Mental Health: Effects of Cannabis

on Depression and Anxiety Disorder

Summer Pagaduan Emmanuel Santuray

Luz Zobell Marina Ruiz
Kelly Truong Patricia Osuna
 Purpose and significance of Integrated Work
What is the purpose of synthesizing literature on cannabis’ effects on mental
health?

- Since many antidepressants/anxiety drugs have various side effects and

responses on the person, exploring different methods of treatment is beneficial to
reduce outpatient care on depression and destigmatize mental health issues.
- SSRIs are potentially harmful (side effects, dependence, etc…) and cannabis
could be a potential alternative to replace them
- De-stigmatize cannabis use as a recreational drug
- Connect gaps in literature that address mental health and whether cannabis is an
effective way to treat/decrease depression and anxiety issues.
- Medical cannabis use has been seen to alleviate pain, why not investigate
 Background
Clinical Problem:

Is cannabis effective in recovery or remission among individuals with diagnosed anxiety

or depression?

- Whether cannabis does more harm, more good, or nothing at all for those individuals
with anxiety disorder
- Current anxiety disorders are treated with a range of SSRIs (Selective Serotonin
Reuptake Inhibitors)
- Ex: Sertraline, Citalopram, Fluoxetine

What has been studied:

Mixed findings between relationship between cannabis use and recovery from anxiety
disorders

Search Terms Used
- Cannabis use AND depression
- CBD vs. THC effects on mental health
- Marijuana use AND depression
- Marijuana use in adolescence
- Medical cannabis AND implications for healthcare
setting
- Cannabis AND (progression OR improvement OR
lessened OR reduce OR recover OR help OR
alleviate)
● Databases used: PubMed, Google Scholar, CINAHL,
ELSEVIER
● Year of Publication: 2002; 2006; 2016-2019
Search Methods
Limits: Age
- Patton et al. - 14 & 15 year olds
- Feingold et al. - 18 years or older
- Bohorik et al. - psychiatric patients (no age
specified)
- Childs et al. - 18-40 y/o
- Bergamaschi et al. - Undergraduate students
- Piper et al. - excluded adolescents
Limits: Types of Studies
- Patton et al. - seven wave cohort study
- Feingold et al. - 3 year longitudinal study
- Bohorik et al. - Longitudinal cohort study
- Childs et al. - RCT
- Bergamaschi et al. - RCT
- Piper et al. - retrospective, cross sectional
Results 1: Intervention Comparisons
Title Purpose Methods Findings

Cannabidiol reduces To confirm whether the Quantitative data gathered from self- SAD patients who were treated with
the anxiety induced CBD component of stated surveys and vital signs CBD showed reduced symptoms of
by simulated public cannabis can reduce stress and anxiety during a simulation
speaking in social anxiety disorder RCT that triggers stressful reactions
treatment-naive (SAD)
social phobia
patients

Substitution of To assess whether Quantitative, Qualitative Statistically significant , p-

medical cannabis for Medical Cannabis could retrospective,cross-sectional value=0.05
pharmaceutical potentially substitute or Members of East Coast medical
agents for pain, lessen dependence on marijuana dispensaries self reported Conclusion: MC does have a
anxiety, and sleep. psychoactive meds for changes in their dependence on substitutive effect for patients taking
anxiety/depressive various antianxiety and antidepressants, antianxiety drugs.
disorders. antidepressant drugs.
Results 1: Intervention Comparisons
Title Purpose Methods Findings

Clinical and functional Cannabis use affect on 3- year cohort study

outcomes of cannabis use clinical outcomes and (longitudinal study) Cannabis users and those with cannabis
recovery from anxiety use disorder presented with poorer
among individuals with
disorders outcomes of anxiety order recovery when
anxiety disorders compared to non-users. However, after
adjusting for confounding variables,
these differences were attributed to
sociodemographic and clinical factors.

Patterns of marijuana use Can cannabis resolve the Randomized controlled Cannabis did not improve recovery from
among psychiatry patients substance-related problems trial depression in psychiatry patients
with depression and its that worsen depression and
impact on recovery mental health Young people, older adults, and high
depression severity patients are at risk
for negative health outcomes with
marijuana use
Results 1: Intervention Comparisons
Title Purpose Methods Findings

“Cannabis use and mental To determine if cannabis A seven wave cohort study ● Use of cannabis increases the
health in young people” use in adolescence would over six years with self chance of becoming depressed
lead to higher rates of administered questionnaire and having anxiety
depression and anxiety ● Cannabis use in females
increase the risk for depression
and anxiety

“A naturalistic Determine the perceived - ● 50% reduction in depression

changes in people who Data tracking using and anxiety with increasing
examination of the
suffer from depression and Strainprint, which is an app puffs.
perceived effects of anxiety, depending on the that tracks users mood ● No difference between genders
cannabis on negative concentration of THC and depending on different
affect” cannabinoid. doses and strains of
cannabis.
-Self reported
-enter the location where
cannabis was bought
(Canada)
Results 2: Synthesis Findings
1. How many studies did you include overall?
a. 6 articles
2. How many studies had a specific intervention?
a. All studies that are mentioned, included cannabis use as an intervention to see the effects on changes in depression
and anxiety.
3. How many studies found a positive effect vs. no effect?
a. 2 out of the 6 articles showed that cannabis had no effect on depression and anxiety
b. 4 out of 6 articles showed that cannabis had an effect on depression and anxiety
i. 1 showed negative effects on depression and anxiety
ii. 3 showed improved effects on depression and anxiety
4. How many studies did were RCTs vs. cohort or other study designs?
a. 2 randomized control trials
b. 2 longitudinal cohort studies
c. 2 cross-sectional cohort studies
5. What were the outcomes measured in the studies that you found? How many of each?
a. All studies utilized self reported data
6. What was the quality of evidence for each types of studies and those that found positive results vs. no effect?
a. For the ones that gave a positive effect, high reliability due to known concentrations of cannabis and amount used
amongst users.
b. For studies that displayed negative to no effects on depression, they showed low reliability due to many confounding
factors (missed dosing, mixed write ups, other background information: socioeconomic status, education level, marital
status, etc.)
c. Overall, studies with positive or no effect results did not factor stress as a risk factor for depression and anxiety
Results 2: Synthesis of Findings-Conflicting Themes

“Cannabis causes anxiety and “Cannabis can alleviate depression “Cannabis does NOT cause
depression” and anxiety” depression nor anxiety”

“Cannabis increases the “Depending on the cannabis strain

likelihood of developing (THC or CBD) and dosage (low or
depression and anxiety later in high), you could develop negative
life” health outcomes”

“Depression and anxiety

symptoms are heightened in
those already diagnosed with
depression and anxiety”
Conclusions
● There’s inconclusive findings regarding the effects of marijuana on
treatment of depression and anxiety disorder symptoms.
○ Some studies claim that….
■ there’s no negative correlation between cannabis use and anxiety disorders.
■ teenage girls using cannabis are more susceptible to depression and anxiety.
■ alcohol use and having a psychiatric disorder have increased depressive symptoms with cannabis
use.
■ cannabis can replace traditional pharmaceutical drugs for treatment of depression and anxiety.
■ cannabis dosage and strain determine anxiety and depressive symptoms.
■ cannabis use in adolescence increases developing depression and anxiety later in life.
● Cannabis use has variable outcomes on mental health. Some people benefit, some don’t.
● Marijuana use can temporarily relieve depression/anxiety symptoms but chronic use doesn’t continue to reduce
symptoms
● There are health risks associated with cannabis use amongst those with depression and anxiety disorder
symptoms. There’s many unknowns.
Recommendations for Future/ Biases and
Limitations
● Are the psychosocial benefits of cannabis use significant enough to prescribe to patients with
mental health problems?
● Determining the amounts of medical cannabis that will be effective for different people (whether it
be age, or severity of anxiety) to reach the desired outcome
● More studies need to be conducted on specific anxiety disorders
● Long-term use of cannabis would need to be further studied using a retrospective cohort study to
assess long term effects on depression/anxiety.

Biases and Limitations:

● Legality of certain areas restricts who we can do research on (external validity)
● There are inherent social issues in truthful reportation of depressive symptoms and cannabis use
due to social stigmas, laws, and self-perception
● Specific cannabis strains including different ratios of cannabinoids have different effects
● Depressive symptoms are difficult to quantify
Implications for practice
● How do we decide who is eligible for cannabis treatment?
● As nurses, what are we expected to know about cannabis?
○ What is considered safe and knowledgeable nursing practice to care for patients using
marijuana?
● Should mental health treatment involve substance use (e.g. cannabis) or
weaning patients off substances (other forms of therapy)?
● How can we establish the necessary rapport and safety to help our patients
feel comfortable enough to reveal their cannabis use and anxiety disorder
symptoms?
● Nursing scope of practice: would cannabis use be considered a nursing
intervention rather than a medical intervention?
● Ethical issues?
References
Bergamaschi et al. (2011). Cannabidiol reduces the anxiety induced by simulated public speaking in treatment - Naive social phobia patients.
Neuropsychopharmacology, 36(6), 1219-1226.

Bohorik, A. L., Leibowitz, A., Sterling, S. A., Travis, A., Weisner, C., Satre, D. D. (2017). Patterns of marijuana use among psychiatry patients with
depression and its impact on recovery. Journal of Affective Disorders, 213. 168-171.

Childs, E., Lutz, J. A., de Wit, H. (2017). Dose-related effects of delta-9-TFC on emotional responses to acute psychosocial stress. Drug and Alcohol
Dependence, 177, 136-144.

Cuttler, C., Spradlin, A., & McLaughlin, R. J. (2018). A naturalistic examination of the perceived effects of cannabis on negative affect. Journal of
Affective Disorders, 235, 198-205.

Feingold, D., Rehm, J., Factor, H., Redler, A., & Lev‐Ran, S. (2018). Clinical and functional outcomes of cannabis use among individuals with
anxiety disorders: A 3‐year population‐based longitudinal study. Depression and Anxiety, 35(6), 490-501.

Patton, G. C., Coffey, C., Carlin, J. B., Degenhardt, L., Lynskey, M., & Hall, W. (2002). Cannabis use and mental health in young people: cohort
study. BMJ, 325(7374), 1195-1198.

Piper, B. J., DeKeuster, R. M., Beals, M. L., Cobb, C. M., Burchman, C. A., Perkinson, L., ... & Abess, A. T. (2017). Substitution of medical cannabis
for pharmaceutical agents for pain, anxiety, and sleep. Journal of Psychopharmacology, 31(5), 569-575.