Cannabis and Mental Illness

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Contributor: Asia Mayfield

Nearly 50 percent of Americans will experience a mental health crisis at least once in their lives. Current solutions aren’t working. A growing number of people believe cannabis may have the answer.

A connection between cannabis and mental health disorders has been theorized for decades. However, the research is minimal and the results are conflicting. There are more than 100 distinct compounds found only in cannabis plants. These are called cannabinoids. Our understanding of how they work is rapidly expanding. Yet, there’s a large gap between the perceived benefits and those confirmed by science.

Cannabis and Mental Illness by Asia Mayfield

Most studies focus on tetrahydrocannabinol (THC) and cannabidiol (CBD). THC has psychoactive properties while CBD is thought to have therapeutic value. Researchers are particularly interested in THC’s relationship to mental illness.

Patients with mental health disorders use cannabis at a greater frequency than the rest of the population. Patients use cannabis to treat depression, anxiety, PTSD, bipolar disorder, schizophrenia, and more. The plant is also used to combat the symptoms of neurological diseases like drug-resistant epilepsy and multiple sclerosis.

Schizophrenia

Schizophrenia is a chronic illness marked by periods of psychosis. Patients may experience severe mental disturbances.

“My first thought about schizophrenia and marijuana is that they are at odds with one another,” Julie Foster, Medical Director of Portland, Oregon’s Pohala Clinic told a leading psychiatry journal. “Unless followed closely as a medication, I think marijuana could easily contribute to the delusions and hallucinations that come with schizophrenia.”

Foster is not alone. Many researchers believe that using cannabis increases a patient’s risk of psychosis. However, the effect is slight. It’s not clear if cannabis triggers schizophrenia or if people who are vulnerable to the disease are more likely to start using drugs. It’s possible that people who struggle with mental health disorders attempt to self-medicate with cannabis.

In 2017, The National Academy of Sciences, Engineering, and Medicine issued a report exploring the link between cannabis use and psychosis. The report determined that there’s “substantial evidence of a statistical association.”

According to Marc Manseau, clinical assistant professor of psychiatry at the New York University School of Medicine: “A healthy brain seamlessly filters useful bits of information from the irrelevant noise and constructs a ‘reality’ that allows us to function in the world. When someone is psychotic, however, the system goes awry… the danger lies in the THC, which has psychotic properties.”

Yet, the question is far from settled. Researchers from Israel’s Tel Aviv University published a study in 2017 that looked at mice with a genetic predisposition for schizophrenia. The mice were split into four groups. The mice with the genetic risk factors developed schizophrenia after consuming THC while the, “normal,” mice did not.

“Our research demonstrates that cannabis has a differential risk on susceptible versus non-susceptible individuals,” study authors wrote. “In other words, young people with a genetic susceptibility to schizophrenia – those who have psychiatric disorders in their families – should bear in mind that they’re playing with fire if they smoke pot during adolescence.”

A few studies have used CBD to treat schizophrenia with positive results. It’s believed that CBD mitigates the psychoactive effects of THC.

A very small study looked at six patients diagnosed with schizophrenia. They were each prescribed low doses of THC in addition to their usual antipsychotic medication. Four patients saw improvement with THC.

Dementia

Dementia can trigger irritability, trouble eating, and aggression among other personality changes. Clinicians and patients report symptom improvements after using cannabis.

Evidence suggests that cannabis can ease symptoms related to dementia. The body emotions are regulated, in part, by the endocannabinoid system (ECS). Endocannabinoids, compounds that form naturally within the body, attach to receptors in the ECS.

Cannabinoids hijack the system. They play the role of endocannabinoids, affecting the way the body responds to chemical signals.

A study focusing on patients with a cannabis use disorder found decreased blood flow in multiple brain regions. The authors theorized that long-term cannabis use increased people’s risk of developing Alzheimer’s disease.

PTSD

Post-traumatic stress disorder, or PTSD, is notoriously difficult to treat. Evidence shows that cannabinoids may be effective. Many states list PTSD as a qualifying condition for a medical marijuana card. In states like, California, where physicians have broad leeway to give recommendations, many patients seek medicinal cannabis to alleviate psychiatric symptoms.

The endocannabinoid system includes, CB1, and, CB2 receptors. CB1 receptors are common in the brain while CB2 receptors are found throughout the body. Extensive animal studies indicate that the ECS is involved with storing and eradicating memories. When someone suffers from PTSD, their bodies have a conditioned negative response to certain stimuli. Exposure to cannabinoids can weaken that response.

According to Shelley Franklin, the Veteran Program Coordinator for the Canadian Cannabis Clinics, medical cannabis is rarely used as the sole treatment for PTSD. Cannabis, she believes, works in conjunction with other treatment methods.

Zach Walsh, an associate professor of psychology at the University of British Columbia, believes that cannabis shows promise in reducing nightmares. Walsh runs the Therapeutic, Recreational, and Problematic Substance Use lab, where his team studies the therapeutic and adverse effects of cannabis.

The research is so promising that Canada’s Department of Veterans Affairs (VAC) reimburses the cost of medicinal cannabis for veterans diagnosed with PTSD.

Like Franklin, Walsh believes cannabis works best when it’s paired with other therapies.

Depression

Depression is often a qualifying condition for medicinal cannabis.

The studies looking at THC use in depressed patients have been mixed. Consuming mall amounts have been shown to be useful. However, long-term THC use is linked to increased rates of depression. One study notes that, “while acute cannabis intoxication temporarily alleviates perceived states of depression, anxiety, and stress, the repeated use of cannabis does not appear to lead to any longer-term reductions in these symptoms.”

The research on CBD and depression is even more promising. A review published in 2014 determined that CBD reduces anxiety in animals. A more recent study found CBD worked as a, “rapid and sustained,” anti-depressant in rats.

However, depression is very difficult to eradicate. Patients frequently battle multiple bouts of the disorder. Physicians often prescribe multiple treatment options, including therapy. Cannabis can be used to augment the effect of other therapies.

The Law

Due to the uncertain political climate, psychiatric patients who use cannabis for symptom relief, may feel reluctant to discuss it with their physician. However, the stigma surrounding the plant is fading.

Physicians in the U.S. cannot prescribe cannabis directly, but they can recommend it in states with legal medical marijuana programs. The Food and Drug Administration has approved one cannabis-based drug- Epidiolex. It uses CBD and is approved to treat certain forms of epilepsy. Sativex, a drug with a 1:1 THC/CBD ratio that’s used to treat multiple sclerosis symptoms, is approved in dozens of countries outside of the U.S.

Conclusion

Research into cannabis and mental health is still developing. Patients who are interested in incorporating cannabis into their own treatment regimen are advised to speak to their doctor. Self-reporting and frequent experimentation are critical. There are no specific doses or strains that a patient should try. A strain that eases one patient’s anxiety may increase it in another. Doctors are reliant on patient observations until more objective data is available. Still, patient reviews can give useful guidance. A dispensary menu is just a long list of names when you have no idea which strain helps which ailments. Read our in-depth cannabis reviews to learn how people respond differently to varying strains and to find the perfect bud for you.