Mental Health and Medical Cannabis
This blog highlights the benefits of cannabis in the management of symptoms associated with depression, attention deficit hyperactivity disorder (ADHD), and anxiety.
A Look at How Medical Cannabis Has Helped Patients
Depression is reported to affect approximately 280 million people worldwide1. Symptoms of depression include a lack of interest or enjoyment in daily activities, significant weight loss or gain, oversleeping or insomnia, fatigue, inability to concentrate, and feelings of worthlessness2.
Medical cannabis has been shown to be beneficial in the treatment of depression across various population groups3–9. In one study, Li et al examined the real-time effects of consuming cannabis flower on the treatment of symptoms associated with depression10. A majority of individuals (95%) reported a reduction in depression intensity symptoms with an average reduction of 3.76 points on a 0-10 visual analogue scale10. Across studies, there appears to be a particularly beneficial effect of oral CBD for depression11-13. CBD rich products were particularly effective in decreasing depression symptoms in patients with moderate to severe depression14.
ADHD conservatively occurs in 2.5-4.4% of adults15-16. It can be characterized by high levels of inattention, hyperactivity-impulsivity, or a combination of both17. ADHD was associated with a 4-5% reduction in work performance and an elevated risk of workplace accident injuries18. Although prescription stimulants are used in the treatment of ADHD, they are associated with various negative side effects such as loss of appetite, emotional problems, upset stomach, sleep problems, headaches, etc.19
According to various reports, cannabis may be therapeutic for those with treatment-resistant ADHD20. A high THC product was shown to alleviate ADHD symptoms such as poor tolerance to frustration, outbursts of anger, boredom, and concentration problems21. In the same individual adding a balanced THC:CBD product was shown to additionally reduce feelings of anxiety, restlessness, need to be on the go all the time, and reducing the patient’s chronic pain indication21.
A randomized placebo-controlled study examined the therapeutic potential of a balanced THC:CBD cannabis extract, an oromucosal spray, in adults with ADHD22. It was found that the balanced THC:CBD product was associated with statistically significant improvements in hyperactivity/impulsivity and a cognitive measure of inhibition (often impaired in those with ADHD)22. There were also trends towards improvement for inattention and emotional lability22.
Anxiety disorders affect approximately 4.6-10% of Canadians23. Anxiety disorders include generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, and social anxiety disorder24. Symptoms can be clustered into four categories: physical responses (i.e., insomnia, fatigue), thoughts (i.e., excessive worrying, difficulty concentrating), emotions (i.e., feeling helpless, mood wings), and behaviors (i.e., irritability, social withdrawal)25,26.
There is evidence that cannabis may be effective in treating anxiety27,28. As a matter of fact, anxiety treatment is among the top three endorsed reasons for medical cannabis use29. The results of a recent study led by Aurora revealed that 85% of patients with anxiety reported improvements in their condition following six weeks of medical cannabis therapy30. This was accompanied by an increase in quality of life30. Of those who rated cannabis as being helpful for their anxiety, 32% selected high CBD products and 28% selected high THC products30.
The efficacy of cannabis in the management of anxiety is supported by larger reviews of the literature. For example, a systematic review performed on 83 studies (40 randomized controlled trials) found that THC alone or in combination with CBD improved anxiety symptoms among individuals with comorbid medical conditions31.
- World Health Organization. Depression. Accessed September 19, 2021. https://www.who.int/news-room/fact-sheets/detail/depression
- American Psychological Association. Depression. Accessed September 19, 2021. https://www.apa.org/topics/depression
- Ware MA, Wang T, Shapiro S, et al. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ: Canadian Medical Association Journal. 2010;182(14):E694. doi:10.1503/CMAJ.091414
- Walsh, Z., Callaway, R., Belle-Isle, L., Capler, R., Kay, R., Lucas, P., & Holtzman, S. Cannabis for therapeutic purposes: patient characteristics, access, and reasons for use. The International journal on drug policy. 2013;24(6):511-516. doi:10.1016/J.DRUGPO.2013.08.010
- Ogborne, A. C., Smart, R. G., Weber, T., & Birchmore-Timney, C. Who is using cannabis as a medicine and why: an exploratory study. Journal of psychoactive drugs. 2000;32(4):435-443. doi:10.1080/02791072.2000.10400245
- Nunberg H, Kilmer B, Pacula RL, Burgdorf J. An Analysis of Applicants Presenting to a Medical Marijuana Specialty Practice in California. Journal of drug policy analysis. 2011;4(1). doi:10.2202/1941-2851.1017
- Harris, D., Jones, R. T., Shank, R., Nath, R., Fernandez, E., Goldstein, K., & Mendelson, J. Self-reported marijuana effects and characteristics of 100 San Francisco medical marijuana club members. Journal of addictive diseases. 2000;19(3):89-103. doi:10.1300/J069V19N03_07
- Aggarwal, S. K., Carter, G. T., Sullivan, M. D., ZumBrunnen, C., Morrill, R., & Mayer, J. D. Prospectively surveying health-related quality of life and symptom relief in a lot based sample of medical cannabis-using patients in urban Washington State reveals managed chronic illness and debility. The American journal of hospice & palliative care. 2013;30(6):523-531. doi:10.1177/1049909112454215
- Webb CW, Webb SM. Therapeutic Benefits of Cannabis: A Patient Survey. Hawai’i Journal of Medicine & Public Health. 2014;73(4):109. Accessed September 19, 2021. / pmc/articles/PMC3998228/
- Li X, Diviant JP, Stith SS, et al. Focus: Plant-based Medicine and Pharmacology: The Effectiveness of Cannabis Flower for Immediate Relief from Symptoms of Depression. The Yale Journal of Biology and Medicine. 2020;93(2):251. Accessed September 19, 2021. /pmc/articles/PMC7309674/
- Allsop DJ, Copeland J, Lintzeris N, et al. Nabiximols as an agonist replacement therapy during cannabis withdrawal:A randomized clinical trial. JAMA Psychiatry. 2014;71(3):281-291. doi:10.1001/jamapsychiatry.2013.3947
- Solowij, Nadia, Samantha J. Broyd, Camilla Beale, Julie-Anne Prick, Lisa-marie Greenwood, Hendrika Van Hell, Chao Suo et al. Therapeutic Effects of Prolonged Cannabidiol Treatment on Psychological Symptoms and Cognitive Function in Regular Cannabis Users: A Pragmatic Open-Label Clinical Trial. Cannabis and cannabinoid research. 2018;3(1):21-34. doi:10.1089/CAN.2017.0043
- Beale, C., Broyd, S. J., Chye, Y., Suo, C., Schira, M., Galettis, P., ... & Solowij, N. Prolonged Cannabidiol Treatment Effects on Hippocampal Subfield Volumes in Current Cannabis Users. Cannabis and cannabinoid research. 2018;3(1):94-107. doi:10.1089/CAN.2017.0047
- Rapin L, Gamaoun R, el Hage C, Arboleda MF, Prosk E. Cannabidiol use and effectiveness: real-world evidence from a Canadian medical cannabis clinic. Journal of Cannabis Research 2021 3:1. 2021;3(1):1-10. doi:10.1186/S42238-021-00078-W
- Artigas, M. S., Sánchez-Mora, C., Rovira, P., Richarte, V., Garcia-Martínez, I., Pagerols, M., ... & Ribasés, M. Attention-deficit/hyperactivity disorder and lifetime cannabis use: genetic overlap and causality. Molecular psychiatry. 2020;25(10):2493-2503. doi:10.1038/S41380-018-0339-3
- Simon, V., Czobor, P., Bálint, S., Mészáros, A., & Bitter, I. Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. The British journal of psychiatry: the journal of mental science. 2009;194(3):204-211. doi:10.1192/BJP.BP.107.048827
- Miller AR. Attention-Deficit Hyperactivity Disorder. Journal of developmental and behavioral pediatrics: JDBP. Published 1996. Accessed September 16, 2021. https:// www.apa.org/topics/adhd
- Kessler RC, Lane M, Stang PE, Brunt DL van. The prevalence and workplace costs of adult attention deficit hyperactivity disorder in a large manufacturing firm. Psychological Medicine. 2009;39(1):137-147. doi:10.1017/S0033291708003309
- Thiruchelvam, D., Charach, A., & Schachar, R. J. Moderators and mediators of long-term adherence to stimulant treatment in children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry. 2001;40(8):922-928. doi:10.1097/00004583-200108000-00014.
- Mitchell, J. T., Sweitzer, M. M., Tunno, A. M., Kollins, S. H., & McClernon, F. J. “I Use Weed for My ADHD”: A Qualitative Analysis of Online Forum Discussions on Cannabis Use and ADHD. PloS one. 2016;11(5). doi:10.1371/JOURNAL.PONE.0156614
- Hupli AMM. Medical Cannabis for Adult Attention Deficit Hyperactivity Disorder: Sociological Patient Case Report of Cannabinoid Therapeutics in Finland. Medical Cannabis and Cannabinoids. 2018;1(2):112-118. doi:10.1159/000495307
- Cooper RE, Williams E, Seegobin S, Tye C, Kuntsi J, Asherson P. Cannabinoids in attention-deficit/hyperactivity disorder: A randomised-controlled trial. European Neuropsychopharmacology. 2017;27(8):795-808. doi:10.1016/j.euroneuro.2017.05.005
- U.S. Department of Health & Human Services. What are the five major types of anxiety disorders? | HHS.gov. Accessed September 20, 2021. https://www.hhs.gov/answers/mental-health-and-substance-abuse/what-are-the-five-major-types-of-anxiety-disorders/index.html
- Mental Health - Anxiety Disorders - Canada.ca. Accessed September 19, 2021. https://www.canada.ca/en/health-canada/services/healthy-living/your-health/diseases/ mental-health-anxiety-disorders.html#tsad
- Anxiety Canada. Anxiety in Adults - Anxiety Canada. Accessed September 20, 2021. https://www.anxietycanada.com/learn-about-anxiety/anxiety-in-adults/
- Sexton M, Cuttler C, Finnell JS, Mischley LK. A Cross-Sectional Survey of Medical Cannabis Users: Patterns of Use and Perceived Efficacy. Cannabis and Cannabinoid Research. 2016;1(1):131-138. doi:10.1089/can.2016.0007
- Lee C, Round JM, Hanlon JG, Hyshka E, Dyck JRB, Eurich DT. Generalized Anxiety Disorder 7-Item (GAD-7) Scores in Medically Authorized Cannabis Patients-Ontario and Alberta, Canada. doi:10.1177/07067437211043393
- Wadsworth E, Leos-Toro C, Hammond D. Mental Health and Medical Cannabis Use among Youth and Young Adults in Canada. Substance Use & Misuse. 2020;55(4):582-589. doi:10.1080/10826084.2019.1691594
- Walsh Z, Callaway R, Belle-Isle L, et al. Cannabis for therapeutic purposes: Patient characteristics, access, and reasons for use. International Journal of Drug Policy. 2013;24(6):511-516. doi:10.1016/j.drugpo.2013.08.010
- Cahill SP, Lunn SE, Diaz P, Page JE. Evaluation of Patient Reported Safety and Efficacy of Cannabis From a Survey of Medical Cannabis Patients in Canada. Frontiers in Public Health. 2021;9. doi:10.3389/fpubh.2021.626853
- Black, N., Stockings, E., Campbell, G., Tran, L. T., Zagic, D., Hall, W. D., ... & Degenhardt, L. Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis. The lancet Psychiatry. 2019;6(12):995-1010. doi:10.1016/S2215-0366(19)30401-8.