Can cannabis (marijuana) use help with major depressive disorder?

From the Guidelines

Cannabis should not be used as a primary treatment for depression due to limited evidence and potential risks, and instead, evidence-based treatments like therapy and conventional antidepressants should be prioritized. The most recent and highest quality study, published in 2022 in the Annals of Internal Medicine 1, recommends against the use of cannabis for depression, citing limited evidence and potential risks. This study suggests that while some people may report temporary mood improvement from cannabis, regular use can potentially worsen depression symptoms over time and lead to dependence.

Key Considerations

• The endocannabinoid system does influence mood regulation, which explains why cannabis affects emotional states, but these effects vary greatly between individuals based on genetics, existing mental health conditions, and usage patterns.
• If considering cannabis for depression, it's best used as a complementary approach alongside evidence-based treatments like therapy and conventional antidepressants, and only after consulting with a healthcare provider who can provide personalized guidance.
• Starting with low doses and CBD-dominant products is generally safer if exploring this option, but it's essential to be aware that cannabis remains illegal in many places, which may limit access to consistent, quality-controlled products.

Evidence-Based Treatments

• The American College of Physicians recommends selecting between either cognitive behavioral therapy or second-generation antidepressants to treat patients with major depressive disorder after discussing treatment effects, adverse effect profiles, cost, accessibility, and preferences with the patient 1.
• These treatments have been shown to be effective in managing depression and should be prioritized over cannabis use.

Important Notes

• The potential risks and benefits of cannabis use for depression should be carefully weighed, and patients should be closely monitored for any adverse effects.
• More research is needed to fully understand the effects of cannabis on depression and to determine its potential as a treatment option.

From the Research

Cannabis Use and Depression

• There is limited research directly linking cannabis use to the treatment of depression.
• However, a study published in 2021 2 suggests that cannabis may have favorable outcomes in treating depression, although the evidence is not yet substantial enough to support its use as a primary treatment.
• The study notes that cannabis has been used to treat various conditions, including chemotherapy-induced nausea, vomiting, and cancer-related pain, as well as anorexia, insomnia, and anxiety.

Alternative Treatments for Depression

• Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat depression and have been shown to be effective in various studies 3, 4, 5, 6.
• SSRIs, such as sertraline, fluoxetine, and citalopram, have been found to have a better benefit-risk profile compared to other antidepressants 3.
• However, SSRIs also have limitations, including delayed onset of therapeutic effect, sexual dysfunction, and sleep disturbance 5.

Comparison of Antidepressants

• A study published in 2020 6 compared the efficacy and tolerability of six SSRIs (fluoxetine, citalopram, escitalopram, sertraline, paroxetine, and fluvoxamine) in the treatment of major depressive disorder.
• The study found that escitalopram was more effective than other SSRIs in terms of response rate, remission rate, and withdrawal rate.
• Another study published in 2021 3 found that sertraline and paroxetine were effective for the largest number of ICD-11 disease subgroups, with sertraline being less tolerated than placebo.