The doctor’s perspective: treating depression, anxiety and insomnia with cannabis

In his latest article, consultant psychiatrist and cannabis clinician, Dr Tahzid Ahsan, explores the potential of cannabis in the treatment of depression, insomnia and anxiety. 

Almost 80% of people I see in my medical cannabis clinic suffer from a combination of depression, insomnia or anxiety. 

According to the 2010 Global Burden of Disease Study, the most predominant mental health problems worldwide were depression and anxiety. The workplace health report in 2022 highlighted an estimated 109 million workdays were lost in the UK due to sickness caused by depression and anxiety, equating to a cost of £9 billion a year to companies. 

People who suffer from depression usually experience low mood for over a minimum period of two weeks, with accompanying low motivation and low energy, lack of enjoyment in normally enjoyable activities, insomnia and possibly self-harm or suicide depending upon severity. 

Anxiety can manifest in many different forms, from an underlying baseline of anxiety such as Generalised Anxiety Disorder (GAD) to panic attacks. Patients can experience their heart racing, sweats and even dizziness when experiencing an extreme anxiety attack. Most experience a sense of underlying trepidation that worsens when facing stressful situations. Conditions such as Obsessive Compulsive Disorder (OCD) and other neurotic disorders are characterised by debilitating anxiety affecting someone’s ability to function on a daily basis.

Many of the patients that present to my clinic have gone through a whole host of failed treatments such as antidepressants and talking therapies, and are then left to their own devices by their GP having exhausted all treatment options recommended by NICE.

There is good evidence that medical cannabis helps with anxiety, with moderate evidence for depression and insomnia, offering patients a chance for relief from what can be a paralysing condition. 

A case study for cannabis in anxiety and depression 

I will now reflect upon a typical case history that can present in most psychiatrists medical cannabis clinics patient lists. 

I reviewed a 27-year-old male in my clinic with a diagnosis of depression, insomnia and GAD beginning in his teenage years. We shall call him Peter. 

Peter has a caring partner who supports him as he had lost his job during the pandemic and struggled to gain employment since. 

He quite often presents with periods of low mood and lack of motivation and energy, not being able to enjoy his normal activities. His Irritable Bowel Syndrome (IBS) and migraine symptoms also seem to be exacerbated when he is experiencing low mood and anxious periods. He tends to sleep less due to worries about his future with a generalised feeling of worsening anxiety in the background.

Peter has been on different antidepressants in the past such as Fluoxetine and Mirtazapine and completed a course of Cognitive Behavioural Therapy (CBT). He was on Sertraline 150mg when I reviewed him in my clinic. He had been self-medicating with cannabis for many years, however due to financial constraints and worsening anxiety when leaving the house, he has struggled to purchase cannabis and that had subsequently worsened his anxiety and sleep-related symptoms. 

The above story is a typical one that presents itself in many guises in my clinic. Approximately 60-70 % of the patients have a diagnosis of depression, anxiety or insomnia. 

During our initial consultation, Peter decided to start on a daytime oil to help alleviate his anxiety and lift his mood. As he was not cannabis naïve, we went for a balanced oil, with a higher CBD ratio. The oil contained 10mg/ml THC vs 15mg/ml CBD. He was asked to take 0.1ml at a time, placed under his tongue for a few minutes and then to swallow. The oil can take between 10 minutes to one hour to take effect depending on the dose taken. He was to build up to 1ml per day maximum dose if he needed to. 

At his one month follow up he reported that he found the oil partially beneficial. He struggled to figure out when to take the oil and found that the impact varied between 15 -90 minutes. Peter had increased the oil to 0.2ml four times a day which had alleviated his anxiety to an extent that he was able to go to his local shops with his partner.

His IBS symptoms markedly improved due to the CBD affecting the PNS [parasympathetic nervous system] in the gut. He found the use of the oil as too pernickety due to the varied nature of its onset of effect. He was used to using cannabis flower, and hence wanted to trial a flower during the day and an indica to help him sleep at night. 

Peter explored a balanced flower of THC 10%:CBD 10% for the day, with a hybrid balance of indica (50%) and sativa (50%). He was to use 0.1-0.2g at a time as required, up to 1g daily. I then added an indica flower as an adjunct at night to help him sleep. The indica flower contained THC 20% : CBD 4%, to use between 0.2-0.5g at night before bed. He was to use a dry herb vape for both flowers, starting at 170 ℃ , increasing by 5℃ every few inhalations until reaching 195℃, this is in order to utilise all the terpenes that have different boiling points. 

He was immensely relieved that he did not have to source cannabis from the street, which was a main cause of his generalised anxiety. Many patients experience a palpable sense of liberation from the guilt of sourcing cannabis illegally.  

During his three month follow up he reported a huge improvement in the reduction of his anxiety. He suffered no more panic attacks, he had been able to go out more and socialise. His sleep had improved from four to five broken hours of sleep to a solid seven or eight hours. He reported he hadn’t slept this well for over 10 years. His partner was very pleased by his progress. His mood was more stable. The frequency of his migraines had also reduced.

Peter decided to carry on with the balanced flower and high-THC flower for sleep until his next review, while we slowly started to reduce his Sertraline by 50mg a month. 

A new lease of life – the impact of medical cannabis 

When we met again at his six month follow up, Peter found his anxiety was very well managed, noting no withdrawal effects from the reduction of his Sertraline due to the medical cannabis. He was so pleased that he was finally off the Sertraline. With the support of his partner, he was able to start a part time voluntary role at a local charity shop. 

Peter’s confidence had now returned to how he was before the pandemic. He felt like a revitalised person with a new lease of life. His partner and his family were amazed how medical cannabis had changed his life in such a profound way. His sleep was still excellent and he noted no tolerance or side effects. However, he still struggled with low motivation and low energy in the mornings, despite the fact that he used to be quite energetic in the mornings, heading to the gym before work.

I decided to prescribe a small amount of a more potent energy-giving 90% sativa with containing THC 18% : CBD 1% called Delahaze, to use only 0.1-0.2g early morning only. He would continue with the balanced flower for the day and an indica at night for sleep. 

During his nine and 12 month reviews, Peter reported that he was so pleased that he had finally stopped the Sertraline. I recall him saying: ‘I can experience the full range of life again.’ 

The high-THC Delahaze gave him ample energy in the mornings for the gym and work and he found he was using a small amount of the balanced flower later in the afternoon. The amount he was using overall had reduced, as he had found a perfect synergy of using the smallest amount whilst maintaining optimum effectiveness and keeping tolerance at bay.

Look out for our final article in the series, in which we will be discussing how ADHD and autism can be successfully managed with medical cannabis.  

Dr Tahzid Ahsan

Dr Tahzid Ahsan is a consultant psychiatrist and prescribing cannabis doctor. Dr Ahsan is looking for volunteer cannabis users to be interviewed for a new book about the effects of medical cannabis from the patients perspective. Anyone interested please contact: volunteercannabiscalm@gmail.com

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