Medical Cannabis and Depression

Occasional feelings of sadness or “feeling blue” are normal and usually pass within a couple of days.  Depression, on the other hand, is a serious illness that interferes with daily life and causes pain both for you and those around you.

Mood disorders such as depression, dysthymia, and bipolar disorder are very common.  The National Institute of Mental Health estimates that such mood disorders have affected 9.5% of the U.S. adult population within the last 12 months.  45% of these cases (4.3% of the U.S. adult population) are classified as “severe.”  Women are 50% more likely than men to experience a mood disorder over their lifetime.  The average age of onset is about 30 years old.

Depression is most likely caused by a combination of genetic, biological, environmental, and psychological factors.

There are several forms of depressive disorders.

Major depressive disorder (major depression).  Characterized by symptoms that interfere with a person’s ability to work, sleep, eat, and enjoy pleasurable activities.  Most commonly, a person may have multiple episodes during his or her lifetime.

Dysthymic disorder (dysthymia).  Characterized by long-term (2 years or longer) symptoms that may be severe enough to cause disability but can prevent normal functioning or feeling well.  People with dysthymia may also experience episodes of major depression.

Minor depression.  Characterized by symptoms for 2 weeks or longer that do not meet the criteria of full depression.  Without treatment, individuals with minor depression are at high risk for developing major depressive disorder.

Bipolar disorder (manic-depressive disorder).  Characterized by cycling mood changes – from extreme highs (mania) to extreme lows (depression).

Other forms of depression may be slightly different or develop under unique circumstances.  For example:

  • Seasonal affective disorder (SAD)
  • Postpartum depression
  • Psychotic depression

Signs and Symptoms of Depression
The severity, frequency, and duration of symptoms vary from person to person.

  • Persistent sad, anxious, or “empty” feelings
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Irritability, restlessness
  • Loss of interests in hobbies or pleasurable activities (including sex)
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details, and making decisions
  • Insomnia, early-morning wakening, or excessive sleeping
  • Overeating, or appetite loss
  • Thoughts of suicide or suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems that do not ease, even with treatment

Conventional Treatments

If you think that you have depression, the first step is to visit a doctor or mental health specialist.  It is important to have an evaluation to rule out medical conditions that can cause the same symptoms as depression as well as to have a psychological evaluation.

Depression is most commonly treated with psychological counseling and/or prescription drugs.

Antidepressant medications primarily work on brain chemical known as neurotransmitter, especially serotonin, norepinephrine, and dopamine.

  • Selective serotonin reuptake inhibitors (SSRIs):  fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa).
  • Serotinin and norepinephrine reuptake inhibitors (SNRIs):  venlafaxine (Effexor) and duloxetine (Cymbalta).
  • Norepinephrine and dopamine reuptake inhibitor (NDRI):  bupropion (Wellbutrin).
  • Tricyclic antidepressants: amitriptyline (Tryptomer), nortriptyline (Pamelor), imipramine (Tofranil), doxepin (Sinequan)
  • Monoamine oxidase inhibitors (MAOIs): isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl), tranylcypromine (Parnate)

There are many side effects associated with antidepressant medications that limit their usefulness in many patients.  Side effects associated with antidepressant medications range from blurred vision and constipation to fatigue and impaired thinking to headaches and sexual problems to liver failure and suicide.

Complementary and Alternative Medicine

Often frustrated with pharmaceutical drug side effects, many individuals seek out more natural alternatives to assist in treating depression.

Psychological counseling.  Cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) are the two main types of psychotherapy that are effective in treating depression.

St. John’s wort.  Extracts from the herb St. John’s wort (Hypericum perforatum) have been used for centuries to treat mild to moderate depression.  It is one of the top-selling botanical products in the U.S.  St. John’s wort may be effective in the treatment of minor to moderate depression.  Its use in the treatment of major depression remains under study.  St. John’s wort may interfere with a number of medications (including oral contraceptives).  You should consult with your doctor before taking any herbal supplement.

Omega-3 fatty acids.  A diet rich in omega-3s or omega-3 supplements may help to ease depression when used in addition to standard depression treatments.  Omega-3 fatty acids are found in cold-water fish, flaxseed, flax oil, and walnuts.

Medical Cannabis

For many patients with depression, medical cannabis helps to improve many functional aspects of their lives, including such things as their ability for self-care, attendance at job or school, social interactions, sleep, and thinking ability.  Medical cannabis may also relieve the anxiety that is commonly associated with depression, and its pain-relieving properties can reduce depression that is related to chronic pain.  Patients commonly say that medical cannabis provides relief of many of their symptoms better than pharmaceutical medications with significantly fewer side effects.

Throughout history, various societies have used cannabis to treat symptoms of depression for hundreds, if not thousands, of years.  More recently, scientists have been investigating “cannabinoids” and the endocannabinoid system for their therapeutic potential in the treatment of depression.  Cannabinoids are the molecules in the cannabis plant that exert its medicinal effects.

Highlights from the Scientific Literature

Hill MN, Gorzalka BB (2005). Is there a role for the endocannabinoid system in the etiology and treatment of melancholic depression?

Conclusions:  Pharmacologic and genetic blockade of the cannabinoid CB1 receptor induces a phenotypic state that is analogous to melancholic depression, including symptoms such as reduced food intake, heightened anxiety, increased arousal and wakefulness, deficits in extinction of aversive memories and supersensitivity to stress.

Conclusions: An endocannabinoid deficiency may underlie some of the symptoms of melancholic depression, and the enhancement of this system may ultimately be a novel form of pharmacotherapy for treatment-resistant depression.

Serra G, Fratta W (2007). A possible role for the endocannabinoid system in the neurobiology of depression.

Results:  This review of the available preclinical and clinical evidence suggests a possible role for the endocannabinoid system in the physiopathology of depression, and the pharmacologic enhancement of endocannabinoid activity at the CB1 cannabinoid receptor level appears to exert an antidepressant-like effect in some animal models of depression.

Conclusions:  The data available are sufficient to suggest a possible involvement of the endogenous endocannabinoid system in the neurobiology of depression, and additional studies should be performed to better elucidate the role of this system in the pathogenesis of depression.


Medical Marijuana Patient Information

Besides smoking, delivery methods for the use of medical cannabis include vaporization, tinctures, teas, and edible products.  Most commonly reported side effects from the use of medical cannabis include dry mouth, red eyes, increased appetite, and tiredness.   There has never been a death attributable to a medical cannabis overdose.  Medical cannabis should be used in consultation with a physician who specializes in cannabinoid medicine.


How to “Help Yourself” if You are Depressed

Following are some suggestions from the National Institute of Mental Health to “Help Yourself” if you are depressed.

  • Recognized the signs of depression such as exhaustion, helpless, and hopelessness
  • Seek evaluation/treatment as soon as possible
  • Try to stay active and exercise
  • Set realistic goals for yourself
  • Break large tasks into smaller ones, set priorities, and do what you can, as you can
  • Try to spend time with friends, relatives and people in general
  • The transition “out of” depression is gradual.  Don’t expect too much too soon.
  • Postpone major decisions (e.g., marriage, divorce, changing jobs) until you feel better and have an objective view of your situation
  • Positive thinking will replace negative thoughts as your depression responds to treatment
  • Continue to educate yourself about depression


Mind-Body Connections

Practitioners of complementary and alternative medicine believe that the mind and body must be in harmony for you to stay healthy.  The mind-body connection has been studied for centuries, and there are a number of mind-body techniques that may be useful as adjuncts to ease depression symptoms.

  • Acupuncture
  • Yoga
  • Meditation
  • Guided imagery
  • Massage therapy

References and Resources

Hill MN, Gorzalka BB (2005). Is there a role for the endocannabinoid system in the etiology and treatment of melancholic depression? Behavioral Pharmacology. 2005; 16(5-6):333-352. http://www.ncbi.nlm.nih.gov/pubmed/16148438

National Institutes of Health (NIH). National Institute of Mental Health (NIMH). Depression.  http://www.nimh.nih.gov/health/publications/depression/complete-index.shtml

National Institutes of Health (NIH). National Institute of Mental Health (NIMH). Statistics.

http://www.nimh.nih.gov/statistics/1ANYMOODDIS_ADULT.shtml

Serra G, Fratta W (2007). A possible role for the endocannabinoid system in the neurobiology of depression. Clinical Practice and Epidemiology in Mental Health. 2007; 3:25. http://www.ncbi.nlm.nih.gov/pubmed?term=18021439

Mayo Clinic. Health Information. Depression (major depression) http://www.mayoclinic.com/health/depression/DS00175

Advertisements

About markrabe

Mark L. Rabe, MD, ABIHM Integrative Holistic Medicine Centric Wellness 2308 6th Avenue San Diego, CA 92101 Telephone: (619) 546-0420 Fax: (619) 615-2346 E-Mail: info@CentricWellness.com

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s