This is a hard topic to communicate in depression treatment. It's easy to mistake substances that temporarily boost your mood or calm your nerves for effective treatments for an underlying condition.
There was a brief period of time before the opioid prescribing backlash when some fringe psychiatrists were proposing weaker opioids as adjunctive treatments for treatment resistant depression. It's hard to fathom now, but opioids were more casually prescribed a few decades ago. I recall some discussion where one of them said they were seeing good initial results but the effects faded, and then it was hard to get the patients off of the opioids when they were no longer helping. Not surprising to anyone now, but remember there was a period of time where many seemingly forgot about their addictive properties.
I feel like I've seen a weaker version of this in some friends who turned to THC to "treat" their depression: Initial mood boost, followed by dependency, then eventually into a protracted period where they know it's not helping but they don't want to stop because they feel worse when they discontinue. This wasn't helped by the decades of claims that claimed THC was basically free of dependency problems.
> but remember there was a period of time where many seemingly forgot about their addictive properties.
There was also quite alot of talk about how doctors, by being reticent to prescribe opioids, were inhumanely forcing patients to live in pain, and not being sufficiently deferential to patient autonomy. Moreover, the rhetoric was incorporated into discussions about racist disparities in treatment, given there was some evidence doctors were less likely to prescribe opioids to black patients, suggesting doctors were systematically being cruel. Naturally, the easiest way to dodge those accusations was to simply prescribe opioids as a matter of course. Even in the absence of Purdue Pharma pushing their claims about lack of significant addictive potential, there was already significant pressure to discount the risk of addiction.
If you take it and you feel your anxiety is lessened, that's the greatest proof you can ask for. All the psychiatric studies are already based on self assessment.
Second, a lot of psychatric treatments are temporary, ending whenever the medication is stopped or wears off so I dont see how this would be any different
> If you take it and you feel your anxiety is lessened, that's the greatest proof you can ask for.
This mistake has been made many time throughout history. Cocaine was originally believed to be a viable treatment for depression. Opioids and amphetamines too. You take them and you feel good for a while, which was mistakenly equated with treating depression.
Many drugs will make you feel good temporarily by blocking certain feelings or tricking your brain into feeling good. This is not the same as treating a condition.
You can think of actual treatments as working closer to the source to reduce the problem, not temporarily overriding it with a powerful drug-induced sensation.
Psychiatry as its practiced has no idea as to what depression even is under the hood. The entire science is based on the patients self reported feelings or the psychatrists feeling of how someone else is feeling.
What you're saying is something else, that drugs can produce long term harm despite short term improvements
I dont have a problem with the study or its conclusions, just the parent post I was replying to.
>Recreational drugs make you feel good temporarily. That's literally why people do them.
The point Im making is this is true for a ton of psychiatric or even non psychatric treatments. And to be perfectly clear Im not saying you should be treating your anxiety with weed, even if it does help you
> The point Im making is this is true for a ton of psychiatric or even non psychatric treatments
That point wasn't intended to be taken in isolation.
I was making statements about how long-term treatment of an underlying condition is not the same as taking a drug which temporarily masks a problem or induces altered mood states.
The fact that a drug has acute effects, good or bad, is separate from any conversation about chronic effects.
For depression, anxiety, and other conditions it's the chronic effects that matter. The acute effects almost become side effects at that point. For some drugs, getting to long-term treatment involves tolerating the acute effects while your body adapts
You keep ignoring the fact that what you just said applies to current medications used to treat depression and anxiety. They do not treat the underlying issue long-term, and if you stop them, you are worse off than before due to rebound effects, and even if those effects subdue, your depression and anxiety returns. And just to add to this for clarification, antidepressants may treat depression, but it does not cure it either.
Same with amphetamines for ADHD. And yes, if you take much more, you will experience side-effects ("cause harm when abused"). Opioids are not an outlier at all.
> Recreational drugs make you feel good temporarily
Drugs are only recreational if you take them recreationally, there is nothing that makes them inherently recreational.
And we have not discussed MDMA, which is considered a hard "recreational" drug, yet there are lots of benefits for treatment of PTSD, for one, similarly to psychedelics.
... or ketamine for depression, which is now approved by the FDA, even.
> Cocaine was originally believed to be a viable treatment for depression.
Is it not??
Sure there's the addiction and harm from abuse that make it less than ideal for long term use, to put it mildly, but weed isn't coke so what's really the argument here?
Duration of effect matters when it comes to successful treatments.
If we take your position and apply reductio ad absurdum, we could say that cocaine is a highly effective treatment for anxiety, although of course we know that in the not-so-long run it has the opposite effect.
But a lot of psychatric treatments are just that. Treatment for ADHD for example is giving ampethamines (which btw are chemically no different than a low dose of meth), which have a duration of 3-6 hours and its back to worse than baseline after the effect has worn off.
There are multiple treatments for ADHD, including alpha-2 receptor agonists and norepinephrine reuptake inhibitors. Some of them show patterns of increasing efficacy out to a year (the length of the study).
The reason amphetamines are used for ADHD but not depression is that they've been studied to show that the ADHD improving effect can remain for many months, while the mood-improving effect will taper off quickly if you take them every day. Almost everyone who takes ADHD stimulant, feels a mood and motivation boost ("so happy I could cry" is the common phrase) and then is disappointed when that mood boost stops happening after a few weeks or months will learn this. Attention enhancement is less prone to tolerance, though it still accumulates tolerance too. There are some studies showing that the effects of stimulants in ADHD diminish substantially on a multi-year time frame, and it's probably not a coincidence that many people (though not all) who take stimulants discontinue after several years.
Well, it's not that simple. It's reasonable to expect that you could see some increased level of oxidative and excitotoxicity. It's harder to draw a bright line around the dopaminergic system specifically because some level of neuronal death is expected over the course of a lifetime. We lose 5-10% starting with middle age yet don't tend to show parkinsonian symptoms until 60-80% are gone.
It's pretty reasonable to expect reversing DAT and inhibiting VMAT2 increases oxidative flux, the question is really how much not if. Methheads certainly get "brain damage", but is nudging the average loss from 5-10% to 7-12% "damage"? Is it meaningful? Over 30, 40 years that could very well add up.
There’s a difference between intoxication and treating the chemical imbalance behind depression or anxiety. For one thing, treatments for anxiety only target the anxiety: they don’t impair the person the way that weed or alcohol does. (They can have other side effects, of course.)
Drugs for anxiety treatment do wear off, but not the same way that weed or alcohol does: something like Celexa takes a few weeks to build up in the system, and don’t lose effect 12-24 hours later if you miss a dose. I’m not sure how long you’d have to stop before it loses efficacy entirely.
I’m not Nancy Reagan, though: I would not advise people to self-medicate with booze or pot if they’re suffering from depression or anxiety, but I’m not going to preach at anybody who is doing so and thinks it’s working for them. I will say that I’ve seen that end badly, though. I can think of three people I’m close to who’ve tried it and have had problems with addiction: all of them are now sober and (I believe) on regular antidepressants.
Im prescribed adderall for ADHD. It is a high. You feel more positive, more productive, more forward looking for a few hours and its back to baseline or worse when you crash.
As for impairment, it really depends. If weed removes your anxiety and lets you relax, its benefit could be greater for what youre doing than the impairment it causes. And adderall, SSRIs can cause impairment of sorts too.
Psychiatric treatments return a person to a baseline that can be managed with therapy or healthy coping mechanisms.
Chasing a high is not a treatment, it merely defers the problem. As tolerance to the high builds, patients lose the therapeutic value but have gained crippling dependency and addiction.
I think the problem is that, at least in my experience, you end up with more anxiety once the initial high wears off. Paranoia is an extremely common side effect of Marijuana, and so are nightmares with prolonged use. And once you kinda get into a routine with it, you have a hard time quitting, because your overall anxiety is raised, and you need it just to get back to a normal functioning level. My guess is that this is due to the effects that THC has on blocking your REM sleep. Without the proper REM sleep, it seems pretty common to be anxious and foggy-brained.
Doing ten shots of tequila is a 100% scientifically proven cure for social anxiety then. If you take it and your anxiety lessens, that's the greatest proof you can ask for! Let's just completely ignore the crippling morning hangover and liver damage
I mean... Yeah. Alcohol is very well documented and even more widely used for exactly this purpose BECAUSE it works.
The side-effects are often terrible. This is also true for many widely-prescribed drugs, and has been even more true in the past. The folks I've known on MAOIs were pretty wrecked.
Yeah this has been my experience with THC. I never took it for depression, but it was always a temporary thing. I doesn't treat anything IMHO. its a symptom relief at best.
it works pretty good as a temporary relief from anxiety.
Title says "helps" but the summary says "it doesn’t effectively treat anxiety, depression, or PTSD". Big difference between the two IMO.
Plenty of people use cannabis to alleviate symptoms. I don't think they expect to be cured entirely. Getting a good night's sleep or being without chronic pain for a few hours is often enough.
It's a meta-study and came to the conclusion that there isn't reliable evidence that it alleviates symptoms of a bunch of stuff:
> There were no significant effects on outcomes associated with anxiety, anorexia nervosa, psychotic disorders, post-traumatic stress disorder, and opioid use disorder. There were insufficient data to meta-analyse studies of ADHD, bipolar disorder, obsessive-compulsive disorder, and tobacco use disorder. There was an absence of RCT evidence for the treatment of depression.
I've always been suspicious of the claims THC helps anxiety. CBD may, but my experience is that high doses of THC without corresponding CBD tends to induce anxiety in many people. I also found the brief notes in the article about MMJ and autism intriguing. I'm diagnosed ASD. I would think the use of THC to manage overstimulation could be problematic, as it tends to make colors and sounds and flavours _more_ intense. Conversely, indica strains tend to slow you down.
DISCLOSURE: I use large amounts of high potency cannabis flower with CBD/CBG edibles for intractable neuropathic pain. I also smoked a hell of a lot of weed in my 20s and 30s. I've more experience of Pot than most. MMJ lowers my pain a bit, and reduces suffering a lot. Its the suffering that makes life difficult.
American media has really been shockingly pro weed/cannabis for the past 20 or so years. Really astounding to witness considering the well known downsides to human health and cognitive function. Main characters smoke weed as a cool disobedience, in sitcoms even.
Wonder what is behind it, from my perspective it's quite remarkable.
I think it became socially acceptable because there’s not a huge reason to hate on it.
The risks to cognition and health exist, but they’re no where near as bad as alcohol or cigarettes (and the negative effects basically don’t exist at low, even moderate doses)
The biggest negative effect of using weed regularly is it seems to slowly kill people’s motivation to do stuff over time. It will turn just about anyone into a couch potato. That’s more dangerous than any other effect IMO.
People were smoking weed even when it was socially unacceptable and illegal. Then they were going to jail for a decade or more because of it. This simply did not make any sense. I believe most of this is a backlash effect.
Weed was the worst thing ever. Weed is the best thing ever. Eventually weed will be in the same category as coffee.
Since the 1960s and the emergence of the New Left, and the introduction of the Frankfurt School and 60s post modernism into academia, there has been a widespread belief amongst a large segment of the population that everything traditional is wrong. A social stigma is merely ignorance, that which is seen as bad is actually good, traditions are wrong. All of these things need to be overturned for the enlightenment. Since society deemed marijuana bad, it is therefore good. As those people who were went through that indoctrination in the 60s as students got older, they got into power. They took power in universities. By the 90s they were pushing all of the ideas as the status quo. Students in the 90s then took those ideas, and when they got into power in Media, they pushed those ideas into all movies and tv.
Alternate theory: there's a shit load of money to be made with legal marijuana so it will be mainstream just to ensure those paychecks keep coming. And for media, it's a low hanging trope that if you want your character to seen edgy but not dangerous, you have them do safe drugs like marijuana. It's easier than the weeks of story it would take to let the audience know they're just slightly anti establishment.
I'm not sure I buy your theory even a little, to be honest. The children of the 60's have, by and large, gotten FAR more conservative as they've gotten older.
Tell that to my depression. Back before I got sober days after alcohol were certainly some of my lowest mood days. Its well known that alcohol impares next day production of neurotransmitters responsible for balancing moods.
Now I've been sober for 7 years and my depression has been treated, but I certainly remember those days
Okay, I've read the meta-study now and I think the summary article isn't representing the picture very well. In particular they found for anxiety there actually seems to be evidence in this exact data set that does help.
What they are doing is saying "there isn't 95% evidence it reduces anxiety" therefore "no evidence" even though they mean "some evidence, just not at the statistical significance level" -- it's one of the biggest confusions (and sometimes it feels deliberate) you'll see people do.
Also when you have a confidence interval that big it's a red flag. They themselves admit the data is all over the place.
In summary, don't assume much from the title of the summary article.
The data being all over the place on benefits, but pretty clear on harms, is about as good a reason you could want for experts not to recommend something as treatment. That's what it often looks like when something doesn't work, or doesn't work very well.
It's really easy to convince yourself that something works when it doesn't, that's the whole reason why people have to take statistical significance seriously.
I guess if you weren't around for the 30 years when every marijuana advocate on the planet wouldn't shut up about it being a cure for anxiety, evidence that it is not wouldn't be particularly interesting to you.
The Lancet has been around for 200 years. It publishes weekly.
It's a highly regarded journal, but it doesn't mean 100% of the papers published are perfect.
If you're trying to dismiss a study because it was published in The Lancet then that's not a convincing line of reasoning to anyone who understands the scientific publishing landscape.
These dismissals based on the source rather than the material are getting really annoying. We’re supposed to be intellectuals here, we can do better than that.
Studying the effects of recreational drugs is similar to studying diet in terms of the level of complication. The headline "No evidence" is a good example of the discourse about this subject. There absolutely is such evidence, but this new analysis comes to different, potentially more robust, conclusions from the same data. As long as results are presented in this way a meaningful shared comprehension of the situation is likely to remain out of reach.
As someone who's used cannabis regularly for over a decade, I tried to start to explain in this body my experience but every sentence written ends with me deciding, "that's too circumstantial to my lifestyle-physiology to include."
I think at the end of the day, empirical research's purpose is to get us closer to being able to just make our own decisions surrounding mind-altering drugs. Beyond that, cannabis affects a great deal of systems in our body concurrent to the rest of our environment's effects. Use your autonomy to determine if it's a positive or a negative for you. Don't drive fucked up, please.
This is the most reasonable take I’ve seen in this whole thread. Alcohol doesn’t reduce anxiety either yet tons of people take it as a social lubricant and it probably does more damage to those consuming it than those who consume weed. So shrug? Just be responsible folks and let people blow off steam how they like without judging it like weed is an 8 ball.
The studies cited by this metastudy all suffer from the same issue: They aren't studying the cannabis plant at all and even if they are, it's not in the chemovars (chemical makeups) that real consumers are actually consuming - due to cannabis sourcing issues stemming from cannabis's continued illegality.
For randomized controlled trials, even in "legal" states, university scientists can't just walk into a dispensary and buy cannabis to then administer to test subjects.
That's Post-Prohibition for you.
As far as I can tell, most (EDITED FROM ALL) of the studies utilize isolates - and not necessarily in conjunction.
For instance, none of the 6 anxiety studies included in this metastudy used THC and CBD together.
The headline could read instead: No evidence cannabinoid isolates help anxiety, depression, or PTSD.
Cannabis advocates are the first to mention the entourage effect. Cannabis prohibitionists on the other hand, love nothing more than to cite incomplete science.
Using quantified isolates is the correct way to do a controlled study. Dosing is important.
Claims that you need a special combination of exactly the right strains are just a way to move the goalposts forever. They could study 10 different strains in controlled trials and the same people would show up to dismiss this study because they weren't using some random strain that has some perfect combination of entourage effect.
Using actual plants and smoking would also introduce another major variable, with further claims that the strains they were giving patients were too weak or they were smoking it wrong.
EDIT: I don't have time to read every single citation included, but the claim above that they were all THC or CBD isolates does not appear correct. One randomly selected citation:
> The short-term impact of 3 smoked cannabis preparations versus placebo on PTSD symptoms: a randomized cross-over clinical trial
So the claim above that they didn't investigate smoked cannabis or "entourage effect" is false.
Way to completely misunderstand and try in an underhanded way to the dismiss entourage effect.
It’s not smoking 10 strains in a row it’s the fact that you need CBD THC and all the terpenes to get the effects. So the current growing trend of just getting the THC number higher tends to result in plants that don’t actually give people the full spectrum of effects, beneficial or not.
So the correct way to do this would be a full spectrum isolate, which again you coincidently forgot to mention I’m sure.
I never said it was. I was saying you could run 10 different studies on 10 different strains with 10 different "entourage effect" profiles and even if all of them were negative, they would be dismissed as not having precisely the right entourage effect.
If there are anti-depressant compounds in cannabis plants then they can be extracted and isolated, too.
> So the correct way to do this would be a full spectrum isolate, which again you coincidently forgot to mention I’m sure.
Of course, the correct formulation is something other than what was tested, right? And if they tested a full spectrum isolate with negative results, we should assume that it just wasn't the right blend of terpenes and therefore that study should be dismissed too? Repeat ad nauseum?
That's a great example study to highlight what I really mean by entourage effect. I've edited my post to emphasize most not all - i only looked at the 6 anxiety studies as that's what I have the most experience with - as well as the included table which highlighted that the vast majority of studies included in this metastudy only looked at THC.
That particular study did look at High THC low CBD, mid THC mid CBD, and high CBD low THC. There's no information on the terpene profile of the smoked cannabis preparations, though, and that is a confounding variable in the entourage effect that potentially defeats the part of the entourage effect they did test. Additionally, a quick look at the cannabinoid %s in those smoked preparations rehighlights my point that these are not inclusive of all the chemical compositions that the cannabis plant could present itself in.
I still stand by my point and hope the clarifications bring the conversation back on track to the fact I was highlighting which is simply that this is a metastudy built off of studies that were conducted with restrictions on experimental design that few observers fully understand the research implications of.
Yeah, I noticed this too. Canadian universities have been studying cannabis use using actual cannabis, so I'm not sure why this metastudy considered anything else. "We need to publish something" perhaps.
>The headline could read instead: No evidence cannabinoid isolates help anxiety, depression, or PTSD.
There’s no evidence that what they tested with was pure THC isolates. If they’re using cannabis in plant form, even if it was bred for higher thc content, there is still cbd.
Those that are interested to click through should and see the studies cited by this metastudy and whether they used whole plant cannabis extracts, cannabis isolates, or even non cannabis derived isolates.
tldr; "If they're using cannabis in plant form" is a very, very high bar for the current state of cannabis (really cannabinoid) research.
- Not adjusted for strain, dose or delivery method across all studies.
- Not adjusted for receptor downregulation, for which rotation and/or drug holidays would be appropriate strategies.
- Not adjusted across all studies for time effect, e.g. 6 hours of relief, 1 hour, etc.
I can tell you from personal experience with a related disorder that disciplined rotation of 10mg edible cannabis provides 90% relief, 90% of the time, with far fewer side effects than alternative medications for the same disorder.
My initial take from reading the headline was: no shit this is what mdma is for…
Tangentially,
The etymology nerd in me has been taunted by the current article thats been on the front page for the as of now last 19 hours[1] which conveniently has the origin of the term linked to in the first sentence! [2]… which @suprisetalk also links to in the article description!…
So now I’m wondering why mdma has got the street name molly… and if they're not perhaps related?
As in molly (aka mdma) has got the name as its used as a guard against these ailments specifically…
How does your "anyone knows" control for false negatives? i.e. how can you be certain that the people you met who aren't "anxious and stupid" aren't also weed addicts?
Well how do you know if you overdosed? What else happens besides anxiety and paranoia? Some of the reaction may be genetic, but I think many people have a negative reaction to taking mass quantities of cannabis. I don't know if you want to take a poll here but it's pretty common...
There was a brief period of time before the opioid prescribing backlash when some fringe psychiatrists were proposing weaker opioids as adjunctive treatments for treatment resistant depression. It's hard to fathom now, but opioids were more casually prescribed a few decades ago. I recall some discussion where one of them said they were seeing good initial results but the effects faded, and then it was hard to get the patients off of the opioids when they were no longer helping. Not surprising to anyone now, but remember there was a period of time where many seemingly forgot about their addictive properties.
I feel like I've seen a weaker version of this in some friends who turned to THC to "treat" their depression: Initial mood boost, followed by dependency, then eventually into a protracted period where they know it's not helping but they don't want to stop because they feel worse when they discontinue. This wasn't helped by the decades of claims that claimed THC was basically free of dependency problems.