Welcome to the CBD for depression topic page at the universal plant, where you can find information about depression, and about treating depression with cannabis.
Depression is a painful and pervasive element of our society. The chart below is a survey of adults 18 and over, and shows how common depression is in the U.S (source).
- An estimated 16.2 million adults in the United States had at least one major depressive episode. That's 6.7% of all U.S. adults.
- The prevalence of major depressive episode was higher among adult females (8.5%) compared to males (4.8%).
- The prevalence of adults with a major depressive episode was highest among individuals aged 18-25 (10.9%).
- The prevalence of major depressive episode was highest among adults reporting two or more races (10.5%).
This NSDUH study defined major depressive episodes based on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV):
- A period of two or more weeks where there is a depressed mood or loss of interest/pleasure, and at least four other symptoms that indicate a change in day-to-day functioning (i.e. problems sleeping, eating, concentrating, etc).
- For this study, no exclusions were made for major depressive episodes caused by illness, bereavement, or substance abuse.
In this article, we'll briefly go over the science of clinical depression, and then we'll talk about the endocannabinoid system's role in regulating our mood, as well as how to use cannabis to treat major depressive disorders.
Clinical depression is not a uniform disease. While the feelings and symptoms of depression are somewhat standard, the causes for depression are numerous. Before getting into using CBD to treat depression, let's make sure we've got a grasp on the disease, it's origins, and the most common symptoms.mThis will make it so that our discussion later is more useful and complete.
Types of Major Depressive Disorders
Clinical depression might be prevalent, but it's still a serious mood disorder that needs careful and thoughtful treatment. The symptoms of depression make you feel like you're living in a different world, where daily activities become complex ordeals to be wrestled (usually with little success).
If you feel like you're in this type of fog, you might be clinically depressed. Depression usually begins in early adulthood, but it can strike at any time if encountering a triggering event. Here's a list of the major types of depression you can possibly use CBD to treat.
- Major depressive disorder: this is clinical depression not arising from a triggering event, and reoccurs throughout the patients lifetime.
- Persistent depressive disorder (dysthymia): this type of depression is characterized by a depressed mood lasting more than two years. Some time periods may be less severe than others, but the main characteristic of dysthymia is a persistent depressed mood for years.
- Postpartum depression: this is a serious, full-blown major depressive disorder developing during or right after giving birth. Many women experience mild feelings of depression and anxiety after giving birth, but those usually clear up in a few weeks. Women with postpartum depression have to contend with symptoms so severe, it interferes with daily care activities for themselves and/or the newborn baby.
- Seasonal affective disorder: a type of depression triggered during the winter months, when there's less sunlight. Usually symptoms clear up during the spring and summer months. This depressive disorder is characterized by social withdrawal, increased time sleeping, weight gain, and the cyclical nature of symptoms coinciding with changes in the seasons.
- Psychotic depression: characterized by depression accompanied by some form of psychosis.
- Bipolar Depression: a type of depression that comes with Bipolar Disorder; a mood disorder that is defined by alternating states of mania and depression.
Other types of depression include Premenstrual Dysphoric Disorder (severe depression that shows up during the second part of a woman's menstrual cycle), and situational depression (caused by a life-changing event like a death).
The rest of this article is applicable to any of the major depressive disorders listed above. It will not be applicable to situational depression, unless the depression develops into a full-blown case of clinical depression.
Causes of Depression
As with most mental disorders, it's not known exactly what causes depression but we do know there are a variety of factors and risk factors involved in developing a major depressive disorder. These include:
- Genetic biological characteristics: it appears that individuals with clinical depression have physical changes in their brains. Additionally, depression seems to be genetic.
- Brain chemistry imbalances: the disruption of the neurotransmitters serotonin and dopamine play a role in developing depression.
- Hormonal fluctuations: changes in hormones in the body may trigger depression (this is a theory behind postpartum depression).
No matter the cause, depression is a serious disease that should be treated with the gravity it deserves. As we will discuss next, depression is more than feeling sad. It's more than being glum. It's a condition that severely interferes with your life, and needs to be taken very seriously.
Now let's talk about the most common symptoms of depression.
Symptoms of a Major Depressive Disorder
Clinical depression presents in many different ways depending the cause, how old you are, and other lifestyle factors. First I'm going to list out the symptoms that are defined by medical professionals. Then I'm going to take you through a layman's description of what depression feels like to them, as these words are not close to adequate:
Symptoms of clinical depression include (source):
All of these symptoms are accurate, and, taken together, can fully describe a depressive situation. With that said, it's inadequate to simply use adjectives to describe a state of depression. So we asked someone who has dealt with depression for years, and this is what she said:
Depression feels like nothing. It feels like there is nothing. Nothing worth anything. Nothing worth being emotional about. Sadness is a quaint term for the feeling of emptiness I feel. Movies make you sad. Criticism makes you sad. Depression makes it so that nothing matters. There's no getting sad over movies, because there's nothing worth feeling anything over.
The Research: Clinical Depression, Cannabinoids & The Endocannabinoid System
Although not weighed heavily by the medical community, as many as one-third of patients who use medical cannabis say they use it for depression. Patients who cite anxiety, stress, or insomnia as primary reasons for using medical cannabis also cite depression as a secondary reason (study).
The neural network of the endocannabinoid system works similarly to the way that serotonin, dopamine, and other systems do, and, according to some research, cannabinoids have an effect on serotonin levels in the brain (i.e. increasing serotonergic and noradrenergic signaling, dampening the hypothalamic-pituitary-adrenal axis, and increasing neurogenesis and cellular resilience in the hippocampus (study).
In 2009 researchers concluded that there was substantial evidence pointing to endocannabinoid signaling as a target for the pharmacotherapy of depression (study).
Another study found that CBD could represent a novel fast antidepressant drug, via enhancing both serotonergic and glutamate cortical signaling through a 5-HTIA receptor-dependent mechanism (study).
Given the plethora of studies available that show that the cannabinoids THC and CBD can be effective at treating depression, patients and their doctors should seriously consider this natural alternative before beginning pharmaceuticals.
How Cannabis Hemp/CBD Compares to Modern Medicine
Now we will talk about the current treatments used to for clinical depression. We want to make sure that you have all of the options before making your choice, including all possible side effects.
While there are many receptors and neurotransmitters involved in neurochemical deficits leading to depression, ultimately all antidepressants work by enhancing the transmission of 5-HT in the hippocampus (primarily). There are various mechanisms to achieve this goal, and that's how antidepressant medications are segmented into the types we are about to go over below.
Medications used to treat depression are called antidepressants. When effective, they improve the way your brain uses chemicals that modulate mood and stress. It's likely that you'll have to try more than one antidepressant before you find the one that works for you (source). This is not ideal given that antidepressants usually take a few weeks to work, or for patients to feel the effects. That means testing a medication sometimes for up to a year before discontinuing the medication.
There are several classes of antidepressants:
SNRIs (serotonin and noradrenaline reuptake inhibitors) and SSRIs (selective serotonin reuptake inhibitors): These are the most common types of antidepressants out there. SNRIs raise the levels of serotonin and norepinephrine in the brain, while SSRI's block the absorption of serotonin in the brain. Examples include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil) and sertraline (Zoloft). Side effects include:
Possible adverse reactions include (source):
TCAs (Tricyclic antidepressants) are named from their chemical structure and are used to treat anxiety as well as depression. They are also known to help treat fibromyalgia and chronic pain. Examples include amitriptyline (Elavil), amoxapine- clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil) and trimipramine (Surmontil).
Side effects of TCAs (source):
MAOIs (monoamine oxidase inhibitors): These antidepressants inhibit monoamine oxidase, a brain enzyme that helps to break down neurotransmitters like serotonin. They are usually the last resort, as they are known to interact with other medications and some foods (source). Examples of MAOIs include phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan) and selegiline (EMSAM, Eldepryl).
Common side effects of MAOIs (source):
NASSAs (noradrenaline and specific serotoninergic antidepressants): these antidepressants are used to treat depression and anxiety disorders (and some personality disorder). Examples include Mianserin (Tolvon) and Mirtazapine (Remeron, Avanza, Zispin).
Possible side effects include (source):
There are herbal supplements that are currently in use, but they are not approved by the larger medical community.
Several types of 'talk therapy' or counseling can help individuals cope with depression. These include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy.
Other Current Treatments
Brain Stimulation Therapy (source)
If medications and psychotherapy do not reduce the symptoms of depression, some sort of brain stimulation therapy such as electroconvulsive therapy (ECT) may be an option to explore.
ECT is a painless procedure that's often performed on an outpatient basis. The treatment consists of a series of sessions, typically three times a week, for two to four weeks.
Adverse side effects of ECT include confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course.
Other brain stimulation therapies used to treat medicine-resistant depression are repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS).
The Verdict on Using CBD for Depression
Depression is a serious medical condition and should not be taken lightly. Ironically, using antidepressants have been known to lead to an increase in suicidal thoughts, especially in young people under 25. This is alarming considering that an estimated 15% of clinically depressed people will succeed in committing suicide. Additionally, as we've seen, antidepressants have a number of adverse side effects, some of them serious.
So do you try CBD for your depression, or do you stick to your antidepressants? The answer to this question depends.
If you're taking antidepressants with minimal adverse side effects, and the medication is successful in managing your symptoms, we recommend simply supplementing with CBD. Withdrawal symptoms from sudden cessation of antidepressants can be deadly, and depression is so complex and all-consuming that we're wary of advising you to stop an effective treatment, even if it is a semi-dangerous pharmaceutical.
However, if your depression remains resistant to medication, or if you experience intolerable side effects, we highly recommend giving CBD a shot. As we've gone over, cannabinoids have shown great promise in treating major depressive disorders. People have been self-medicating for years, and clinical trials have demonstrated the potential of cannabinoids as a potent anti-depressant. If you do decide to try to replace your antidepressant medication with CBD, please do so with a doctor so you can titrate your dose down and avoid any dangerous withdrawal symptoms.
Now that we've given some guidance on deciding if you should try CBD for your depression, let's talk about how to go about doing that safely, effectively, and for as little money as possible.
Tips For Treating Major Depressive Disorders With Cannabis
So, we know cannabis can be effective at treating depression. This next section goes over how to begin taking cannabis for your clinical depression.
We'll go over the strains you should consider, as well as concentrations of other compounds in the plant with therapeutic potential. We'll cover the best delivery methods when using cannabis for your depression, and then we'll talk about dosing CBD for depression.
Then, after all of this, we will provide specific product recommendations formulated to elevate mood, or shown anecdotally to be successful in treating clinical depression (based on patient testimonials).
Strains, Terpenoids, & Cannabinoids For Depression
As we know, all cannabis varieties have a unique cannabinoid and terpenoid profile (if you don't know that, visit the cannabis hemp education section of The Universal Plant). Each strain of cannabis has either evolved, or been bred, to present certain traits that translate to therapeutic benefits.
First let's talk about specific cannabinoids that have been tested and shown to be at least somewhat effective in treating depression. In terms of phytocannabinoids (originating from the plant and not synthetic), Delta-9-THC, Delta-8-THC, CBG, CBN, CBC, and CBD have been tested for treatment of depression, all with some level of success (study, study, study). When choosing your medicine, see if there are levels of other cannabinoids besides THC and CBD.
According to research, cannabis/hemp strains that are more likely to be successful at treating depression include Tangerine Dream, Bubba Kush, Valentine X, Electra 4 and Zeta. These strains are successful because they are energizing and/or because they have high concentrations of limonene, which is a terpenoid proven to be a mood elevator (study).
Best Delivery Methods For Depression Patients
For depression, you'll want to go with either the oral or inhalation delivery method. Orally administered medicine has the option of sublingual tincture delivery, or edible ingestion delivery.
In the end, you'll probably end up using a combination of both, depending on severity of symptoms, time of the day, and other individual preferences.
CBD Dosage For Depression
Dosage is critically important when treating depression. Whereas low doses of THC increase serotonin, high doses cause a decrease in serotonin that could make depression worse (source).
Start with a dose of 2.5 mg of THC and/or 5 mg of CBD, and increase the dose by 20% every few days. A CBD:THC ratio of 10:1 or higher will mitigate THC's psychoactive effects in doses of 5 mg in the morning and mid-afternoon. Because CBD can promote wakefulness, it's not recommended that you take it after 5PM. If you're having trouble sleeping, up to 10mg of THC an hour before bedtime can help.
For inhalation therapies, a matchstick-head-sized piece of cannabis flowers has about 2.5 mg of cannabinoids in it. Cartridges are a bit harder to dose, but, depending on the cannabinoid concentration, you can calculate the amount of cannabinoids in one inhalation by dividing the number of pulls contained in the cartridge (usually listed) by the advertised number of cannabinoids in the cartridge.
Medical professionals report that patients sometimes need up to 50 mg a day of cannabinoids to see the desired effect, however, do not shoot up to this dosage right away. No permanent damage will happen to your body, but you'll be in for a very unpleasant experience for a few hours.
Next I'll go over three CBD products formulated to address depressive episodes.
Recommended Hemp/CBD Products for Depression
The products listed below aren't the only medications that can be effective in treating depression. They were selected specifically for their formulation and ingredients shown to treat depression.
For a larger selection of products, see our recommended products page.
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