What about Medical Cannabis and Depression

Clinical depression is a very serious illness. People with this condition have long-term, often debilitating feelings of sadness and low self-esteem. There can be suicidal thoughts. Depression makes ordinary tasks such as going to work, cooking, cleaning, even personal hygiene, very difficult.

Once the symptoms have been evaluated by a doctor, prescription medications are routinely prescribed. There are many types of anti-depressant medications: tricyclic antidepressants, MAOs(monoamine oxidase inhibitors), SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin-norepinephrine reuptake inhibitors) and a few others.

Is marijuana responsible for John Patrick Bedell's suicidal

assault on the Pentagon? Yes,
says Washington Post blogger Charles Lane, although
his theory of the plant's criminogenic effects is slightly more
sophisticated than Harry
Anslinger's. Instead of obtaining “effective treatment for his
obviously serious mental illness,” says Lane, Bedell sought help
for his insomnia from a California physician, who gave him a
recommendation for marijuana. “Bedell's loved ones' anguish at his
death,” Lane writes, “may be compounded now by the knowledge that,
at one important moment in his troubled life, a doctor gave him
help obtaining more marijuana—as opposed to real help.” Lane
believes this incident illustrates his point that “the legalization
of physician-recommended pot in California is a prescription for
disaster because it authorizes the 'treatment' of a wide range of
real maladies with a spurious 'medicine'…that might be
ineffective or actually harmful.” Although Lane thinks marijuana's
medicinal benefits are generally fictitious, he is willing to let
cancer and AIDS patients use it, as long as they're dying.
Furthermore, he wants to “debate legalizing marijuana as a
recreational drug.” In short, Lane is prepared to consider a legal
regime that would have allowed Bedell to obtain all the pot he
wanted (something he apparently managed to do anyway), as long as
no one called it a medicine.

Lane is right that a lot of recreational pot smoking is
masquerading as medical use in California, and he is also right to
suggest that general legalization would be better than the current
situation. But given his confidence that Bedell's maladjustment,
wacky beliefs, and violence were all symptoms of a disease that
psychiatrists know how to treat, I'm not sure how Lane can so
readily reject the idea that people are using marijuana as a
medicine when they use it to alleviate such quotidian psychological
problems as stress, anxiety, depression, and insomnia.
Psychiatrists do treat such problems with government-approved
pharmaceuticals, after all. Lane cites one psychiatrist who “knows
of no research to support the notion that marijuana is a safe and
effective remedy for chronic insomnia.” The psychiatrist agrees pot
“can be a sedative,” but adds, “You could say the same thing for
alcohol.” Well, yes, you could. And you would be right, unless
everyone who has ever taken a nightcap has been imagining its
effectiveness. Likewise, marijuana surely helps some people who
have trouble getting to sleep, which is the problem for which
Bedell sought medical assistance. If marijuana were treated like
alcohol, there would have been no reason for Bedell to seek a
doctor's recommendation entitling him to purchase it, but that
would not have changed the nature of the benefit he got from
it.

Lane suggests Bedell's California physician was negligent. But
it sounds like he gave Bedell what he wanted, and Bedell was
pleased by the results. I can see how that might offend those who
believe doctors should treat patients like children instead of
paying customers. Did marijuana use compound Bedell's problems or,
as he believed, relieve them? I don't know, but I am willing to
entertain the possibility that marijuana, like
psychiatrist-prescribed pharmaceuticals, can improve people's
ability to function as well as impair it. If Bedell had obtained
whatever “effective treatment” psychiatrists thought appropriate
but had nevertheless shot guards outside the Pentagon, would Lane
have blamed that prescription for the attack?

Early, and then continued, use of marijuana does seem to be associated with an increased risk of psychosis and hallucinations, but allow us to quell some incipient panic.

Caveats, after all, are our specialty.

Previous studies had found a link (not necessarily a cause or effect) between cannabis use and psychosis. So researchers in Queensland, Australia, decided to investigate further and have now established what they consider a fairly strong connection between the length of marijuana use and the likelihood of psychosis in young adults.

The researchers even checked out pot use and psychosis symptoms among siblings just to make sure they haven't been missing some genetic or environmental factor. They don't seem to have been.

So pot use may well play some kind of role in what the researchers term "psychosis-related outcomes."

But, the researchers write in their conclusion: “The nature of the relationship between psychosis and cannabis use is by no means simple."

As they point out: "Those individuals who were vulnerable to psychosis (i.e., those who had isolated psychotic symptoms) were more likely to commence cannabis use, which could then subsequently contribute to an increased risk of conversion to a nonaffective psychotic disorder. In addition, analyses that incorporated adjustments for depressive and anxiety-related disorders led to a reduction in the strength of the association between cannabis use and psychosis-related outcomes. This suggests that depression and/or anxiety disorders may mediate or moderate the pathways between cannabis use and psychosis-related outcomes. We plan to further explore these issues in more detail in future studies."

This is fascinating and provocative stuff, especially as it pertains to young adults' still-developing brains. But the key word from the first paragraph is "associated."

So as for these headlines? "Long-term cannabis use can double risk of psychosis," "Study finds cannabis use is 'crazy-making'," "Teen pot smokers at high risk of mental illness," "Marijuana smoking teens prone to schizophrenia"… Perhaps some panic-quelling is in order.

Here's the full study, published online Monday in the Archives of General Psychiatry.

For a different look at marijuana, here's a recent L.A. Times story: UC studies find promise in medical marijuana

(Not cures, just promise.)

— Tami Dennis

Credit: Daniel Karmann / EPA

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