Depression is one of the most common mental health issues, and cannabis is the most commonly used federally illegal drug in the United States. People use cannabis to self-medicate for a whole lot of things—including mood disorders—usually based on anecdotal evidence and sometimes on research. But the lack of firm pharmaceutical guidelines for these uses means it can be hard to know if cannabis is helping a problem, or possibly even making it worse.
Any time cannabis comes up in a medical context, it must be noted how little is really known about how the drug works—partly because the history of its prohibition has made studying it difficult. We’re at an impasse, where hard science is restricted by federal policy.
When it comes to treating depression with cannabis, that lack of hard data does a disservice to those who could potentially benefit. How much is too much? Which cannabinoids are ideal for treatments, and which exacerbate symptoms? What do the latest studies tell us? (But first, if you are considering treating your depression with cannabis, it’s important to consider other treatments or therapies as well, particularly if your symptoms are severe.)
What research can tell us
Depression is hardly a specific condition. There are multiple types with varying symptoms; depression can even manifest in people with chronic pain. There are too many factors to recommend a universal treatment option. (Seasonal depression is vastly different from bipolar disorder’s low mood swings, and the treatments for each follow suit.)
The same holds true for cannabis. There are no universals when we’re talking about a plant with thousands of cultivars and chemical variations based on its growing and processing conditions. These unknowns would make research a challenge even if legality wasn’t an issue, and it’s why the science is currently divided on the use of cannabis for depression and a host of other medical issues.
As Leafly’s Emma Stone recently noted, “no clinical trials to date have focused on cannabis as a treatment for depression, so it’s currently difficult to draw decisive conclusions about whether the plant is helpful or harmful for individuals with depression.”
Indeed, a study from 2020 found, “There is…evidence that the use of cannabis may lead to the onset of depression; however, strong evidence points to the inverse association; i.e. that depression may lead to the onset or increase in cannabis use frequency.”
Another analysis of a few years’ worth of studies found promise in the idea that, under controlled production conditions, cannabis can be fine-tuned to treat specific disorders. “There is currently encouraging, albeit embryonic, evidence for medicinal cannabis in the treatment of a range of psychiatric disorders,” the analysis noted. “Supportive findings are emerging for some key isolates, however, clinicians need to be mindful of a range of prescriptive and occupational safety considerations, especially if initiating higher dose THC formulas.”
In the absence of research, anecdotal evidence
Some practitioners are more bullish than that. Eileen Konieczny, the New York based author of Healing with CBD: How Cannabidiol Can Transform your Health Without the High is a registered nurse and board certified patient advocate who has been providing guidance on cannabis-based treatments to her patients since around 2008. She finds the plant to be generally low-risk when used with care, but is careful to note that it isn’t a cure-all, and isn’t a suitable treatment for all conditions.
She believes people are eager to understand cannabis’ potential as a treatment for mental health disorders for the simple reason that so many people experience depression, but that the answers just aren’t there yet. “Patients deserve to understand how a medication might affect them to weigh the benefits or limitations they may encounter,” she said. “Having a clear-cut answer would help everyone involved. Unfortunately, there is little clinical evidence to support the use of cannabis for depression.“
Much of the evidence we have to rely is anecdotal, though some of that has at least been studied. Konieczny cited a 2018 study of patient-reported data from Strainprint, an app allowing users to track cannabis use by strain/cultivar and symptom, noting, “89.3 percent of the tracked sessions of 3,000 contacts with symptoms of depression reported a reduction in symptoms; those using low-THC/high-CBD strains of cannabis experienced a greater reduction in symptoms than those using strains predominantly THC.”
There was a catch, however: “When observed over time, these same individuals noted a recurrence in depression the more prolonged and frequently they used cannabis. This may suggest that the use of cannabis for depression may be effective in the short term, while escalating baseline depression in the long run.”
Before we can really understand how cannabis and depression are connected, we need to understand more about how the drug affects the body’s endocannabinoid system, as well the entourage effect—or how cannabis signals that system.
People who work with cannabis as creatives or hands-on service providers have contributed their own anecdotal evidence that cannabis can be used to treat depression. Jordana Wright, a photographer and the author of Cannabis for Creatives, said she has been taking antidepressants for most of her adult life, and sometimes supplements her treatment with cannabis, and the results vary.
“There are times where it gets me out of acute flare ups in a painless, predictable way,” she said. “There are also times where it has the same effect as listening to a sad song when you’re miserable—it amplifies things in the wrong direction. It all depends on the situation, the timing, the strain, the dosage, and your perspective.”
Of course, no antidepressant drug—even those that have been researched extensively—works the same for every patient; some people try several of them before finding one that seems to best treat their mental health issues without triggering too many unwanted side effects. But Wright thinks the stigma surrounding cannabis means most people refrain from thinking of cannabis as medicine at all. “Once I de-stigmatized pot in my own mind and life. I was able to see it as a positive tool toward better mental health,” she said. “If you’re working with a psychologist or psychiatrist, be honest about your cannabis use. If you know that it’s something that helps you, it’s important to have a doctor who is pro-cannabis, or at least open to it.”
In Wright’s experience, finding the right treatment was key. “I’m lucky to have found an antidepressant and dosage that still lets me feel a range of emotions, but when I’m having a flare up of symptoms, I prefer cannabis to something like Xanax. Pot takes the edge off [my] intrusive thoughts and painful emotions so [I] can think through problems and be more proactive toward finding healthy patterns and solutions.”
Danielle Olivarez, Founder of Highlites, a platform for de-stigmatizing the use of cannabis for wellness, is also an advocate for moderation and mindfulness, telling Lifehacker via email, “As someone with depression, anxiety, and fibromyalgia, I acknowledged that overconsumption could quickly be a form of self harm, and that self-awareness helps me stay honest and intentional.”
In the absence of reliable scientific studies, people looking to cannabis to treat their depression must go it alone—but Olivarez believes they can do so responsibly. “I truly believe in the power of Cannabinoids to help manage symptoms of depression…when consumed intentionally and with self-awareness,” she said.