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
Mental health, addiction and medical cannabis – an expert’s insight
We sit down with the recently-appointed medical director of The Medical Cannabis Clinics, Dr Luisa Searle.
The recently-appointed medical director of The Medical Cannabis Clinics, Dr Luisa Searle, shares how her background in psychiatry and addiction is feeding into her new role.
Dr Luisa Searle has been treating patients with addiction disorders for the last six years, seeing patients struggling with substance misuse and establishing outreach services for young people and the homeless across London.
Now, she is helping people legally access cannabis, a substance that has historically been demonised as a ‘gateway drug’.
Feeling burnt out and craving a fresh new challenge, Dr Searle was looking for a change in her career when she crossed paths with The Medical Cannabis Clinics, joining the team as medical director in April this year.
“It frustrates me, this division that there seems to be in mental health, whereby if you’ve got a substance misuse issue, you’re not worthy of mental health treatment,” Dr Searle told Cannabis Health.
“But actually, your mental health is often being self-medicated by substances and whether you agree with that or not, that’s how some people cope.”
Prior to joining TMCC, Dr Searle was unaware that medical cannabis was beginning to be prescribed more widely.
She was coming into the industry with a fresh perspective, and despite her background in addiction medicine, she said she had very little prejudice against cannabis.
“It didn’t make sense to me to not explore it,” Dr Searle said.
Dr Luisa Searle, medical director at The Medical Cannabis Clinics
A balanced approach
“I’m not here to say it’s a wonder drug. I’m not here to say it doesn’t have its risks or side effects. It’s by no means suitable for everybody, but this idea that it’s a substance of abuse and not even [worth] researching as a potential medicine I think is, unfortunately, based in historical racism and hysteria, which has no place in science as far as I’m concerned.”
But while she was intrigued by this new and emerging field of medicine, due to her past experience, she was determined to take a “balanced approach” to prescribing.
For Dr Searle, it is imperative that cannabis is seen for what it is. While it has immense potential for managing hard-to-treat conditions and a possible alternative to physically addictive opioids, it is still a substance that can cause dependence.
“Any substance, legal or illegal, with some psychoactive effect has the potential for abuse, but that’s where I come in as the doctor,” Dr Searle said.
“If I felt that you needed diazepam, that prescription is entirely under my control. It is down to me to work with patients to try to prevent [dependency] from happening and to advise and educate them, so that they can make informed decisions about their care.”
Dr Searle is only three months into her role at TMCC but she is already seeing the positive impact that medical cannabis is having on patients.
People with difficult-to-treat conditions like insomnia and anxiety are seeing improvements in their lives after trying numerous conventional treatments that failed to help.
Meanwhile, patients who have previously relied on pharmaceuticals like antidepressants and SSRIs – which can come with severe side effects – were able to “feel themselves” again after reducing their dose of traditional medication in favour of medical cannabis.
“What’s really been nice is seeing success with people who have tried lots of different conventional treatments and haven’t really gotten anywhere,” Dr Searle said.
“I was talking to a gentleman who had a traumatic brain injury and was getting migraines on a regular basis. He had really struggled with his work and his life. With a small amount of medicinal cannabis flower, he feels much more himself.
“That’s the really nice thing [about] working in this clinic; just seeing that turnaround in people who’ve been quite stuck.”
Having worked for the NHS for 15 years, Dr Searle is a firm believer in everyone having access to the healthcare they need.
Right now, this does not apply to the medical cannabis space. Very few people have been able to access an NHS prescription while private prescriptions can cost hundreds per month.
“It is a little bit challenging for me that I have to be in a private clinic in order to provide medical cannabis treatment,” Dr Searle said.
“While TMCC has extremely reasonable prices in comparison to other types of private health care, it is still a cost and if you’re on a low income it might as well be a million pounds.”
Dr Searle wants to see medical cannabis being more widely prescribed, but it has to be “sensible” with regulations around who can prescribe and how.
She continued: “Why shouldn’t it be available on the NHS in the right circumstances? What I don’t want to see is what can potentially happen with opioids – with people becoming dependent on them.
“It’s not a medication for all. There are concerns, particularly among younger people. We’re still not 100 per cent clear as to the risks around potentially life-changing mental health issues and specifically psychosis.”
Importance of eduction
Dr Searle has not encountered huge numbers of cases where recreational users have later developed psychosis, but she has seen enough for it to be a concern.
“It’s not something that I could just dismiss,” she said.
“When we have young people coming to us, it’s all about education. It’s just like any medication, if you start on antidepressants, you don’t start with a high dose, you start on a low dose and build it up. You check the tolerance and you review the patient regularly to see if there have been any improvements or side effects.”
Dr Searle also points out that studies into psychosis and cannabis use have examined street cannabis rather than medical-grade products prescribed by clinics like TMCC.
“Street cannabis potentially has incredibly high levels of THC and very low levels of CBD,” she said
The benefits for some patients speak for themselves, but Dr Searle stresses the fact that a medical cannabis prescription is not right for everyone.
“Whilst I think [medical cannabis] is great and we get lots of positive feedback, we do have some adverse reactions to it where it’s not suitable,” she said.
“People shouldn’t be lulled into a false sense of security that just because your doctor prescribed it and it’s legal for medicinal use it’s not without its risks.”
Dr Searle sees a lot of potential in cannabis as an alternative drug for chronic mental health disorders and pain, even as a possible method for weaning patients off opioids. But she warns that people who are prone to addiction may end up transferring their dependency from one substance to another.
“If you break your leg, opioids are fantastic for that, but what they’re not so good for is chronic pain,” she said.
“The withdrawal process from them can be horrendous and there could be a place for cannabis to alleviate some of those withdrawal symptoms.”
But, she added: “I think I would be much more cautious about that, simply because until you’ve dealt with and understood your addiction and those behaviours and those are resolved and you’ve engaged with other ways to cope with your emotional stresses, you may just be switching one addiction for another.”
Cantourage Clinic now offers discounts to Armed Forces community
Cantourage Clinic, is hoping to improve access to cannabinoid therapies for members of the Armed Forces community, after committing to the Armed Forces Covenant.
The CQC-registered clinic, which launched in the UK this year, is now offering a permanent 10 per cent discount on consultations for veterans and their direct family members.
This is in addition to making donations to the veteran’s mental health charity, Combat Stress, following its recent commitment to the Armed Forces Covenant.
The Armed Forces Covenant is a government-run obligation pledging support to those who have served in the UK Armed Forces.
In honour of Armed Forces Day on the 25 June, Cantourage Clinic has also now reduced the cost of initial consultations for all patients from £99 to £49 for the month of June. Members of the Armed Forces community will receive a further 10 per cent discount off this price.
A donation of £1 from each consultation will be made to COMBAT STRESS – a UK charity dedicated to helping servicemen and women in dealing with post-traumatic stress disorder, and other mental health conditions.
Shortage of mental health staff within the NHS and military is an ongoing issue.
Reports from a study conducted by the Royal College of Psychiatry and published in the BMJ last year, highlighted that England has just one consultant psychiatrist for every 12,600 people.
With at least 1.5 million people waiting for mental health treatment, sufferers are being forced to contact emergency services or crisis services whilst they await treatment, with one in 10 ending up at an emergency department.
According to data presented by the British Journal of Psychiatry (2018), the prevalence of post-traumatic stress disorder (PTSD) among veterans (7.4 per cent) is almost double that of the UK public (4 per cent) – and even higher among veterans who served in Afghanistan or Iraq.
Effective mental health services and treatment options is, therefore, an important consideration in the support of veterans and those close to them.
PTSD often has a long-lasting and debilitating effect on the affected individual and a wider impact on those close to them.
It often co-occurs with other mental health concerns, including anxiety, depression and insomnia. A growing body of evidence supports the potential of medical cannabis in the treatment of PTSD and co-occurring conditions.
Recent data shows that cannabis use is on the rise among veterans diagnosed or experiencing symptoms of PTSD.
A recent study found that participants with a diagnosis of PTSD who used cannabis were 2.57 times less likely to no longer meet the criteria for PTSD at the end of the one-year study period.
In another study, participants with PTSD reported improvements in sleep quality among other therapeutic effects of cannabis use.
Cantourage hopes its 10 per cent discount on initial and follow-up consultations to all veterans and their direct families will help to improve the accessibility of treatment to those affected by PTSD and related conditions.
Lead psychiatrist Dr Anup Mathew said: “I’m extremely proud be part of an organisation such as Cantourage Clinic which acknowledges and understands that those who serve or who have served in the Armed Forces, along with their families, should be treated with fairness and respect in the society they serve with their lives.
“Especially in view of recent and on-going conflicts, we should never forget the sacrifices the Armed Forces community have made and continue to make for all of us.”
Gabriel Newman, CEO at Cantourage Clinic, said: “We are delighted to show our support to the brave community of veterans. All over North America, there are programmes in place to equip military servicemen and women with improved access to cannabis.
“The benefits of substituting Opioids or Benzodiazepines for medical cannabis have been widely reported, studies have shown that patients experienced ‘fewer adverse side effects’ and ‘better symptom management’ in comparison to opiate-based drugs.
“Cantourage Clinic is the UK’s first medical cannabis clinic to directly support the Armed Forces Covenant. We are proud to be leading the way in providing education and support to help improve the quality-of-life for military veterans in the UK.”
US study to explore best CBD/THC ratio for anxiety
To date not much is known about the specific ratio of cannabinoids that works best to alleviate symptoms.
A new study aims to shed light on the best ratio of CBD and THC to treat anxiety symptoms.
A new study – led by Florida Gulf Coast University (FGCU), the Releaf App, which allows patients to track their symptoms and usage and CannaMD, a network of medical cannabis prescribers – aims to explore the subject.
Researchers plan to recruit up to 1,000 medical cannabis patients to track patient-reported experiences while consuming medical cannabis purchased at dispensary locations across the state of Florida.
Eligible study participants will use MoreBetter technologies to answer standardised anxiety-related questions via a smartphone for a 45-day period to track details of their cannabis use and associated outcomes related to symptom relief and side effects.
MoreBetter technologies are widely used by researchers, healthcare professionals, and cannabis product manufacturers to collect data on the performance of cannabis and CBD products, as reported by cannabis patients and consumers.
“Given the increased anxiety and stress that has been reported over the past few years, this is a timely study,” says Tyler Dautrich, COO of MoreBetter Ltd, the company behind Releaf App.
“Working with groups like FGCU and CannaMD enables us to collect localised real-world data outcomes, which will ultimately help improve the experience for registered cannabis patients in Florida.”
Representing one of Florida’s largest networks of medical cannabis physicians, CannaMD’s chief medical researcher, Jessica Walters, agrees: “Identifying specific CBD/THC ratios that work best for anxiety is a critical area of study with immediate real-world applications for a large percentage of the patients we see every day.”
As Dr Martha Rosenthal explains: “Approximately one-third of Americans will suffer from a significant anxiety disorder at some point in their lives, and many turn to medical cannabis to alleviate their symptoms.
“This study will expand our knowledge on the effects of medical cannabis on symptoms of anxiety, patient patterns of use, and the correlation of medical cannabis with other anxiolytic drugs and practices.”
This study marks the first in an ongoing collaboration between FGCU, MoreBetter, and CannaMD to advance medical cannabis research in the state of Florida and contribute to evidence-based literature regarding the use and efficacy of cannabis products statewide.
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