Cannabis for Depression: A Complicated Relationship

• Depression is not a qualifying condition to get a medical marijuana card in most states. 
• The research on the effect of cannabis on depression is ongoing and the results are a mixed bag. 
• In general strains with low THC and high CBD content are considered the best for depression.

Does marijuana help depression? Possibly, but the relationship between cannabis and depression is not as cut and dry as something like cannabis for pain. 

As of 2021, medical marijuana is available in more states than it’s not. Most states have at least one mental illness listed as a qualifying condition for a medical marijuana card. Florida is actually pushing for The Florida Medical Marijuana for Mental Health Disorders Initiative, which would add nine mental health conditions to the current list. One of those mental health conditions is major depressive disorder (MDD). 

Anecdotal reports of people using marijuana for depression are not hard to find either. Therefore, there does seem to be some support for using cannabis for depression, but does science back up this ideology? 

Let’s get a closer look at the role marijuana could play in helping people who feel depressed, what the research says, and more. Here’s a preview of what we will discuss below: 

• Physical and mental pain are often closely connected, which means cannabis may be more suitable for depression among pain sufferers. 
• Cannabis use may uplift the mood temporarily, but formal research into the effectiveness of marijuana for depression has yielded conflicting results. 
• Certain cannabis strains may be better suited for depression than others, according to cannabinoid and terpene content. 

Cannabis products may be good for depression, especially when the depressive symptoms are related to chronic pain. 

Elizabeth Ardillo, PharmD, has seen firsthand how physical and mental pain are connected, in the eyes and the stories of the people she meets. As a lead pharmacist for RISE Dispensaries in Pennsylvania, she counsels many patients who have symptoms of depression alongside the condition that brings them in the door. 

“A lot of patients with chronic pain and illness also have depression,” Ardillo says. “Often, they’re mentally and physically drained by the time they get to us. Their pain keeps them up at night, they don’t have a good sleep cycle and it affects their mood.” 

Of course, you don’t need to have a physical illness to be depressed; it can happen to anyone, especially during periods of intense stress. In a typical year, more than 7 percent of the U.S. population experiences depression; during the COVID-19 pandemic, the incidence of depression appears to have tripled. 

The first line of standard depression treatment tends to be with a selective serotonin reuptake inhibitor (SSRI). These medications elevate serotonin levels by chemically slowing down the breakdown of the feel-good element in the brain. Unfortunately, this standard depression treatment tends to also lead to undesirable side effects in depression patients such as agitation, indigestion and blurred vision. This naturally leads some people to search for an alternative treatment in the form of medical cannabis. 

“Cannabis has the potential to relieve symptoms of depression and lift mood, but it can also aggravate depression and worsen feelings of sadness”, Ardillo says. “That’s why it’s important to get expert guidance if you’re interested in using marijuana for depression. ” 

“People need to work with their mental health providers and track how they feel when they use cannabis,” Ardillo says. “That can help us get them to a product that may relieve their symptoms instead of aggravating them.” 

As we’ve stated, depression is not a qualifying condition to get a medical marijuana card in most legal states. However, many patients with other conditions who also have depression find cannabis to be helpful. 

Maria Caligiuri, 32, is a RISE medical marijuana patient who lives in Pittsburgh. She has multiple sclerosis, chronic knee pain and major depressive disorder, and cannabis use has been a helpful part of her treatment plan for all of these conditions, she says. She takes a daily antidepressant, but she also has found that cannabis can be a mood lifter, especially strains that have low doses of THC. For her, using cannabis while she’s feeling depressed has inspired creative pursuits, such as painting, which is a good distraction from ruminating thoughts. 

“It enables your mind to hack into your creative space so you see things differently,” she says. 

The research into cannabis and depression is in its infancy, and so far it’s a mixed bag, Ardillo says. Some studies show cannabis improves symptoms of depression; others have found that it is not useful for improving depression and that it might even be tied to an increased risk of developing depression. 

One study found that cannabis improved depression symptoms in cancer patients; researchers have considered whether cannabis can ease symptoms of depression caused by chronic stress. 

The cannabis plant contains chemical compounds called cannabinoids, including THC and CBD, that generate effects on the body and mind. Our bodies have a natural endocannabinoid system that reacts to the cannabinoids in cannabis via cannabinoid receptors. 

When cannabis does improve symptoms of depression, it may be because of the plant’s ability to boost certain endocannabinoids (chemical compounds made by the human body) that help regulate how we feel, Ardillo says. Deficiencies in two of these endocannabinoids, 2-AG, and anandamide, may signal depression; cannabis may mimic the effects of these endocannabinoids and lift the mood. 

One of the most important things to remember about cannabis and depression is the effects of cannabis are biphasic, which means high and low doses can create opposite effects, Ardillo says. Typically, a low dose of THC helps relieve symptoms of depression and a higher dose may worsen symptoms of depression, she says. 

Here’s the deal: certain strains will be better for depression than others. In general, it may be best to find cannabis flower that has a lower THC potency and some measurable amount of CBD. These strains may also be less likely to lead to anxiety or paranoia, as CBD seems to counteract this undesirable side effect of THC. 

The terpene makeup of different strains matters too. Terpenes may support the actions or effects of preset cannabinoids to offer a more profound outcome. Some terpenes have a more uplifting effect, while others seem to have a more sedating effect. 

For example, limonene, a terpene associated with mood elevation is often found in strains with citrus names; check the label or ask for help. On the flip side, avoid products prominent in myrcene, a terpene that can cause sedative effects, because many people with depression already feel lethargic. 

While there has been no formal research into the best marijuana strains for depression, there are claims that some strains are a better fit. A few examples include: 

• Jack Herer 
• Cinex 
• Grandaddy Purple 
• Cannatonic 

For a person diagnosed with clinical depression or struggling with low mood and wanting to try cannabis, Ardillo offers these tips: 

• Start with a low dose of THC and increase very slowly: Select a product that is balanced between THC and CBD (look for a 1:1 ratio on the label), and increase THC gradually once you know how it affects you. Low levels of THC are more likely to improve depression, Ardillo says. So look for cannabis strains that have lower THC levels. With actual inhaled cannabis, take a puff or two and wait 20 to 30 minutes to see how you feel before taking more. 
• Choose your terpenes carefully: Terpenes are the compounds that give every marijuana strain its smell and flavors. People with depression will want to look for the best marijuana strains for depression according to the terpene and cannabinoid profile of the strain. 
• Talk to your mental health provider about cannabis as part of your treatment plan: Work with you’re a therapist or doctor to make sure any medications, including cannabis, are helping and that symptoms are improving. 
• Take note of how cannabis affects your depression symptoms: Use a cannabis journal to note what was taken and when, including the dose, and your mood in the minutes and hours after. This will help a pharmacist or cannabis consultant select the most effective products moving forward. 
• Don’t drink alcohol while using cannabis: This is general advice Ardillo gives all her medical marijuana patients because she wants to know that any physical or mental effects are coming from cannabis, not alcohol. But this is especially important for people with depression because alcohol is a depressant and can worsen symptoms, with or without cannabis. 

If you think you might be clinically depressed, it’s important to talk to your doctor or a mental health therapist. If you are having suicidal thoughts, please seek emergency help by calling 911 or the National Suicide Prevention Lifeline: 800- 273-8255. 

If you have more questions about medicinal cannabis and depression, feel free to reach out to one of our patient care specialists for help. Find a RISE Dispensary near you and give us a call or send us a message today.  

• Expanded Medical Marijuana To Include Mental Health | Constitutional Amendment Full Text   
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