Why Did Science Say Cannabis Doesn’t Work For Mental Health First Aid?
Patients have long relied on cannabis for the alleviation of the symptoms associated with mental health issues.
From anxiety to depression to post-traumatic stress disorder (PTSD) – many patients report relief thanks to the medicinal qualities of cannabis and cannabinoids. This potent plant has become a key element in a mental health first aid kit. But, what does the research say about cannabis for mental health?
In October 2019, the Times reported on the results of a systematic review and meta-analysis of cannabis for mental health. This painted a much different picture of cannabinoids for mental health than what patients have been anecdotally reporting. As the Times said, cannabinoids “don’t seem to do much for mental health,” while the meta-analysis in the Lancet confirmed, “There remains insufficient evidence to provide guidance on the use of cannabinoids for treating mental disorders within a regulatory framework.”
These results do not reflect the reality for many patients, so what is going on?
How do Patients Today Use Medicinal Cannabis?
In every patient survey of note, mental health concerns always rank as one of the top reasons for patient use of medical cannabis. According to RYAH Data, a medical vaporizer company, close to 40 percent of the app users rely on cannabis for the treatment of mental health conditions.
A Tilray sponsored study, published in the Harm Reduction Journal in 2019, found mental health conditions were the 2nd most popular condition treated (behind pain).
A third survey published two years prior, in the Journal of Pain Management, found 32.9 percent of respondents relied on cannabis to alleviate the symptoms of anxiety, and 32.6 of respondents used it for depression.
Patients are not waiting for randomized controlled trials to start working with the plant for medicinal relief. Clearly, patients are already working with the plant to soothe the symptoms of anxiety, depression, and other mental health conditions. Cannabis has become a key aspect of the mental health first aid kit for many people, even without scientific support.
Review of the Research, What did the Meta-Analysis Say?
In October 2019, The Lancet Psychiatry published “Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis.” The researchers behind this systematic review are from the National Drug and Alcohol Research Centre at the University of New South Wales in Australia.
The team set out to understand what evidence, if any, existed to show a benefit in cannabinoids for the treatment of mental health disorders. They pulled studies from several major databases, published between January 1, 1980, and April 30, 2018. These included studies on “any type and formulation of a medicinal cannabinoid” for the treatment of depression, anxiety, attention-deficit hyperactivity disorder (ADHD), Tourette syndrome, post-traumatic stress disorder (PTSD), and psychosis. The data collected only pertained to adults, but did not filter for publication status, language, or study-type.
In the end, just over 80 publications went under review, with the vast majority examining cannabinoids for depression and anxiety. Researchers analyzed this body of work for both primary and secondary outcomes. Primary meant that the main objective of the study was to use cannabinoid therapy for a change in mental health.
Secondary outcomes meant that the purpose of the study was to look at cannabinoid therapy for other chronic health issues, but there were mental health outcomes. For example, if a study on cannabis for chronic pain detailed a reduction in depression and anxiety.
After rigorous and thorough analysis, what did the authors at the National Drug and Alcohol Research Centre determine? Is cannabis a valuable option for mental health first aid?
The results of this meta-analysis were not as conclusive as many would have predicted. The authors found some low-grade evidence to support pharmaceutical THC for improving anxiety, but this was a secondary outcome. They also noted that in several cases, pharmaceutical THC seemed to worsen the mental health outcomes.
A Few Issues to Note with the Meta-Analysis
First and foremost, there is not a substantial body of controlled study into cannabis for mental health. When the authors of the Lancet study did locate randomized controlled trials, they noted these studies “were typically very small (with median sample sizes of 10–39 participants across mental disorders), with short follow-up periods (median trial length 4–5 weeks).” They also determined there were few, if any, eligible trials looking at CBD.
Furthermore, most of the useful research relied on pharmaceutical THC. Pharmaceutical THC is not a full-spectrum cannabis flower that is available to most patients today through medical cannabis programs.
Most studies included within this meta-analysis used either nabiximols (pharmaceutical extraction containing 50:50 ratio of THC:CBD) or nabilone (a synthetic THC). Both are far removed from the medical cannabis flower most patients keep in their mental health first aid kit.
How to Use Medical Cannabis for Mental Health First Aid
For those experiencing anxiety, depression, or other mental health issues, the first step is to seek professional support. There is no miracle cure or magic pill to solve these issues. Also, the treatment protocols vary significantly from patient to patient. Some patients find benefit in therapy, some with pharmaceuticals, and many use a combination of the two.
If patients choose to incorporate cannabis into their holistic treatment plan, ask a healthcare professional about the risks and benefits. For example, cannabis might not be appropriate for mental health issues involving psychosis. Cannabis might make the situation much more dangerous. Also, some cannabinoids may interact with hepatic drugs (drugs metabolized through the liver), and a physician would need to monitor blood levels to manage dose.
Once cleared with a physician, patients should start with low potency and well-balanced strains to start. The higher the ratio of CBD, the lower the effects of THC. For anyone sensitive to THC, they may wish to begin dosing before bed or skip the THC altogether in favor of CBD options. This can make the process of self-titration much more comfortable. Typically, patients report that THC helps lift depression and CBD lowers anxiety.
As the mantra goes, start low and increase slowly to ensure a comfortable time experimenting with dose and strain. Managing the symptoms of depression and anxiety requires a delicate touch. Although many patients are indeed finding relief with cannabis, everyone is different. It’s important to take your time to find a solution that works best for you.