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Citation |
Modesto-Lowe V, León-Barriera R, Jain L. Expert Rev. Neurother. 2023; ePub(ePub): ePub. |
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Copyright |
(Copyright © 2023, Future Science Group) |
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DOI |
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PMID |
37068050 |
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Abstract |
Major Depressive disorder (MDD) manifests by dysphoria, anhedonia, sleep disturbances, poor concentration, fatigue, hopelessness, and suicidality [Citation1]. MDD is highly prevalent worldwide and a major cause of disease burden [Citation1]. Antidepressants are helpful, but many individuals do not respond optimally to these medications [Citation2]. Seeking relief, patients have been utilizing cannabis for thousands of years [Citation3], and more recently have been increasingly turning to medical cannabis (MC). Persons with MDD are more inclined to use marijuana [Citation4,Citation5] and a cross-national meta-analysis identified that pain (64%), anxiety (50%), and depression (34%) were among the major reasons for the use of MC [Citation6]. Several countries including the UK, Canada, Israel, Australia, and the US have approved MC registries, providing convenient samples to help understand the effects of MC in naturalistic settings. Many of these studies examine whether MC alters the course of pain, depression, insomnia and generally include measures of tolerability and safety. Although such studies cannot establish causality, they may help clarify MC safety in real world clinical settings. In one such study, Mangoo et al. (2023) [Citation7] examined changes in depression scores in 129 UK patients who received MC for depression. These patients were moderately depressed as measured by the Patient Health Questionnaire (PHQ-9) and unresponsive to antidepressants. PHQ-9 is a nine-question validated tool that screens for the presence and severity of depressive symptoms. MC was administered via sublingual, vaporized or oral routes. The median daily cannabidiol dose was 100 mg from oil and 0.5 mg from dry flower. This study found that MC treatment was associated with reductions in depression severity at 1, 3, and 6 months [Citation7]. Improvements in PHQ-9 were larger in patients with anxiety, illicit cannabis users and those with severe depression. MC was also associated with decrease in anxiety symptoms as well as sleep and health-related quality of life after 1, 3, and 6 months [Citation7]. 14% reported adverse effects such as fatigue and insomnia, mostly of mild to moderate degree with no disabling adverse events [Citation7]. While this study suggests potential benefits of MC, a Canadian study [Citation8] casts doubt on some of these findings. Round et al. 2020 conducted an observational cohort study (N = 5103) examining the effect of MC on the PHQ-9 in adults receiving MC for any reason up to 3.2 years [Citation8]. These patients had mild depression with the average PHQ-9 score at baseline of 10.5. Of interest, 3.4% of the sample reported improvement and 1.5% reported worsening of their depression [Citation8]. Overall, most MC users showed no clinically significant changes in PHQ-9 scores following MC use [Citation8]. Of note, the patients in the UK sample who exhibited improvements had moderate depressive symptoms relative to the Canadian sample which had mild symptoms. This may have influenced the results. Also noteworthy, are the possible contribution of pharmacological variables, as the mood effects of MC may depend on THC content, frequency, and quantity of use. MC formulations in Canada and the UK may vary in their THC/CBD concentrations, which may account for the variability of clinical effects. While both studies included various MC formulations such as smoking, vaporized or sublingual they did not report on THC/CBD dose ratios. Finally, patients were free to consume illicit cannabis, which can further confound the findings. In both studies, MC was relatively well-tolerated and when it did not help, it apparently did not worsen outcomes. Language: en |