- Research into cannabis and its effect on mental illness is complicated by the fact that it is not just one general substance.
- Zach Walsh spends a lot of time researching the links between cannabis use, mental health and addiction
In Canada, where cannabis is slowly but surely approaching, there is a growing interest in its medical use, especially in the field of mental illness. Maybe it's also because it's a problem that affects one in five Canadians.
Do people with mental illness use cannabis to relieve their symptoms, or do they use it precisely because they suffer from a mental illness?
The reality is that, apart from tobacco and alcohol, cannabis is the most common psychoactive substance used by the general public, and it is therefore inevitable that the potential overlap between cannabis and mental illness will lead to an increase in questions for doctors.
And yet most patients share a similar experience: When asked by a doctor if cannabis use could help them with their mental illness, the question is usually quickly swept off the table. Cannabis carries the stigma of a banned drug and it will take a long time to get rid of it. Therefore, when it comes to cannabis and the treatment of mental illness, there are people who compare this situation to the riddle of the hen and the egg. Do people with mental illness use cannabis to relieve their symptoms, or do they use it precisely because they suffer from a mental illness?
Because research in this area is minimal and doctors are often inseparable, information is unofficial and is obtained mainly from the testimonies of sick people.
Toronto photographer and activist Andy Lee uses cannabis along with speech therapy to treat depression and anxiety. He came up with this combination after trying antidepressants and finding that they didn't help.
His doctor had made it clear to him that he was opposed to treating mental illness with cannabis , so Lee decided to find another doctor who had no problem prescribing. "I know it's a hot topic and a taboo, but it helped me," he says.
Lee is now committed to advocating cannabis and mental health.
"I know it's a hot topic, but it helped me." - Andy Lee on treating cannabis depression
Although he has discovered a treatment that helps him, he admits that there are certainly risks when cannabis is used in excessive amounts. "It's a medicinal plant, but it shouldn't be abused and taken for granted," he says. "It's like antibiotics, the more the body gets used to them, the less positive it has."
Claire Gabereau agrees. Vancouver costume designer has been smoking cannabis for many years. When she was diagnosed with depression and borderline personality disorder, the doctor strongly warned her against using cannabis. However, her psychiatrist was more open and never criticized her for her habits. The problem occurred when further examination showed that he was suffering from a substance use disorder. She decided not to take antidepressants and to stay sober.
"I didn't like my psychiatrist saying something like, 'sobriety can be good for you, here's a bunch of drugs," Gabereau said.
It's been three months since Gabereau changed her habits, and her depression and anxiety began to subside. "I don't want to go back to smoking so much again, because I would definitely be paranoid and anxious," he says. " Cannabis can certainly be used as a tool and medicine, but because I've been abusing it for too long, it has lost its value and significance to me."
Invaluable research from Israel
Most scientists agree that the compounds found in cannabis , known as cannabinoids, have a clear effect on human biology. There is still a large number of gaps in research into the role that cannabis can play in the treatment of mental illness. This is especially true in the United States, where research is dampened by the position of cannabis, a class 1 narcotic.
Shauli Lev-Ran is a Tel Aviv psychiatrist specializing in addiction. It focuses on the psychiatric aspects of cannabis use and the link between pain, mental disorders and the risk of addiction.
It regularly treats patients with both mental and cannabis disorders. As the legislation and regulations surrounding cannabis began to change in the United States and Canada, he began to look even more deeply at the connection between mental health and cannabis.
Despite his area of expertise, however, Lev-Ran admits that there was no clear conclusion about the theory of hens and eggs, which used to be whether mental illness or cannabis addiction. "It's complicated, there are a lot of methodological problems that thwart our efforts to get the most sensible results for our questions," he says.
In 2013, Lev-Ran conducted research through the Center for Addiction and Mental Health (CAMH) in Toronto. This study used corpus data collected by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and was a cross-sectional study of more than 43,000 people, the largest epidemiological study of mental disorders and substance abuse. Lev-Ran found that people with a mental disorder were more than seven times more likely to use cannabis each week than those without a disease.
More specifically, the study examined the differences in cannabis use and use between people with mental illness and those who were not sick. The research was based on a number of mental illnesses and their types and intensity of cannabis consumption. And it is Lev-Ran who finds it difficult to quantify the amount consumed. Unlike alcohol, cannabis dosing is not standardized.
"Lev-Ran has found that people with a mental disorder are more than seven times more likely to use cannabis every week than those without a disease ."
"We can talk about frequency and we can talk about dosing, but neither is standardized," he explains. "It's one thing to smoke two joints a day that are low in THC. But when I smoke a skunk or joint with a high THC content and a large joint that is not mixed with tobacco, it may seem similar, but it is not, there is a big difference. ”
This was followed by Lev-Ran's meta-analysis, which he compiled from thousands of existing studies to find that people who use cannabis are more prone to develop depression. At the same time, however, he found that many of the studies from which the meta-analysis was compiled did not take into account some factors, such as childhood education and family history of substance abuse.
In 2016, Lev-Ran conducted further research focusing on people who had never had depression, both cannabis users and those who had not used cannabis. Research has shown that users who have never suffered from depression are at greater risk of suffering from a mental disorder than those who have not used cannabis. The research also analyzed data from the National Institute on Alcohol Abuse and Alcoholism, and this time 34,000 individuals were trained in 2013.
Lev-Ran found that regardless of the regularity (or irregularity) of cannabis use, there was no difference in the rates of depression. Conversely, individuals who suffered from depression were more prone to starting cannabis than those without depression.
"We can say that cannabis is not very harmful, but at the same time it does not help much." - Shauli Lev-Ran
Next, Lev-Ran looked at whether cannabis helps people with depression. He examined people with depression, both those who used cannabis and those who did not, and found that there were only slight differences between the two groups. It is a conclusion that can be interpreted in two ways.
"We can say that cannabis is not very harmful, but at the same time it does not help much," he says, noting that this conclusion is based on only one study. "But it shows how we approach these issues."
Research into cannabis and its effect on mental illness is complicated by the fact that it is not just one general substance. There are thousands of varieties and each plant contains hundreds of chemical compounds such as carabinoids and terpenes.
"It's clear we're not talking about one particular compound," he says. "So throwing all cannabis users in one bag is ridiculous."
Research on mental disorders such as bipolar disorder or schizophrenia is clearer. Cannabis is the trigger for these diseases and can lead to their worsening. However, the risk for any disease or disorder is a combination of predisposition and exposure to risk factors. People with an inherited predisposition to schizophrenia and using cannabis are at increased risk of developing mental illness, especially during adolescence.
PTSD paves the way
Zach Walsh spends a lot of time researching the links between cannabis use, mental health and addiction. As an associate professor of psychology at the University of British Columbia, he oversees a research laboratory that examines cannabis for medical and "recreational" purposes.
Walsh says the only way to really find out if mental illnesses are caused by cannabis use, or if it works the other way around, is to monitor people from an early age. This is because most people start using cannabis at about the same time as they experience the first signs of mental illness - in the middle to late teens.
Walsh says the greatest evidence from his laboratory that confirms the effectiveness of cannabis can be found among patients suffering from post-traumatic stress disorder.
"Let's say you started smoking at 14 and you were diagnosed with depression at 18. It's hard to say if you felt a little depressed and tried to drive it away with smoking cannabis, "he comments.
Medical studies can help reveal whether people with mental illness do better when they use cannabis or not. But even so, researchers are still a long way from understanding all the contexts.
Welsh points to the stigma of cannabis, which is still illegal in most countries, and how this stigma destroys the potential view of cannabis as a real cure. Because cannabis is classified as an illegal substance, it is often associated with crime, not relief from the symptoms of the disease. And it will take some time for that to change.
"I think cannabis should be considered from all sides," he says. "All medicines have their risks and benefits. But cannabis still has that stigma. We are much less critical of the drugs that are made by the pharmaceutical industry. "
Welsh says the greatest evidence from his laboratory, which confirms the effectiveness of cannabis, can be found among patients suffering from post-traumatic stress disorder. Specifically, it is a reduction of nightmares. This is especially true for the Canadian Department of War Veterans (VAC) and the Department of National Defense (DND), which are also reassessing existing research on cannabis use for medical purposes. The VAC will cover some veterans who suffer from PTSD with the cost of medical cannabis (maximum 3 grams per day).
In a statement for Leafly VAT she wrote. "Because we know it's still an emerging practice and area of study, we want to assure you that the specific direction of our research working with DND will only have the best impact on strengthening evidence of the positive effects of cannabis on veterans' health."
"All medicines have their risks and benefits. But cannabis still has that stigma. We are much less critical of the drugs that are made by the pharmaceutical industry. ” - Researcher Zach Walsh
Walsh thinks that future studies will focus more on anxiety disorders, which are currently often treated with pharmaceuticals such as Valium or Ativan.
"It's important to look at these drugs as well, they also have side effects," he says. "They can lead to tolerance and withdrawal symptoms."
If a patient suffering from a mental illness or anxiety chooses cannabis treatment, Walsh emphasizes the importance of self-observation. It's similar to antidepressants, you need to find the right kind and amount. With the trial-and-error method, this process can take several months, but by monitoring how individual species and doses affect humans, the best results can be achieved. The patient will thus better find out what is effective for him and what is not.
"Adults should have a choice," he continues. "Even though the harmful effects of cannabis have been tested countless times, the benefits are not. I think an adult should choose for himself whether he wants to be treated with cannabis or not.
The results speak for themselves
Alexandra Charendoff, a Toronto resident, fully agrees, although doctors regularly discourage her from using cannabis. After being diagnosed with borderline personality disorder, anxiety disorder, and agoraphobia, Charendoff found that cannabis was the most effective way to relieve the anxiety that paralyzed her when she decided to go out.
"It was almost instantaneous," he says. "When I smoke cannabis, I can finally work. It's one thing that helped me. When I take Ativan, I just want to lie down and sleep. ”
When she suggested this option to her doctor, "it was obvious that he had led this conversation many times," but he was unwilling to take the cannabis journey. She wasn't too surprised. Every time she had an episode and went to the emergency room, the doctors definitely discouraged her from using cannabis, but they never had any data to support their claim. It seemed to Charendoff that their approach was too one-sided.
"They'll say it's not a good idea, but they won't give you any room for discussion," says Charendoff.
It is likely that once cannabis is legalized in Canada, more research will be conducted and there will be much more evidence of its effectiveness in treating mental illness. Until then, doctors will still be able to push the issue of cannabis effectiveness into the background. But if they don't have the answers, it's very likely that patients like Lee and Charendoff will start exploring their options on their own.
"I don't think cannabis can cure my mental illness," Charendoff says. "But it helps me."