Combating Mental Illness with Cannabis
Mental health disorders are widely prevalent in the United States. In fact, nearly 1 in 5 American adults has a mental health condition. Citizens commonly suffer from mood or anxiety disorders yet treatment for many years has been limited to prescription medication instead of natural plant-based alternatives like medical cannabis.
Today, 56% of American adults with a mental illness do not receive treatment. Beyond this, there has also been a steady rise in mental health conditions amongst younger populations with the rate of youth depression rising from 8.5% in 2011 to 11.1% in 2014. The state of mental health in the United States is a pressing issue that needs to be addressed and more research needs to be done to look at how medical cannabis can be used as a treatment [2].
But because cannabis is still labeled a Schedule-I drug, there has been limited research about its effects on treating mental health conditions. However, some patients who suffer from mental illness do use medical cannabis to provide relief for their conditions.
The three mental illnesses that we will look at in greater depth are Depression, Bipolar Disorder, and Obsessive Compulsive Disorder.
Depression
While sadness is normal to human emotion, depression is described as persistent sadness due to biological, psychological, or social distress. We all feel unhappy from time to time, but these feelings often fade over the course of a couple days. Individuals with depression go through long periods of overwhelming sadness and many of the activities they used to enjoy no longer bring them happiness.
Depression is the leading cause of disability in the world. In 2012, the National Institute of Mental Health estimates that 16 million adults have experienced at least one depressive episode. This is 6.9% of the United States population above the age of 18. [3]
If depression is left untreated, there can be serious complications that put your life at risk. Of the around 30,000 suicides that occur in the United States each year, two-thirds of them are attributed to depression. Depression is not an issue anyone should take lightly but cannabis could be the medication that provides patients with treatment that they are seeking.
Effects of Cannabis on Depression
Cannabis is an effective alternative to antidepressants that stimulates the endocannabinoid system. Cannabis can be useful to patients who suffer from depression in a multitude of ways. Being a natural remedy, cannabis relieves anxiety and provides energy and focus to patients, making it easier for them to get out of bed in the morning and embrace the day ahead of them [4].
In addition, cannabis can help combat some of the symptoms that are associated with depression, such as loss of appetite and insomnia. Cannabis allows patients to have an easier time falling asleep, stay asleep longer, and enjoy a deeper sleep.
Researchers at McGill University discovered that while low doses of THC can act as an antidepressant, THC in high doses can actually induce symptoms of depression. Patients should always recognize the potential side effects of any medication they are taking, which includes medicating with cannabis. Taking any necessary precautions by safely monitoring their dosage levels and speaking with certified physicians about how cannabis can be used to effectively treat their symptoms are great ways to get educated about cannabis before medicating.
Bipolar Disorder
Bipolar disorder, also known as manic-depressive illness, is a form of depression that is associated with unusual shifts in mood, ranging from depressive lows to manic highs.
The National Institute of Mental Health estimates that bipolar disorder affects approximately 5.7 million adult Americans, or about 2.6% of the U.S. population age 18 and older every year. 82.9% of these cases are considered to be severe. [5]
Bipolar disorder has a heritable component. More than two-thirds of people diagnosed with Bipolar Disorder have at least one close relative who also has been diagnosed with Bipolar Disorder or major depression.
Effects of Cannabis on Bipolar Disorder
There is no clear answer about cannabis and its effects on Bipolar Disorder. Knowing how your body and brain could react to cannabis are vital in knowing whether or not you should incorporate it into your treatment plan.
Research from Lancaster University showed that cannabis use was associated with positive emotions, but also with increased manic and depressive symptoms. Cannabis usage was not associated with self-medicating behavior, meaning the research subjects tended to use cannabis when feeling good rather than after a manic or depressive episode. The relationship between cannabis and Bipolar Disorder is still up for debate.
If you plan to incorporate cannabis into your medication for Bipolar Disorder, you should know that a strain with higher CBD is more beneficial than one with more THC. CBD is fast-acting and also doesn’t produce the psychoactive effects associated with THC. [6]
If you are sensitive to THC and use a high THC strain, this may cause a spike of dopamine in your system. Too much dopamine at the wrong time is thought to be associated with psychotic symptoms.
Obsessive Compulsive Disorder
Obsessive Compulsive Disorder, commonly referred to as OCD, is an anxiety disorder that is associated with irrational fears that drive the individual to engage in repetitive compulsive behavior. Usually, individuals with OCD recognize that their fears are irrational and attempt to ignore them. However, in their effort to do this, their level of anxiety skyrockets until they engage in their compulsive behavior.
OCD affects an estimated 3.3 million people in the United States. This number equates to about 1% of children and 2% of adults. [7]
While the obsessive behavior that the general public associates most with OCD is cleanliness, there are many different types of obsessions that a person with OCD can have. Common obsessions include cleanliness, organization, and the fear of attack.
OCD doesn’t just affect the one’s emotions. OCD behavior can have devastating consequences on all aspects of a person’s life. The behaviors surrounding OCD can take over one’s life to such an extent that it effects relationships with loved ones, as well as performance in education and career.
Effects of Cannabis on OCD
Because the effects of OCD in individuals vary, it can be hard to know whether or not cannabis can be the right medication for you. Some people diagnosed with OCD struggle to feel like they are in control when they consume cannabis. On the other hand, many others are able to obtain much-needed relief after medicating with cannabis. In addition, cannabis can be useful in treating some of the side effects of OCD, including nausea [8].
Cannabis can help with OCD because of its anxiety-reducing effects. When the anandamide reacts with the THC found in cannabis, it produces a calming effect throughout the body which can decrease the anxiety felt by the individual. By reducing anxiety, the urges that an OCD sufferer feels are often diminished.
The next steps for patients looking to obtain medical cannabis…
Determine if medical cannabis may be a treatment option for you.
Go through a reliable service provider to obtain a medical cannabis recommendation from trusted physicians. Understand that having a medical cannabis recommendation will not put you on a government list and that your patient information remains confidential.
Once you get your recommendation, determine what strains and methods of consumption (i.e. smoking, vaping, edibles, etc.) work best for you. Seek local dispensaries near you that carry medical cannabis products you are interested in trying.
Try medical cannabis to help alleviate symptoms of mental health, but as always, it is advised to use discretion and consume cannabis responsibly.
Transcript of Meadow MD Podcast
David Hua: Hey, this is David Hua with Meadow. And this is the Meadow Podcast. Today we are talking with Dr. Dan. Welcome Dr. Dan.
Dr. Dan: Thank you.
David Hua: For those that don’t know Dr. Dan, we’ve been working with him on Meadow MD. He’s spent over 20 years in the ER and has seen over 10,000 patients; helping them with recommendations on cannabis. Today we’re going to be tackling the subject of mental health. Mental health relates to, depression, bipolar disorder, OCD, and we’re going to be covering a little bit about each of those, and how cannabis can help, and what we’re seeing. Dr. Dan, welcome, and why don’t we briefly talk about the state of mental health in the U.S. and from your perspective.
Dr. Dan: Well I think mental health is an issue that really can’t be swept under the rug because, patients who have difficulty with mental health, who either don’t have health insurance or some of the new proposals for healthcare reform, drop off benefits like mental health, and I think that’s very short-sighted. Those patients can do harm to others and to themselves and wind up with a lot of medical problems that can be very costly. Whereas, just a basic amount of care with a mental health professional and perhaps with medication as well. That medication may be pharmaceutical, that medication may be cannabis related, or both. I think the key is finding what works best for the individual and just having someone that can help them understand and address their needs, and, I think that’s very important. I’m concerned, because of the way the discussion has been with relationship to the health care bill, that this could be a huge problem and we really need to address it.
David Hua: To look at it. Well, you kind of brought up a point to me, which is mental health is a state of mind where if you are in a bad state of mind then it’s almost like a self-fulfilling prophecy. If you’re not feeling up to it you might not go to work or you might not show up for school. You may flake out on friends and family. You hermit up which then reinforces that feeling that you have and it keeps going down. Whereas, someone with solid mental health has an outlook that’s more positive and that can also be a self-fulfilling prophecy as well. The first thing we can talk about is depression. You’ve encountered, I’m sure, plenty of people who’ve had depression. What are some of the signs that you have it and how can cannabis help you with that condition?
Dr. Dan: Depression is very widespread throughout the world and has many different causes. Some of it is situational depression. They’re a lot of different sub-diagnoses or sub-classes of depression, but it is a chemical disorder and it can be helped chemically either with pharmaceutical medications or with cannabis-based medicine. The hallmarks of depression are that basically the person tends to be sad, down, they have a condition that we call in medicine anhedonia. Hedonism means pleasure, anhedonia means that the patient is unable to experience pleasure. Those things that usually would give you pleasure like ice cream or sex or listening to music, no longer have any appeal at all, and the person is simply unable to enjoy anything. Often they’ll stay in bed, have difficulty getting out of bed, they’ll miss school or they’ll miss work, as you mentioned, and really that’s a big part of making our nation productive, is having healthy workers. If they have mental health issues and they’re well controlled they can be tremendously productive. If they fall through the cracks they’re not going to rise to their potential so I think it’s very important. Depression can ultimately lead to suicide which is painful for so many involved.
David Hua: You mentioned that depression is a chemical imbalance in your body. We know with the endocannabinoid system we have these endocannabinoid receptors, CB1, CB2. What forms of cannabis would be helpful to bring that chemical balance and help this go in the right direction?
Dr. Dan: Balance I think is the key word. That really is the purpose of the endocannabinoid system is to work with all the other physiologic systems in the body to maintain balance or what we call homeostasis. Depression is obviously an imbalance. Part of the reason that there is so much more depression or maybe we’re just recognizing it more, but, I think there may truly be more depression and that some people feel, is due to an endocannabinoid system that’s been overloaded by stress. Maybe that’s the stress of war, whether that is the stress of living in a high-paced stressful society. We’ve overloaded what our endocannabinoid system was designed to do, so it makes perfect sense to me, that if we then take phytocannabinoids or cannabinoids derived from plant, cannabis
David Hua: Which the endocannabinoid receptors work with.
Dr. Dan: Exactly.
David Hua: Because we produce cannabinoids within our body, but the phytocannabinoids, are plant-based that work with the receptors.
Dr. Dan: Exactly, exactly, and that’s what defines a cannabinoid, as opposed to something like a terpene, which is another medically active compound in a plant, and actually there is a going back to CBDs, we define a main state of depression, but what I often recommend to patients is that you can use a technique called titration, using a vaporizer and vaporizing a strain that’s high in one of the terpenes, called limonene, sounds like lime, or lemon, so any strain that smells like citrus, or has a citrus-sounding name is going to be high in limonene, and good for depression. What I recommend patients do is take a puff from the vaporizer, wait about three minutes, and that way you get a good sense of what your body’s response to the limonene is, and, you’re just going to go up to the point at which you feel the sort of characteristic…
David Hua: Homeostasis, right?
Dr. Dan: Deep sigh. It’s going to be okay, I can continue on with the evening, or I can move forward, I can get out of bed, I can do something that I haven’t been able to do, because…
David Hua: Just that initial inertia or catalyst for that next step.
Dr. Dan: Exactly.
David Hua: Right, so, to get you out of that cycle and move forward.
Dr. Dan: And that is, that’s the strategy we always want, is to be able to use the lowest effective dose possible. We want to get the patient to the right place, where they’re productive, and safe, and they feel okay. We don’t have to get them giddy. That’s probably not a good move. It’s fine to feel good sometimes, I don’t have a problem with that at all, but the depression shouldn’t lead one into a cannabis non-motivational syndrome. I think there’s so much non-motivation in depression, that…
David Hua: Yeah, that’s the risk.
Dr. Dan: That can be a risk. But the nice thing is that CBD is excellent. It’s really, it’s a good mood stabilizer so patients tend not to swing too far into depression. It has some mild mood-elevating effects, and, it’s just overall very good for brain health. It helps with focus, and memory retention, and so forth. For depression, what I recommend during the day, is using a high CBD preparation that’s anywhere from 18 to 1, to 25 to 1, ratio of CBD to THC, almost all CBD. For example, the formulation that I’ve taken on occasion is a 20 to 1 ratio, so each dose has nine and a half milligrams of CBD, only half a milligram of THC, which does help the CBD work better, but is present in just a tiny sub-psychoactive amount, just half a milligram. You’d need five times that amount to reach the threshold of psychoactivity, at 2.5 milligrams of THC. This is something that patients, even if they’re young adults, can take during the day, they can take while at work, they can take while at school, and they’re not going to feel high or stoned, they’re thinking’s going to be clear, they’ll be able to multi-task, and do essentially whatever they need to do unimpaired. I have a lot of very high-powered patients who have executive VP jobs, at the biggest tech companies in the world, and they have to be on point virtually every waking moment of the day.
David Hua: Yeah and relate to the pressures that are on them and being able to do that…
Dr. Dan: Yes, and they can’t be impaired by medication. On the other hand, they don’t want to be impaired by the stress and anxiety so cannabis can help with that.
David Hua: We have depression and we have also bipolar disorder, which is an off-shoot of depression. Is the treatment similar to depression? There are pretty big mood swings, that’s related to bipolar. How have you seen that path be charted with cannabis?
Dr. Dan: I would say in general, THC bad, CBD good.
David Hua: Got it.
Dr. Dan: THC, especially high, high-potency THC…
David Hua: Could totally wind somebody up.
Dr. Dan: Exactly. It has been associated with manic and hypomanic episodes precipitating those episodes. The great thing is that CBD has been shown to help bring people down from manic or hypomanic episodes. It’s like the way it can bring down a patient with anxiety from a panic attack, it can bring down a patient with biploar disorder from a manic or hypomanic episode. Schizophrenic patients who are having psychotic episodes could be brought down very nicely with…
David Hua: What type of medication then are people with depression or bipolar or schizophrenia being prescribed? Do those still offer the same benefits of cannabis, but are the side effects way worse? I’ve seen that some medications could persist that non-motivational aspect that you were talking about as well.
Dr. Dan: Yes, I think that’s definitely true. A lot of times people will describe to me, and they consult us when the prescription medications have failed them. It’s rare that cannabis is the first thing that people turn to, although, there are quite a few people that are concerned about pharmaceutical medications and would rather try something natural first.
David Hua: Yeah. But usually it’s like, the third thing, or, the next thing.
Dr. Dan: Depression can be very difficult to treat, and, really, patients feel like they’ve wasted their lives, in this…
David Hua: This like listlessness that they experience.
Dr. Dan: Currently probably the most popular ones are SSRI’s or selective serotonin re-uptake inhibitors. Those would be things like, Zoloft, which is sertraline, or Prozac, which is fluoxetine. Cannabis does affect serotonin and increases the amount of serotonin, which is good, that happy chemical, and so it affects the same pathway as the SSRIs, and I think that’s part of the reason that you see this high CBD preparations being good both for depression and for anxiety. Because that’s the way some of the other medications pharmaceutical-based medications work as well.
David Hua: Got it. Are they as addictive or are they addictive at all?
Dr. Dan: Some of them do have some addictive, or withdrawal issues, definitely.
David Hua: Got it, withdrawal.
Dr. Dan: You generally have to taper. It’s a good question. Are you addicted to a medication if you become depressed when you stop taking it, if you’ve been depressed at baseline? Because that’s the same question that people will ask for cannabis, is the person now not depressed, but they’re dependent on…
David Hua: Dependent.
Dr. Dan: You could make an argument for being dependent on any medication.
David Hua: Let’s jump to OCD, which is another form of mental health issues that we’re seeing. How can cannabis help with people diagnosed with OCD? To me it seems like, again that CBD can be very beneficial here. I’m not sure if there’s anything different in how they’re dosing, but I’m open to your thoughts.
Dr. Dan: OCD is a sub-type of anxiety and anxiety in general is really well-treated by CBD, as you mentioned, and again I recommend somewhere between an 18 to 1, and a 25 to 1 ratio of CBD to THC. Almost all CBD. The formulation’s going to be non-psychoactive. This is something people can be very functional, they can go to work, go to school, and, really it’s a performance enhancing medication, and not one that’s going to have these side effects that can be impairing. Sometimes they’re psychoactive. I have a nephew actually, who has OCD, and he finds with some medications, he’s just tired all the time, he’s not functional, he’s not playing with his friends, he’s not doing normal things that people his age should be doing. That is not a good quality of life and having alternatives is nice. Now, maybe if he just moves to a different OCD medication, that might be helpful, certainly want to try that. Maybe you’ve tried all of those and cannabis is your last-ditch effort to try to find something that’s going to be effective. Sometimes they can work really well in tandem. If you have a prescription medication and you’re also using high CBD preparation. In those cases sometimes it’s even synergistic so you can decrease the dose of the anti-depressant or the OCD medication so your side effects would go way down by using a lower dose.
David Hua: Makes a lot of sense. You would just basically take smaller doses, maintain the medication that you’re currently going off of or maybe even just wean off a little bit. That way you can maintain some sort of chemical balance as you’re moving through and bringing CBD in the mix.
Dr. Dan: That’s right. The brain is much happier to let go of a medication supplement if you give it something else that does just as good or better, and you’re not abruptly cutting it off from the system.
David Hua: Great. One thing I want to mention, part of mental health that I’ve seen, is a sense of isolation. A sense of being alone and with cannabis, from what I’ve experienced, it’s a very community-driven alternative. When you’re taking a tincture, or when you’re puffing on a vaporizer, or you’re consuming, usually it’s with a group of people that are looking to be happy, to enjoy life. Whereas, taking medication, oftentimes is a very singular activity, in a bottle.
Dr. Dan: It can leave some people feeling like zombies. I hear that quite a bit from patients, that it zombified me, or I didn’t feel like I was myself, or I felt disconnected from myself.
David Hua: From their prescription medication?
Dr. Dan: From their prescription medications, exactly. Cannabis puts you more in tune with your body and what’s going on. Definitely, especially with depression, you don’t have a desire to be social, and you don’t feel comfortable in that setting because you feel awkward, or you feel like you don’t have anything to say, or want to say, and cannabis can turn that right around. It can have such a positive effect on one’s social interactions. People feel more connected.
David Hua: Yeah, connection. That’s about the time that we have. Thank you Dr. Dan for you know, sharing your wisdom, and experience on mental health. We have a long way to go, but I’m glad that the research is coming out to support CBD for mental health. And, if you haven’t tried it, you should give it a shot. Thank you for your time. Bye.
