marijuana and mental health
I am not a psychiatrist. I do however, live with a very well-read and opinionated psychiatrist, and have spent most of my adult life working in emergency rooms where mental health issues are found in their most destructive manifestations. Depression is the 12th leading cause of death in the world by some measures and severe depression has a mortality of almost 25%. Anxiety frequently goes hand in hand with depression and, depending on how you describe these conditions, can be thought of as the same disorder. Both anxiety and depression have their roots in our ability to exist outside of the moment within our minds and imagine ourselves to be in the past or future. Depression can be thought of as regret about the past and anxiety as worry about the future. Depression and anxiety are, somewhat, a failing to be in this moment and experience it fully. There are a lot of ways to address this. Pharmaceuticals, therapy, meditation, exercise, etc. It is hard to prove that most pharmaceuticals work significantly better than placebo, and that is a topic for another blog. Therapy works but takes quite a long time and quit a bit of money. Exercise and meditation can be difficult skills to learn while in a depressed or anxious state.
What about marijuana? Certainly a lot of my patients use marijuana for mental health, but does it work? Is it different that just using intoxication to escape reality? Honestly, thanks to the federal regulation making marijuana research difficult to impossible, we don’t know, based on any quality evidence, the answer to these questions. But, as a medical marijuana doctor, I have some speculations based on my experience and reading.
In the hippocratic oath, we are asked to “first, do no harm” and this is the basis of a great deal of my support for marijuana as medicine. It is provably very, very safe. Marijuana is safer than Tylenol and certainly has fewer side effects and drug interaction than typical antidepressants and antipsychotics. Questions about marijuana and addiction, however, are difficult to answer simply. There is not the type of addiction that we associate with opiates, alcohol, or nicotine where withdrawing the compound causes disabling and dangerous withdrawal effects. Dependency on marijuana is possible but fairly rare and it is very easy to argue that millions of people in our country are very “dependent” on their antidepressants. The big question then, is “does it work”? Or more precisely, does it address depression and anxiety in some other way than a temporary drug-induced euphoria? Recently, I was reading “The Botany of Desire” by Michael Pollan and came across the following quote that hints at a mechanism by which marijuana may exert its effects on our experience of being in a counterintuitive and useful way…
“Memory is the enemy of wonder, which abides nowhere else but in the present. This is why, unless you are a child, wonder depends on forgetting- on a process, that is, of subtraction. Ordinarily we think of drug experiences as additive-It’s often said that drugs “distort” normal perceptions and augment the data of the senses (adding hallucinations, say), but it may be that the very opposite is true - that they work by subtracting some of the filters that consciousness interposes between us and the world.”
Marijuana’s ability to trap us in the moment and the sensations and experiences in that moment may be a subtly powerful gift to our mental health. Spending time in the moment can be accomplished other ways and without drugs (meditation, chanting, exercise, etc.) but sometimes a person has to realize the value of traveling to this moment from the distant country of rumination and fear before they can become motivated to spend more time there. Marijuana may be a very effective advertisement for the experience life in the moment.
If possible, I would treat most mental health issues with meditation, exercise, diet, and social support. Generally, this is not possible for a variety of reasons. If a patient is at the point where a medicine is required, however, I would argue that marijuana is a safer medicine to try than most antidepressants and may offer a type of benefit that antidepressants do not. Marijuana may offer the opportunity to remind ourselves of the miracle of this moment, its rich sensations, and it’s wonder.
-Josh Short MD, Stillwater Medicine