CANNABIS and DEPRESSION

I can speak with the authority of personal experience on this subject because without the plant, I'd most likely be dead. Plain and simple, cannabis relieves depression in most cases with none of the side effects of conventional pharmaceuticals.

Chronic Depression complicated by Seasonal Affective Disorder ruled my life until I was almost 40.  I did not know what it was, what caused it, and the doctors I went to did not seem to know how to fix it.  I would not be alive today if, after my son's death, a neighbor hadn't brought a joint over with the instructions, "It can't hurt you and it might help."  I guess I had vaguely heard the cannabis propaganda, but I was in such mental pain, had been for a long time, that I was willing to try anything at that low point. Thank God a cop didn't see me sitting out back on a rock smoking 'marijuana':  I'd have lost my chance to heal and probably my chance at a productive life.

My personal story, 'The Bottom of The Mind: Depression" is located at https://www.angelfire.com/la/kaylee/depression.html

Every sick person I've ever worked with has a degree of depression above the norm due to their physical limitations and pain.  I once nursed a quadriplegic who could move only his arms but his hands were drawn and of little use.  He was denied a nurse by the county because he had been arrested and was awaiting trial for trying to grow 12 scraggly cannabis plants in his back yard.  Since he had quit using cannabis, his leg spasms had retured full strength and had caused sores on the back of his feet and legs that made the doctor suggest 'amputation'. The patient refused to go back to that doctor so the county would not give him a nurse until he got a new doctor. I was coming to fill in until he could get a nurse assigned him. He had been alone for three weeks when I arrived. He talked about how cold it got one night and how he couldn't pull the blanket at the foot of the bed over himself; how his dog was hungry and he couldn't feed him; how he felt lying in feces three days until a male cousin could stop by and take care of some of his needs.  He asked if I knew how he had maintained his sanity during that depressing time. "I would smoke pot, watch the ceiling fan go round and round until my mind would take off into space and I'd forget my problems." How could anyone be so cruel as to deny this man the benefits of this plant?   Kay Lee

Depression May Be Worlds Most Disabling Disease | From LiveScience
http://www.livescience.com
Sep 9, 2007

"When compared with other chronic diseases, depression may well be the most disabling disease in the world, a new global study finds.

People with chronic physical diseases such as angina, arthritis, asthma and diabetes also fare far worse if they also suffer from depression, the team of international researchers found.

"Being sad is bad for your health," according to lead researcher Dr. Somnath Chatterji, from the World Health Organization (WHO) in Geneva, Switzerland.

"But all too often," he said, "depression doesn't get the serious attention paid to physical ailments."

No one is safe from being affected by depression because it affects everyone. It doesn't matter whether you're a male or female, rich or poor, educated or uneducated. Once a person starts becoming depressed, he or she usually behaves in a manner that intensifies the illness. It is a vicious circle that can be very difficult to break free from.

The definition and meaning of treatment-resistant depression
http://biopsychiatry.com/treatresist.htm

Oregon Medical Marijuana Act
Debilitating Medical Conditions Advisory Panel
Anxiety with Depression Research Review
This is the html version of the file http://www.ukcia.org/research/AnxietyWithDepressionResearchReview.pdf.
 

NOTE: This review considers one petition relating to depression as stated above. This petition appears to also have anxiety as underlying symptom.
Research relating to cannabis dependence issues has been included only if it represents significant new information which has not been covered
within the Psychotic Disorders Research Review. Depressive issues may more properly fall into the category of Mood Disorders, i.e. bipolar disorder
but will be considered here to maintain consistency. Anxiety and agitation including PTSD will be considered in a subsequent review.

1. CONSIDERATION OF EVIDENCE
Description of Evidence Considered: 1. Cannabis Indica in 19th-Century Psychiatry [Carlson, American Journal of Psychiatry, 131: 9, 1974, pp. 1004-1007.]

A study of the history and usage of cannabis indica. The article makes frequent reports that indicate cannabis was widely prescribed by physicians in Europe and America for depressive and anxious symptoms. The...” review of the drug’s physiological and psychological effects reveals that most of the effects reported in the 1960’s were known to writers of the 19th century, when the drug was alternately considered a cure for and a cause of insanity.” “Frequently cited as a sedative, a hypnotic, or a soporific, cannabis was widely prescribed for insomnia.” “With the widespread reports of the pleasant and cheerful stimulating effects of the drug and its reduction of horrible feelings and fears, it was inevitable that cannabis was to be subjected to extensive trial in the treatment of melancholia.”

GRADE: Good historical evidence that cannabis was widely appreciated as an antidepressant and anxiolytic in the 19th century, prior to the pharmaceutical era.

2. [Delta-9] Tetrahydrocannabinol in Depressed Patients [ Kotin, et. al., Archives of General Psychiatry, Vol. 28: 1973, pp. 345-348.]
Double-blind clinical trial of THC in 8 patients suffering from depression over a period of 7 days failed to produce significant euphoria or anti-depressant effect. 2 patients experienced severe anxiety reactions.

GRADE: Good evidence that THC does not produce an anti-depressant effect.

3. Haschish in Melancholia [ Polli, Medical Times, Vol. 100, No. 7, 1972, pp.
236-238.]

A single case study in the 1860’s of a physician using a cannabis preparation to successfully treat a woman with severe, incapacitating depression with what appeared to be psychotic features. According to the author the treatment lasted 10 days with steadily increasing doses. The cure was permanent.

GRADE: Fair evidence of a single case-report of incapacitating depression being successfully treated with cannabis.

4. The Management of Treatment Resistance in Depressed Patients with Substance Use Disorders [ Nunes, et. al., The Psychiatric Clinics of North
America, Vol. 19, No. 2: 1996, pp. 311-327.]

Discusses depression and comorbid substance use with evaluation of depression and comorbid substance use and treatment recommendations. Case studies are described. It recommends a “harm reduction” approach and emphasizes the debilitating effects of ETOH and cocaine. One reference to cannabis as being perceived by patients as being harmless

GRADE: Good evidence that cannabis is not a significant etiological factor in depressed patients who self-medicate to relieve symptoms.

5. The Management of Treatment-Resistant Depression in Disorders on the Interface of Psychiatry and Medicine [ Gruber, et. al., The Psychiatric
Clinics of North America, Vol. 19, No. 2:1996, pp. 351-368.]
No mention of Cannabis, no relevance to inquiry.

GRADE: No relevance to inquiry

6. Advertisement for cannabis U.S.P. (American Cannabis) fluid extract Parke, Davis & Company 1929-1930 physicians’ catalog of the
pharmaceutical and biological products pp. 82.]

This is an advertisement for a cannabis-based fluid extract of 80% alcohol which was distributed to physicians. “Extensive pharmacological and clinical tests have shown that its medicinal action cannot be distinguished from that of the fluid made from imported East Indian cannabis.” “Narcotic, analgesic, sedative.”

GRADE: Excellent evidence that cannabis preparations were produced and advertised to physicians and were indicated as a sedative.
7. Do patients use marijuana as an antidepressant? [Gruber et.al., Depression 4(2): 1996, pp. 77-80.]

The authors “present 5 cases in which the evidence seems particularly clear that marijuana produced a direct antidepressant effect. If true, these observations argue that many patients may use marijuana to “self-treat” depressive symptoms.”

GRADE: Good case study evidence that some patients use cannabis to treat depressive symptoms.

7. Petitioner application and information submitted with application The petitioner and her husband submitted documents including a letter to the
State Health Officer describing her diagnosis by two doctors of “Clinical Depression and High Anxiety.” She also testified by telephone at the March 20th meeting. Petitioner states:

“The depression/anxiety is nothing new for me as I have struggled with this for most [of] my life with relief only from smoked Marijuana.”
She repeatedly emphasizes less than acceptable results form medications. Her petition is attached to 11 pages of chart notes from her physician, which indicates a gradual decrease of functioning over the 2-3 years of treatment. Chart notes indicate treatment with Paxil, Buspar, Prozac, Lithium, Xanax, Luvox, and Thorazine. The notes indicate some psychotic symptoms of varying frequency and duration as well as fluctuating weight. The doctors’ notes state:

“ I feel that the patient may benefit from medical marijuana to help control her anxiety, but I told her that I would not prescribe this because it does not fall within the guidelines for treatment with medical marijuana.”

The petitioner appears also to be prescribed long-term benzodiazepines. Petitioner states:

“Marijuana eliminates the need for Xanax. It does not produce withdrawal as with Xanax. I can smoke Marijuana without a problem.”
The petitioner relays by telephone that she doesn't get “high” and smokes every few hours.. Her partner states that legal drugs haven’t helped. “Legal drugs make her dysfunctional.” “Marijuana seems to work for her.”

GRADE: Good evidence that this severely incapacitated individual benefits from using cannabis and that cannabis is a drug of last resort after trials of many drugs have failed and she has been on long-term benzodiazepines. Clinical Effectiveness (and comparison with established alternatives)
This research base describes significant although slim empirical evidence of  cannabis’ usefulness for depression. There is good evidence that cannabis falls well within established safety parameters especially when compared with commonly used anti-depressant and mood-stabilizing drugs. Clinical trials are scant and tend to indicate minimal if any anti-depressant effect.

Health Benefits and Risks:
Health benefits appear to be related to increased medication toleration by minimizing side effects, and possibly exerting some anti-anxiety effect, which lifts the cloud of despondency, and hopelessness, which is common with, depressed persons. Risks include the potential for dependence associated with long-term heavy use and the possibility that cannabis may mask or cover symptoms depressive symptoms rather than actually relieve them.
Factors Affecting Safety, Effectiveness, and Related Considerations for All Patients and for Specific Patient Types.

Safety factors appear to favor cannabis. There is no clear evidence that cannabis use exacerbates suicidal ideation in depressed patients without
psychotic symptoms. Factors related to effectiveness are not clear other than underlying substance dependence or perhaps liver disease, which may alter cannabinoid metabolism or interact with other medications. What is clearer is that depression carries with it high mortality rates due to
suicide.

Additionally, depression interferes with energy and enjoyment. Factors, which affect safety, include the side effects of commonly used medications.  These side effects may cause significant harm or death, as with MAOIs. The relative harm associated with cannabis appears minimal when compared with side-effect profiles of many drugs used to treat depression-most notably Lithium. Cannabis appears effective in a small but unknown percentage of depressed persons who do not suffer from underlying substance use disorders.

Net Health and Overall Impact of Medical Marijuana Use for This Condition:
Please see above
Other Considerations
As is the case with all psychiatric conditions evaluated, the legal status of cannabis remains the single biggest detriment to ill persons through contact with law-enforcement or illegal drug networks. Depressed patients sometimes act in a suicidal manner in response to hopelessness and despair. The trauma of arrest and prosecution may be considered a potential risk factor for suicide. II. Performance On Assessment Criteria1. Quality and Sufficiency of Available Evidence: There is sufficient available evidence of sufficient quality to permit reaching a sound determination relating to
the use of medical marijuana for the treatment of this condition.

NO Comments: Few if any carefully controlled clinical trials have been done to measure cannabis’ antidepressant effect. The case histories and “N of 1” studies which have been done indicate that cannabis’ anxiolytic properties may actually represent the underlying mechanism of it’s anti-depressant effect, rather than a primary anti- depressant effect.

2. [A] Clinical Effectiveness: The use of medical marijuana for this condition is clinically effective. POSSIBLY

Comments: For some percentage of patients suffering from depression cannabis is effective.

[B] Relative Clinical Effectiveness: The use of medical marijuana for this condition is clinically effective relative to established alternative treatments for
this condition. NAD

Comments: Insufficient data is available to evaluate relative clinical effectiveness due to a lack of randomized clinical comparison trials with
commonly used antidepressants.

3. Health Benefit/ Risk Ratio: The health benefits of medical marijuana use for this condition outweigh the health risks. POSSIBLY

Comments: For those who do not suffer from comorbid substance use disorders, and have exhausted their medical alternatives the benefits of cannabis use under medical supervision outweigh the risks-especially when compared with the statistical likelihood of suicide.

4. Net Health Impact: The use of medical marijuana for this condition improves net health outcomes (functional status and/or ability to perform activities of daily living) for those individuals with this condition who use medical marijuana. NAD

Comment: The extent to which cannabis use creates a net health impact is unknown at this time.

5. Net Overall Impact: The use of medical marijuana for this condition improves net overall outcomes (quality of life and/or perceived satisfaction with condition improvement) for those individuals with this condition who use medical marijuana. NAD

Comments: Net overall impact is difficult to assess until randomized clinical trials have been conducted. For the petitioner, at least, there appears to be a net overall benefit in her quality of life as perceived by her, her physician, and partner.

6. Safety, Effectiveness, or Related Issues: There are no such compelling or overriding issues that alter any of the determinations regarding the use of
medical marijuana for the treatment of this condition that would have been reached absent these issues.. YES

Comments: The potential danger to the petitioner as well as other depressed patients who use cannabis by contact with the legal system cannot be
overstated. These potentially violent confrontations with police and/or illegal drug networks may result in death directly, or through suicide.III.

Overall Findings and Recommendations
Summary of Findings:
One (1) petitioner’s written and oral comments appear to support therapeutic use of cannabis for depression;
Two (2) surveys detailing the history of cannabis for treating depression and treatment guidelines for depressed people;
One (1) pharmaceutical advertisement indicating that cannabis was prescribed by physicians for insomnia in this century;
One (1) clinical trial indicating no anti-depressant effect from THC in clinical surroundings.
One (1) clinical trial indicating efficacy of THC in treating insomnia;
One (1) survey of no relevance.

Recommendation Regarding Adding this Condition to the list of “Debilitating Medical Conditions” for Purposes of the Oregon Medical
Marijuana Act

Add disease to list of disease conditions pursuant to ORS 475.302(2)(a)

COMMENTS: This “yes” recommendation is based upon the following rationale: It is medically indefensible and contrary to the ethics of the nursing profession for me to advocate that ill people be arrested and jailed for their use of cannabis. This situation has arisen because of Federal abdication of research protocols, which would have long-since clarified cannabis’ relative value. Ill Oregonians should not bear the weight of this governmental negligence. Furthermore, the taxpayers of Oregon should not be saddled with the costs of processing ill people through the criminal justice system. This represents an unfair burden to patients and taxpayers and will further alienate depressed people from accessing the medical system.
I would make the following recommendations for depressed patients and their doctors wishing to avail themselves of cannabis, should depression be approved for inclusion on the list of debilitating medical conditions:

BBC NEWS | Health | 'Cannabis' acts as antidepressant
A synthetic version of a cannabis chemical can act like an antidepressant. A team from Canada's University of Saskatchewan suggest the compound causes nerve cells to regenerate. The animals were seen to have nerve cell regeneration in the hippocampus, which is linked to memory and emotions. The Journal of Clinical Investigation study showed rats given a cannabinoid were less anxious and less depressed. Feb 1, 2006

AAMC: Cannabis and Depression
Some recent studies have linked depression to chronic use of cannabis ...
Cannabis aids the insomnia sometimes present in depression and can improve

"Patients who use cannabis to "relax" may be treating the anxiousness sometimes associated with depression. Cannabis aids the insomnia sometimes present in depression and can improve appetite. Better pain control with cannabis can reduce chronic pain related depression. While cannabis cannot yet be considered a primary treatment of major depression it may improve mood when used under physicians supervision and in combination with therapy and/or SSRI’s." ~Jay R. Cavanaugh, Ph.D.
 

More about Depression can be found at Intelihealth, the website of Harvard Medical School: http://www.intelihealth.com

Depression References: MEDLINEplus: Depression

EMAIL  Kay Lee