Therapeutic Cannabis and the “Chaos of Melancholy”
By Becky DeKeuster, M.Ed I
n 1621, a British clergyman Robert Burton colorfully de- scribed the condition of depression in words that still ring true today: “The Tower of Babel never yielded such confu- sion of tongues as the Chaos of Melancholy doth of Symptoms.” His book The Anatomy of Melancholy recommended a variety of treatments for this disease, including prayer, good company, exercise, and various tinctures and herbs—including marijuana. Today, when faced with the myriad symptoms of a depres-
sive episode, patients and their physicians are more likely to turn to Cymbalta, Effexor, Zoloft, or Celexa. Or Prozac, Well- butrin, Lexapro, Paxil. Perhaps Seroquel, Xanax, or Zyprexa. These pharmaceuticals are helpful to many patients, doubt-
less. However, each comes with its own list of side effects including nightmares, fatigue, dizziness, irritability, even sexual dysfunction. Additionally, pharmaceutical treatments carry vary- ing levels of risk for addiction and liver or kidney toxicity. The difficulty many patients have in finding the right prescription at the right dose is such that we now have Abilify, which can be prescribed in addition to another antidepressant if the patient still has “unresolved symptoms” after six weeks. However, the expansion of access to regulated medical can- nabis in the U.S. provides millions of patients an alternative to what we have come to think of as “traditional” pharmaceutical treatments. Almost 400 years after Burton recommended it, pa- tients and health care providers are again turning to marijuana as a natural alternative to pharmaceutical antidepressants, and part of a holistic approach to mental health care. In 1988, researchers discovered a complex receptor system in humans, the endocannabinoid system. These receptors are found throughout our bodies, and interact both with the active compounds in the cannabis plant, and with analogues of these compounds which our bodies produce naturally. We know that in our brains, these receptors play an important role in modu- lating mood and emotion, including both anxiety and depres- sion. Genetically engineered mice whose CB1 receptors have
26 Essential Living Maine ~ November/December 2014
been “knocked out” may soon be used as models in preclinical studies of depression. Furthermore, the scarcity of cannabinoid receptors in the brain stem means that lethal overdose is essen- tially impossible with marijuana.
Can I Use Cannabis for Depression in Maine?
It is important to remember that depression itself is not a qualifying condition for the medical use of marijuana in Maine. Maine recently added Post Traumatic Stress Disorder to our list of qualifying conditions; in summer 2014, WCM surveyed 526 of our members, and nearly 25% of respondents listed PTSD as one of their qualifying conditions. The same survey asked members if they had also found that their cannabis use for a qualifying condition also helped them with another condition that is not currently approved in Maine. 19.6% of respondents agreed that it had, and depression was among the most frequently listed of these conditions. Because depression so often accompanies serious illness, we frequently hear anecdotal evidence that patients who use cannabis use for a “qualifying” ailment also find that it improves their co-morbid depression.
But Doesn’t Cannabis Cause Depression?
There is no conclusive evidence that marijuana use alone causes depression. This does not preclude the existence of competing studies and various interpretations of data on the part of the scientific community. Dr. Daniel Hall-Flavin of the Mayo Clinic summarizes the topic thus: “Marijuana use and depres- sion accompany each other more often than you might expect by chance, but there’s no clear evidence that marijuana directly causes depression.” In other words, correlation does not prove causation.
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