Cannabis against depression

A supplement to conventional antidepressants?

Depression has long been a widespread disease in Germany, the German Depression Aid confirms. The "Deutschland Barometer Depression¹" reports that every fifth employee has already been diagnosed with the mental illness depression. Overall, 16 to 20 out of every 100 people suffer from depression at least once in their lives². Equally alarming are the numbers of suicides and suicide attempts: Every year, about 9,200 people in Germany take their own lives³ , i.e. 25 people every day. The number of suicide attempts is estimated to be 15 to 20 times higher. Half of the deceased had previously suffered from depression⁴.

That these numbers are so high could be because the options for treating depression are limited and those affected lack drive and struggle to take care of their health.

However, even many of the people who manage to seek help are not satisfied with the effect of their medication: medication does not work as expected or has side effects that are unacceptable.

In some cases, medical cannabis can be a good supplement for depressive patients. Since 2017, doctors in Germany have been allowed to prescribe medical cannabis under certain conditions.

The criteria for prescribing medical cannabis

The law "Cannabis as Medicine⁵" makes it possible for doctors of any speciality (except veterinarians and dentists) to prescribe cannabis as medicine on a narcotic prescription under certain conditions.

These conditions include the presence of a serious illness that is classified as therapy-resistant, for which no standard therapy is available or for which the side effects of the standard therapy are unacceptable. According to medical assessment, there must also be a chance that the symptoms will improve with medical cannabis.

What is depression? Symptoms and forms

Depression is one of the most frequently diagnosed mental illnesses. Those affected suffer from symptoms that every person has probably experienced at some time or another. Such short depressive episodes usually pass quickly. The moods of a morbid depression are much more intense and last longer.

The main symptoms of depression are⁶:

• Depressed, depressed mood: Patients experience their general condition as depressed and feel a constant sadness. It is difficult for them to look positively into the future. Some sufferers also report a feeling of inner emptiness and the inability to feel at all. Often, the depression symptoms are particularly pronounced in the morning and improve in the evening hours.

• Reduced drive with increased fatigue (often even after small efforts) and activity restriction: People with depression often have problems starting or finishing things. Often, even getting up in the morning as well as personal hygiene or household chores become a day-filling task.

• Loss of interest and joylessness: Things that used to give patients pleasure seem meaningless during a depressive episode. Sick people find it difficult to pursue hobbies because they lack motivation and the activity no longer gives them pleasure. The result is often social withdrawal, which can lead to further problems.

In addition, there may be some additional symptoms⁶:

• Sleep disturbances: Depressed patients often find it difficult to fall asleep or to sleep through the night. They often wake up too early in the morning and cannot get back to sleep.
• Decreased concentration and attention: People with depression often find it difficult to concentrate or to cope with everyday tasks and activities, and they may find it difficult to make decisions.
• Decreased self-esteem and self-confidence: Confidence in one's own abilities sometimes disappears completely. The esteem of one's own person becomes less and less.
• Guilt and feelings of worthlessness: Patients feel they are a burden to others and blame themselves for everything that goes wrong.
• Suicidal thoughts, self-harm or suicide attempts: People suffering from severe depression sometimes see suicide as the only way out of their suffering.
• Reduced appetite: Lack of drive and low self-esteem are often followed by a lack of appetite. Affected people then see no point in taking care of themselves and eating something or feel they do not deserve it.

There are different forms and degrees of severity of depression⁶:

• Unipolar depression: Describes "classic" depression, symptoms last from a few weeks to several months.
• Recurrent depression: This is characterized by phases in which depressive symptoms are absent or less pronounced. However, depression always returns.
• Chronic depression: This is a long-lasting and usually fluctuating depression that lasts for years.
• Bipolar disorder: A special form in which phases of extreme dejection alternate with episodes of extreme activity and mania. The disorder is classified as chronic.

The severity⁷ of depression is divided into mild, moderate and severe. People suffering from mild depression can usually still carry out necessary activities, such as work. They are still able to help themselves. In the case of moderate depression, participation in life is already severely restricted.

Severely ill persons can hardly or no longer participate in life. Often they are also unable to seek help. Over time, the psyche suffers more and more, which then also affects physical health.

Diagnosis and treatment

If you suspect that you are suffering from depression, the first step is to contact your family doctor. Further diagnosis usually takes place with a psychiatrist. The psychiatrist will ask about the symptoms and how long they have lasted. Standardized questionnaires are often used for precise assessment.

Depression, what to do? Psychotherapy and medication

After diagnosis, treatment is the next step, because even if it is difficult for those affected to look to the future with confidence: Many forms of depression are treatable and curable.

Medication can be the cornerstone for recovery, as it often gives patients the strength to participate in everyday life again and to seek therapy.

One of the causes⁸ of depression is a lack of messenger substances, so-called neurotransmitters, which are involved in the transmission of information in the brain. These neurotransmitters are called noradrenalin, dopamine and serotonin.

This is where the antidepressants that are used to treat depression come in. Some of the most common antidepressants work by occupying the receptors of the neurotransmitters, preventing the neurotransmitter from being taken up again after it has been released. Others work by inhibiting the breakdown of neurotransmitters or facilitating their release. These effects increase the concentration of neurotransmitters in the so-called synaptic cleft so that the transmission of nerve signals works better.

Because the psychotropic drugs work differently in detail, it is important that the setting is made by experienced specialists. While some drugs have an activating effect, others have a calming effect.

In addition to the positive effects of antidepressants, adverse effects can also occur. For some patients, the side effects are unacceptable and they have to reduce the dose or stop the treatment.

The second, no less important component of treatment for depression is psychotherapy. Depending on the severity of the depression, psychotherapy can take place on an inpatient, day-care or outpatient basis.

Cannabis against depression

Cannabis against depression? For many years, the use of cannabis containing THC was considered a breeding ground for mental illness. The fact that excessive recreational use of cannabis can have a negative effect on the psyche of users cannot be denied, even according to the current state of affairs. One reason for this is that the THC content of cannabis from the black market is usually very high and not precisely known. This often leads to a high THC dosage, which is difficult to control. The purity of cannabis from the street is also not controlled, so the products can be contaminated.

However, when used correctly, medical cannabis does have the potential to improve mood and support patients. The use of cannabis to treat depression was suggested by Robert Burton as early as 1621, when he published his book "The Anatomy of Melancholy". Cannabis has also been considered a source of happiness for millennia in Asia, and especially in India, as it can induce pleasure and a sense of freedom.

Due to the cannabis policy that was established after the second international opium conference in 1925 and whose effects are still felt today, research on medicinal cannabis was limited for a long time. Therefore, research on cannabis as medicine is still immature today and treatment is often based on experience.

The use of cannabis as an antidepressant is also still at an early stage, and there is little evidence of efficacy^9,10. Further studies on this are needed. However, an American online survey of cannabis patients showed that many (50.3%) use medical cannabis for depression. However, many of these patients did so without medical supervision or guidance¹¹. According to the results of a survey in Germany, 2.8% of cannabis prescriptions, the costs of which were covered by statutory health insurance, were prescribed due to depression¹².

Further research has shown that cannabis may also have potential for depression-typical symptoms such as insomnia^9,13.

Cannabis treatment is also not without side effects. The most common side effects include dry mouth, dizziness, poor concentration and fatigue.

How Canify Clinics can help

Canify Clinics wants to support you on your path to medical cannabis.  It is still not easy to find doctors who prescribe medical cannabis. Especially for people with depression, finding a suitable practice can be an insurmountable hurdle. To make your path to medical cannabis easier, Canify Clinics also offers telemedicine treatment.

After you have registered on our portal without any obligation, our doctors will check your documents and contact you promptly to discuss the next steps. If treatment with medical cannabis is an option for you, an appointment with one of our cooperating doctors will follow. The follow-up appointments can take place from the comfort of your own home, and you can discuss everything important with your doctor in the video appointment. Only once a year do you have to go to an on-site appointment – we'll be happy to help you prepare.

FAQ

How can depression be explained?

Depression is one of the most commonly diagnosed mental illnesses. Symptoms of depression include dejection, decreased drive, as well as loss of interest and loss of pleasure. In addition, those affected often suffer from sleep disturbances, a reduced appetite and suicidal thoughts. Affected people find it increasingly difficult to cope with everyday life due to the symptoms.

Can cannabis help with depression?

The studies on the use of medicinal cannabis for depression are still at an early stage and are therefore of limited value. More studies are urgently needed. However, some statistics show that cannabis is often prescribed for depression. There are also studies suggesting the use of cannabis for symptoms typical of depression, such as insomnia.

Which medicinal cannabis strain helps against depression?

Which cannabis product is best suited for the patient's symptoms is decided by the treating physician on a case-by-case basis and in consideration of the individual symptoms. There are different medicinal strains to choose from. It often takes a while to find the right strain for the individual, because everyone reacts differently to cannabis as a medicine.

Disclaimer and legal information

This article is for informational purposes only and is not a substitute for medical advice from a doctor. The content is not intended to motivate self-diagnosis or self-treatment, nor to tempt people to change their own medical treatment. Canify Clinics does not make any recommendations or promote any diagnostic methods or treatments. If you wish to change your treatment, this should always be discussed with a doctor. Furthermore, Canify Clinics cannot guarantee the accuracy, timeliness and balance of the content. Therefore, neither the authors of the texts nor Canify Clinics accept any liability for damages resulting from the independent use of the information described here.

* If you have suicidal thoughts, please contact the telephone counselling service on the Internet at any time of the day or night at www.telefonseelsorge.de or via the free hotlines 0800/111 0 111 or 0800/111 0 222 or 116 123. During the week, the German Depression Aid can be reached during the day at 0800 / 33 44 533.

References

1. Deutsche Depressionshilfe, “Deutschland Barometer Depression - Stiftung Deutsche Depressionshilfe ”

2. Bundesministerium für Gesundheit, “Depression | Die Volkskrankheit verstehen - Bundesgesundheitsministerium”

3. Deutsche Depressionshilfe, “Suizidalität - Stiftung Deutsche Depressionshilfe”

4. Deutsche Depressionshilfe, “Suizidalität - Stiftung Deutsche Depressionshilfe”

5. Bundesgesundheitsministerium, “Fragen und Antworten zum Gesetz "Cannabis als Medizin" - Bundesgesundheitsministerium”

6. Nationale Versorgungsleitlinien, “2 Diagnostik — Leitlinien.de”

7. psychenet - Netz psychische Gesundheit, “Depressionen - psychenet.de”

8. Neurologen und Psychiater im Netz, “Depressionen » Ursachen »”

9. Bilbao, A. & Spanagel, R. Medical cannabinoids: a pharmacology-based systematic review and meta-analysis for all relevant medical indications. BMC Med 20, (2022).

10. García-Gutiérrez, M. S. et al. Cannabidiol: A Potential New Alternative for the Treatment of Anxiety, Depression, and Psychotic Disorders. Biomolecules 10, 1–34 (2020).

11. Sexton, M., Cuttler, C., Finnell, J. S. & Mischley, L. K. A Cross-Sectional Survey of Medical Cannabis Users: Patterns of Use and Perceived Efficacy. Cannabis Cannabinoid Res 1, 131–138 (2016).

12. Abschlussbericht der Begleiterhebung nach § 31 Absatz 6 des Fünften Buches Sozialgesetzbuch zur Verschreibung und Anwendung von Cannabisarzneimitteln https://www.bfarm.de/DE/Bundesopiumstelle/Cannabis-als-Medizin/Begleiterhebung/_node.html;jsessionid=C8FE79E517C28C0C0ACFEEDEA12CA3A2.internet282

13. Kuhathasan, N., Minuzzi, L., MacKillop, J. & Frey, B. N. An investigation of cannabis use for insomnia in depression and anxiety in a naturalistic sample. BMC Psychiatry 22, (2022).