‘There’s a real risk there’: Cannabis use exacerbates depression

April 30, 2022

2 minute read

Source/Disclosures

Source:

Franson K. Cannabis: Harmful or Curative? Presented at: ACP Internal Medicine Meeting; April 28-30, 2022; Chicago.

Disclosures:
Franson claims to be a consultant for Teva Pharmaceuticals.


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CHICAGO — Cannabis has been approved by state legislators across the United States for more than 50 medical indications, according to a speaker at the CPA’s internal medicine meeting.

Kari L Franson, PharmD, PhD, BCPP, a professor of clinical pharmacy at the University of Southern California, said these indications include Alzheimer’s disease (n=15 states), epilepsy/seizures (n=31 states), nausea ( n = 20 states), amyotrophic lateral sclerosis (n = 22 states), pain (n = 30 states), autism (n = 14 states), Parkinson’s disease (n = 15 states), cachexia (n = 24 states) , hepatitis C (n = 11 states), peripheral neuropathy (n = 11 states), cancer (n = 30 states), HIV/AIDS (n = 31 states), PTSD (n = 30 states), Crohn’s disease (n = 20 states), multiple sclerosis (n = 22 states), Tourette syndrome (n = 7 states) and glaucoma (n = 27 states).

Cannabis has been approved by state legislators across the United States for more than 50 medical indications, according to a speaker at the CPA’s internal medicine meeting. Source: Adobe Stock.

“I’ll tell you right now, [cannabis] doesn’t work for glaucoma,” Franson said during the presentation. “Isn’t it funny that 27 states have it as something it’s legal for? So it’s not evidence-based. It’s based on compassion.

Essentially, Franson said she only considered recommending medical cannabis when patients asked for it. Of all the indications, only pediatric seizures, MS and pain have “reasonable evidence” to suggest cannabis is beneficial, she added.

“The evidence for the use of THC-type cannabis for pain is quite good,” Franson said.

Short-term effects associated with THC-type cannabis include dizziness, disorientation, euphoria, dry mouth, drowsiness, nausea/vomiting, fatigue, depression, and anxiety. Less is known about the long-term effects, Franson said. But evidence suggests it can cause cannabinoid hyperemesis syndrome, stroke, acute myocardial infarction, impaired cognitive functioning, and psychiatric effects such as insomnia, anxiety, cannabis use, psychosis and depression.

Although recent research has shown that cannabis can reduce depression in the short term, symptoms seem to worsen over time. This has been demonstrated in a naturalistic study conducted in Canada. Most patients (89%) who reported feeling stressed, anxious, or depressed had a 50% reduction in depression after 20 minutes of cannabis use, and 94% had a 58% reduction in anxiety, according to Frankson. However, the basic symptoms of depression gradually worsened.

“That’s the thing I would really like to see imprinted in your brain when you all get out of here,” Franson told attendees. “I see a lot of patients who use cannabis chronically and really struggle with depression. I can’t tell you enough how difficult it is to talk to a patient about their symptoms of depression when they’re using cannabis and they’re convinced how much better it makes them feel.

The risk of depression — and other poor outcomes — is particularly evident in adolescents, Franson said.

A previous meta-analysis of 11 longitudinal and prospective studies showed that adolescents who used cannabis were more likely than non-users to attempt suicide (OR = 3.46; 95% CI, 1.53-7 .84), having suicidal thoughts (OR = 1.5; 95% CI, 1.11-2.03), and developing depression (OR = 1.37; 95% CI, 1.16 -1.62) or anxiety (OR = 1.18; 95% CI, 0.84-1.67).

“There’s a real risk there,” Franson said.

References:

Cuttler C, et al. J Affect Mess. 2018; doi:10.1016/j.jad.2018.04.054.

Franson K. Cannabis: Harmful or Curative? Presented at: ACP Internal Medicine Meeting; April 28-30, 2022; Chicago.

Gobbi G, et al. JAMA Psychealth. 2019; doi:10.1001/jamapsychiatry.2018.4500.

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