Introduction

Depression, or depressive disorder, is a mental health condition characterised by a persistent low mood. In 2014, it was found that 1 in 6 people in the UK above the age of 16 experience either anxiety or depression – these statistics have risen with the cost of living crisis, as well as the pandemic.¹ The effects of depression can impact an individual’s relationships and work life, leading to feelings of inadequacy and negative outlook towards life. 

Cannabis is a drug known for its recreational use, as it is able to cause mind-altering and calming effects on the users. However, scientists have begun to investigate its ability to soothe users with depression, and help them to regulate their emotional states. This is an important aspect of helping depressed individuals.

This article will discuss how cannabis use could be integrated into a holistic approach to managing depression, supplemented with behavioural therapies and other alternative treatments.

Understanding depression and its causes

Types of depression

Depressive disorders can manifest in multiple ways, and in order to treat them scientists have tried to classify these. The onset of depression can be dimensional, with some overlap or simultaneous affliction with disorders such as anxiety (comorbidity). 

9 types of depressive disorders are defined below, with common features such as prolonged feelings of sadness (over 2 weeks), a loss of interest in hobbies or social activities and physical changes:²

• Bipolar depression, distinguished by excessive daytime sleepiness and slower thinking, or bodily movements
• Major depressive disorder, which can result in insomnia and agitated movements³
• Minor depressive disorder, lasting over a shorter amount of time⁴
• Depressive mixed state, or mixed depression has features of mania, where an individual is irritable or excitable for an extended period of time with extreme changes in mood and activity⁵
• Atypical depression is more likely to occur in people who have bipolar disorder, and ma have a higher tendency towards suicidal thoughts⁶
• Melancholic depression, which has a focus on feelings of guilt and hopelessness. Some sources suggest it can progress into catatonic depression, where an individual shows little reaction to the world around them⁷ 
• Recurrent brief depressive disorder features the severe symptoms of depression such as weight changes and thoughts of self-harm, but these do not last long-term⁸
• Seasonal affective disorder, where depressive symptoms occur in colder, darker months
• Dysthymic disorder, which is chronic depression lasting over several years but is not as severe⁹

Some classifications of depression are not used in a clinical setting, as they have been hard to distinguish as a disorder on its own.

Causes and contributing factors

Depression can have multiple causes. Someone with a family history, or relatives with depression is more likely to have the disorder, suggesting a genetic basis to the disease. 

To add another layer of thought, someone who has the genes for depression may not actually develop the condition until they encounter sufficient stress – such as moving home, relationship issues, or bullying. This means people can have varying susceptibility to depression. 

Psychologists may also look at depression from a biological perspective, which focuses on neurotransmitters- chemical signalling molecules in the brain (specifically serotonin, which is a ‘happy hormone’ – and dopamine, which triggers the reward centre).

The biological approach suggests that people with inadequate levels of these neurotransmitters can develop low mood. 

Challenges in treating depression

Treating depression is difficult as there may be no specific root cause to target. For example, drug treatments such as selective serotonin reuptake inhibitors (SSRIs) may be ineffective for people that have developed depression because of trauma or stressful events.

Furthermore, they might also come with unwanted side effects, such as indigestion or appetite changes.¹⁰ 

On the other hand, behavioural therapies might be difficult for patients to keep up with – cognitive behavioural therapies might involve ‘homework’ tasks that unmotivated individuals struggle to find energy for.

These limitations make it difficult to use one treatment as a cure-all for depression, and instead call for a patient-tailored approach to the management of the disorder. 

Cannabis as a treatment for depression

Cannabis and its components

The cannabis plant, Cannabis sativa, has multiple chemical compounds that can interact with the brain, causing a wealth of different effects. The main compounds that can interact with our brain are called cannabinoids, and two have been extensively studied:

• Cannabidiol (CBD), noted for its calming, anxiety-relieving effects
• Tetrahydrocannabinol (THC), the main psychoactive agent causing hallucinations and changes in perception

Across the cells of the brain and nervous system, are cannabinoid receptors that are activated when these compounds come across them. These can go on to stimulate many mental and bodily effects, such as digestion, learning, memory, pain, and inflammation.¹¹ This system, composed of endocannabinoid receptors and the molecules that activate them, is called the endocannabinoid system (ECS).

Potential benefits of cannabis for depression

Cannabis, specifically CBD, has been found in some cases to be useful for anxiety relief, mood stabilisation, and improving sleep –  symptoms which are often exacerbated in depression.¹²

THC has been found to have mixed results, and its adverse effects stem from its ability to induce psychosis over prolonged use.¹³

Though these are promising, there are some adverse effects which have been observed, such as fatigue. The long-term safety of cannabis as a depression treatment cannot be proved as of yet due to  limited availability of research.

Despite this, it is still worth researching whether we can refine cannabis for its use as a treatment for depression. If the side effects can be reduced, and the dosage or strain of cannabis can be tailored to suit individual needs, it might be effective in helping depressed individuals.

The importance of a holistic approach

A holistic approach includes all aspects of wellbeing – including physical, emotional, and mental health. 

Cannabis can be considered a drug treatment, which would thus be a biological way to relieve symptoms of depression. In a holistic approach, drug treatments would be used alongside cognitive behavioural therapy (CBT) and lifestyle changes – this includes building healthy habits, such as eating a balanced diet rich in nutrients, and engaging in regular physical activity. 

Eating well and moving more can help to release endorphins, which can help to regulate mood. Even going for a walk can help to clear the mind, and make you feel good.¹⁴ 

The food we eat can also affect our mood, through the gut-brain connection; through increasing intake of nutrients such as zinc, magnesium, iron, and selenium, as well as vitamin B6, B12, E, D and folate, we can nourish our bodies and improve our mental function. The Western diet, high in carbohydrates and low in fruit and vegetables, can be a risk factor for depression.¹⁵

Finally, talking therapies can allow patients to voice their thoughts and give them a safe space to work through their troubles. Healthcare providers can provide insight and support by cultivating an environment that allows people to be vulnerable, and let them feel heard. Several mental health services can be accessed through the NHS, if you are in the UK. 

Benefits of a holistic approach with cannabis

The benefits of a holistic approach to managing depression, including cannabis, means that multiple issues can be addressed. When symptoms can be relieved with drug therapies, it can be even more effective to target the root cause of depression, such as past traumas or worries that patients might have. 

This can lead to better outcomes long-term, and can help patients to avoid dependency on antidepressant drugs. 

Case studies and real-world examples

In a group of 129 patients with depression, medicinal cannabis seemed to help improve sleep quality (often noted in the disorder symptoms) as well as improve quality of life and health. 

However, the role of the drug is unclear as there may be other factors that contributed towards the wellbeing of the patients. This means that it may be wise to use a holistic approach to help patients in their mental health journey.¹⁶

Summary

A holistic approach to treating depression, using combinations of drug and behavioural therapies as well as positive lifestyle changes can help patients to achieve a greater sense of wellbeing and control over their mental health. This is because it targets the root cause of depression, as well as relieves its symptoms leading to better outcomes overall in terms of physical and emotional states.

Cannabis as a medicinal drug therapy has some potential, but more research must be done in order to optimise this for patients before it is used. As with all drug therapies, it only alleviates symptoms and is a short-term solution for depression.

As all patients are different, a holistic approach can be personalised to suit every individual need, from the genetic level to their mindset or worldview. This means that it has a very high potential to help people feel better – if cannabis becomes a new treatment for depression, it needs to be tested for safety and dosage for a wide range of people.