Is cannabis more effective at improving mood than antidepressants?

Data from Project Twenty21 (T21) shows that cannabis may be more effective at improving mood than some antidepressants, in patients experiencing major depression.

Preliminary findings from the observational study show that prescribed cannabis can help improve mood and alleviate depression.

Although cannabis is not widely prescribed for depression, depressed mood is a common comorbidity among many of those living with chronic health conditions. 

A questionnaire called PHQ-9, which is commonly used to measure depression, was sent out to 1,777 patients who are enrolled in the study. 

Among 628 people, who completed the questionnaire at both baseline and a three-month follow up, the average score had decreased by around 40 per cent.

According to T21, this is better than the reported effects of antidepressants on major depression  – an effect size of 0.83 (95 per cent) compared to an estimated typical effect size of 0.30-0.40 for antidepressants.

Prof Michael Lynskey, head of data at T21, confirmed to Cannabis Health: “These results are consistent with findings that cannabis-based medicines can reduce a range of symptoms and improve quality of life.”

He added: “We look forward to building on these findings in 2022 as we grow our patient numbers and expand on the conditions covered by the project.”

New NICE guidelines

The findings come as NICE has published the first new draft guidelines on the prescribing of antidepressants for more than a decade. 

According to the new recommendations, patients experiencing less severe depression should be offered alternative options, including therapy, exercise, mindfulness or meditation before prescription drugs. The guidance is subject to consultation in January 2022.

Cannabis has previously been linked to the onset of mental health issues, including depression, however, evidence now points to the reverse causal effect – that it is actually the depression itself, which leads to increased cannabis use, as patients are more likely to turn to it for symptom management. 

While research on cannabis as an antidepressant is in the early stages, a paper published this year found that there is preclinical evidence that “alteration in the endocannabinoid system could potentially benefit patients suffering from depression.” To add to this, the same researchers found little to support the notion that selective serotonin reuptake inhibitors (SSRIs) are “effective in decreasing depressive symptoms.”

At least in the short term, the “vast majority” of patients consuming cannabis are thought to experience antidepressant effects, according to a study published last year, which examined the responses of 1,819 people who completed almost 6,000 cannabis self-administration sessions using the ReleafApp symptom track in the US. On average, 96 per cent of users experienced symptom relief following consumption.

Nemo, a medical cannabis patient and participant of T21 who has diagnosed mental health conditions and experiences mood instability, says cannabis has proven more effective for her than prescription medication.

“Cannabis is the only thing that has ever been able to help me when the emotions are overwhelming,” she tells Cannabis Health.

“It keeps me safe and when I’m feeling overwhelmed or angry, it’s the only thing that calms me down enough to be able to think rationally.”

“It’s not always a miracle for everyone, but it is for me, it’s life-changing. I’ve been to every kind of therapy, I’ve tried mindfulness, meditation, yoga, the Headspace app – it doesn’t work for me. Cannabis is the only thing that is able to stop my mind racing.

“Whilst I’m still aware of multiple thoughts going on, and the sad feelings, I feel more able to manage them.”

Cannabis and mindfulness

Bob Kennedy, the co-founder of the Chi-Ki foundation, which facilitates the use of cannabis alongside mindfulness to help manage mental health issues, is in agreement. 

“For me the predominant advantage of cannabis is that it allows you mindful practice, whereas prescription drugs leave your mind fogged,” he says.

“If I get pressured and overloaded, I medicate and it instantly grounds me. I’m in a much more relaxed state of mind and am able to make a choice, rather than just reacting. 

“The bulk of our work is that cannabis is absolutely key to the physical balancing of the body, but it does require a degree of mindfulness.”

Bob was diagnosed with depression 15 years ago and was prescribed antidepressants, which he says left him suicidal.

“I had a short but really not pleasant experience with prescription antidepressants. I went from being very depressed to suicidal, and I flushed them down the toilet after a week,” he says.

He has used cannabis to self-manage his health since, including his symptoms of PTSD and chronic pain, after being hit by a car in 2012.

“Since my accident I’ve had fast amounts of prescription painkillers. I went cold turkey and have now been three years opiate free,” he said.

“Cannabis gives me an opportunity to self-examine why my mood is lowering. I could not learn or grow when I was on the prescription stuff. It wipes your mind.”

For Bob, having a legal prescription, which he has been able to access through T21, has also had a profoundly positive effect on his mental health.

“The most significant thing for my mood has been accessing a legal prescription, because I’m no longer a criminal, I’m no longer just seen as a druggie, I have a valid point now,” he adds. 

“That ability to be able to consume cannabis openly, as though it is no different than taking co-codamol, has probably been the greatest lift to me.”

Hope for the future

Nemo is still taking the SSRI fluoxetine – although she doesn’t believe it is working for her – but she has been able to come off strong mental health medications, including the antipsychotic aripiprazole, which she was on for eight years, experiencing severe side effects.

“I don’t believe I should have ever been put on it because I haven’t suffered from psychosis,” she says.

“For the past eight years, I’ve been emotionally numb to the world. While it works, in terms of alleviating some of the symptoms, such as my manic depressive episodes, it was also making me a zombie. I felt like I was existing rather than living.”

Nemo is open with her GP and her daughter’s health visitor about her prescription, both of whom she says are supportive.

“I truly believe if it wasn’t for having cannabis, I possibly wouldn’t be alive,” she adds.

“For me it is just as important to me as any of my other medications.”

Although it’s still relatively early days in terms of data collection in this area, experts say the findings indicate the potential for cannabis to be used as a first line treatment for those experiencing depression in the future. 

Head of Project Twenty21, Mags Houston, commented: “It’s exciting that already we’re able to draw these comparisons with commonly prescribed medications like antidepressants. It gives us hope that medical cannabis might become a first line treatment in the future and help people avoid having to take multiple psychiatric medications that can come with more side effects than we see through medical cannabis prescriptions.”

Find out more about Project Twenty21 here