into the mix, and things only get more confusing. People swear by weed to keep depression at bay or stave off anxiety, but others feel the plant aggravates those conditions. The trio –cannabis, anxiety, and depression– are a complicated bunch.

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The sect of people who use cannabis to treat anxiety and depression may swear by it, but that doesn’t change the fact that some experience adverse events after consuming it. There’s an onslaught of coverage, studies, and information about cannabis and anxiety, but very little is published or written on the topic of depression and the plant.

Treatment or antagonist?

Dr. Ryan Sultan, a board-certified senior psychiatrist at Integrative Psych, spoke with GreenState about which comes first: cannabis or depression. The Columbia professor believes that the current state of medical marijuana is driving the disconnect between the plant being a medicine or an antagonist.

“If you’re going to use it for depression and anxiety, it should be medicinal, and what does medicinal actually look like?” Sultan posed.

That’s a solid question because the best-intentioned budtenders still aren’t doctors. Even if there were medical doctors behind dispensary counters, there is no readily available, standardized cannabis medicine akin to Prozac and other SSRIs.

If Dr. Sultan wanted to prescribe medical marijuana to a depressed patient, he would be doing so without accompanying instructions or limitations. Both are generally available for traditional pharmaceutical treatments.

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There are many medical doctors comfortable prescribing cannabis in legal or medical states, but patients rarely speak to their primary practitioner about interest in medical weed. Most seek out Naturopathic Doctors (ND) or specialty clinics for medical recommendations, even if their primary care physician diagnosed the qualifying condition.

If medical doctors don’t have science-based prescribing guidelines, it’s safe to assume that most other practitioners don’t either. That’s unfortunate because the difference between cannabis treating depression symptoms and causing depression may lie in the dose and cannabinoids.

Many patients are playing product roulette every time they try something new for their symptoms. Sometimes the same strain of flower that relieved anxiety last month hits differently this batch. On other visits, a tried and true tincture runs out at the shop with no restock date in sight.

This is usual for medical cannabis patients, but it’s rare for those taking doctor-prescribed pharmaceutical antidepressants. It’s also one of the reasons Dr. Sultan is hesitant about medical marijuana for depression, anxiety, and other conditions.

“I’m not saying a pharmaceutical company should do this. I like the way marijuana is done. And I actually think marijuana, the more and more it becomes corporate, the worse it’s gotten. But, like, we need some standardization,” Sultan said.

Cannabis and depression

Cannabis interacts with many endocannabinoid receptors in the brain, even those that deal with depression like the amygdala, hippocampus, and the dorsomedial thalamus. Dr. Sultan compares cannabinoids from weed to bodybuilders squeezing receptors. The mondo impact makes people feel high, but also makes receptors less sensitive to organic hormones and compounds the body sends to keep equilibrium.

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While at first, cannabis may ease depression symptoms, consistent use of potent products may mean that receptors need a break to upregulate. Without a t-break, those predisposed may experience a period of depression in these times. There is little long-term research on how this type of consumption may impact brain health, and even published cannabis research and depression is preliminary.

“These are weak studies. They’re not the kind of data that we want to give recommendations to people about using cannabis as is,” Dr. Sultan explained. “People that are into medical marijuana should be starting a revolution or a movement to do marijuana in something that resembles a medical way because we could do that. We have models for this that exist.”

To properly ascertain how cannabis and depression intermingle (and anxiety, too, for that matter), products must be standardized and safe dosage defined. Cannabis medicine will eventually be standardized like Epidiolex as more pharmaceutical companies take an interest. Without medical patients and advocates making a ruckus the resulting space may be unrecognizable by that time.

Depression for weed, or depression from weed?

Cannabis and depression, weed and anxiety–these aren’t simple relationships. While some swear by their bong rips when depression rears its dark head, others might fear it will push their mood into a downward spiral. The individuality of the endocannabinoid system may play a role, but with long-term, high-THC consumption, its possible adverse depressive reactions may be due to overuse or incorrect dosage or surpassed limitations.

There’s no argument that some patients find deep relief from cannabis medicine. Decades of anecdotal evidence, patient testimony, and some viable research support these stories. Unfortunately, the disconnect from the medical community is doing a disservice to these patients as they struggle to understand dosage, find the right products, and navigate growing tolerance. This rings especially true for patients navigating recreational stores for their medicine.

For now, the haze around cannabis for depression remains. However, with more input from the scientific community and demand from patients, perhaps the potent power of pot will be taught in medical institutions.

Cara Wietstock is senior content producer of GreenState.com and has been working in the cannabis space since 2011. She has covered the cannabis business beat for Ganjapreneur and The Spokesman Review. You can find her living in Bellingham, Washington with her husband, son, and a small zoo of pets.