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.
As an aside, it is a well established fact that doctors, as a whole, take the the pain of black
people much less seriously than the pain of non-black people.
In emergency departments, Black patients are prescribed opioids for acute pain at a lower rate than White patients with matched chief concerns.4
Discrepancies in prescriptions for chronic pain therapies have also been identified in Veterans Administration and Medicaid payer databases, and several retrospective cohort studies have shown persistent underprescribing of analgesics to Black patients.6,7
White medical trainees, reflecting the general population, can have false beliefs about biologic differences between Black and White patients (eg, “Black patients feel less pain”), and this racial bias leads to inaccurate pain diagnoses and treatment recommendations.8
In anesthesiology and pain medicine, use of regional anesthesia for joint replacement surgery is applied less frequently in Black patients and the underinsured.9
This also holds true in the implantation of spinal cord stimulation for the treatment of postlaminectomy syndrome.10
Among patients with occupational low back injuries, Black patients incur lower treatment costs than their White counterparts and are provided fewer health care interventions, including surgery.11
Perceived discrimination results in psychological distress, and a US population–based study has demonstrated a dose-response relationship between psychological distress and chronic pain.
> White medical trainees, reflecting the general population, can have false beliefs about biologic differences between Black and White patients (eg, “Black patients feel less pain”), and this racial bias leads to inaccurate pain diagnoses and treatment recommendations.8
IMO, it's a little unfair to ascribe deliberate, knowing application of racist stereotypes. That kind of rhetoric by researchers can have unintended consequences, however well-intentioned, such as with the overcorrection wrt opioids, and is often used by interest groups to change policy in directions not otherwise warranted by well-founded evidence. (It's sometimes like people using "think of the children" as a way to stream roll more nuanced, narrowly focused debate.) There is material evidence that, broadly speaking, different ethnicities have different skin characteristics, including thickness (which is admittedly often used in an imprecise manner, but can defensibly include characteristics like elasticity). It figures prominently into aging, and generally considered part of the reason why "whites" (for lack of more precise categorization) tend to wrinkle more with age, particularly relative to Asians with similar skin tone. (Contra stereotypes, some research shows Asians have "thicker" skin than whites and blacks, at least in the sense of being less prone to wrinkle for similar phenotypic pigmentation.) Papers that make the claim of prima facie racism like https://jamanetwork.com/journals/jamadermatology/article-abs... say in the abstract the beliefs are unfounded, but in the full article only go so far as to admit the evidence is equivocal or that doctors draw unnecessary or unsupported implications.[1]
Nonetheless, it's fair to say non-specialists shouldn't be making treatment decisions based on such poor and otherwise collateral evidence. And I would agree the evidence for racially disparate pain management treatment generally is very compelling, just that the racism is more implicit and unconscious. All race-based distinguishers are highly suspect, IMO, even when they accurately reflect a group in context. But unless and until medical systems comprehensively adopt personalized genetic profiling (given various limitations in cost, time, and well-researched data, something still pretty far off for general medicine), doctors are kind of stuck wrestling with old epidemiologic classifiers.
[1] The abstract says, "Although race is a social construct, the biomedical sciences—including dermatological science—have been used to promote the false idea that race has a biological basis. The study of race-based differences in skin thickness is an example." But the full-text says: "Race-based differences in skin thickness remain an active area of investigation. A review of the literature (1977-2014) reporting differences in aging skin across race and/or ethnicity noted that Asian and Black skin had 'thicker and more compact dermis' than White skin, 'with the thickness being proportional to the degree of pigmentation."4 A 2022 meta-analysis of 133 studies concluded that any difference in epidermal thickness in healthy human skin was minor, calling into question the usefulness of distinguishing skin thickness among racial groups.5" Note that this summation is putting a gloss onto research that is itself equivocal, but then is cited in policy debates to make claims about what "the science" unequivocally says.
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
>> This study is showing that THC, CBD, blends, or cannabis do not improve self-reported feelings over the long term.
Just to clarify, the study is not saying that.
The study is saying "there isn't conclusive evidence at this point, but it leans more toward helping than hurting on many categories". Please read the paper if in doubt.
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
By giving a patient the ability & skills to establish a less dopamine-seeking lifestyle while temporarily relieving them of the deficit.
Its use is supposed to be coupled with therapy and/or coaching (e.g. https://www.thriveemerge.com) to ensure that the patient isn't just using it as a lifelong crutch.
That's how it's supposed to be done. This approach is more effective in children for obvious reasons. Persons diagnosed later in life are therefore more likely to require it permanently.
Why do you need amphetamines to do this? Why not a legal stimulant? Even something as trivial as coffee can be effective if you take it strategically, i.e. stay off of it completely until the rare times when you need the turbo boost.
> 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?
As someone who has had depression literally as long as I can remember, being able to releve my symptoms when I really need it, even for just an hour, would be life changing.
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.
No not just like it, because the only difference with methampathemines is that the added meth group makes it able to cross the blood barrier much quicker, hence why I said its equivalent to a lose dose of meth. The chemical/biological response on the body and brain are very similar, the difference is in potency
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.
Meth is also used as an ADHD treatment. I think the reason is just the dosages that are used by addicts compared to people who just need the ADHD treatment.
A typical legitimate therapeutic methamphetamine dose is around ~20mg (up to maybe 60mg a day). A typical dose used by addicts is around 1 gram. And it's usually smoked, resulting in immediate bioavailability.
That's a terrible oversimplification. Stimulant treatments for ADHD are not supposed to produce pronounced mood-enhancing effects. Stimulant treatment has been shown to be effective indefinitely in majority of people without increasing the dosage over time.
These days formulations like lisdexamfetamine and extended release methylphenidate are preferred because they have all-day efficacy with typical duration of action of around 8-12h which carries lower abuse potential.
extended release are just two doses of the drug where half the beads are delayed by ~4 hours. How is that different from taking two edibles a day and claiming full day efficacy?
Shouldn't that be up to bodily autonomy? If someone feels that cocane relieves their symptoms then who is the doctor to say that they don't. Perhaps releaving those symptoms even for a short period of time is worth the consequences.
That's just arguing for drug legalization with extra pseudoscience.
I am all for people doing however much cocaine they feel they need. In broad daylight - let's just drag that into the light and let people go to the dispensary for cocaine hydrochloride, metered, measured and with warning labels.
Because the war on drugs is a stupid waste of time and lives, but no doctor or medical professional has to justify your own stupid actions.
It’s also an argument for quackery and snake oil, as long as the salesman declares “some people said it works!”
“People should be allowed bodily autonomy to take whatever chemicals they want” easily and dangerously turns into “People should be able to advertise and sell miracle cures that don’t work as long as their victims are gullible.”
Every snake oil fraudster hides their fraud behind principles like bodily autonomy.
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.
THC cannot both ”cause nightmares” and ”block REM sleep”, because nightmares happen during REM sleep.
People who suffer from nightmares may benefit from less REM sleep. It’s much more refreshing to sleep in a non-REM state and wake up normally than it is to repeatedly wake up in cold sweat and be afraid to go to sleep again.
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
Sure but my point was that you cannot have an argument where you go "yeah this happens so it's good" while you disregard everything else (it's a different question on how bad it is compared to alcohol etc). But if we follow the logic of the original comment, then it's valid logic since "hey it works so its scientifically proven!" You can replace alcohol with something else to highlight that as well, like how putting out a kitchen fire with a bucket of gasoline is a good idea. It completely covers the flames for a split second! Why worry about the explosion that happens immediately after?
So my comment wasn't about alcohol vrs cannabis but rather how that kind of logic is short-sighted and faulty.
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.
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.
I won't call you an idiot, but assuming that all cases are simply people being sad is a bit simplistic.
Some people are going to be more susceptible to depression, for whatever reasons, and improving someone's surroundings is probably going to prevent or alleviate depression to an extent, but to people who are depressed now it's somewhat pointless advice.
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.
Yes. Rather it is the reverse that helps. Exercise is the biggest one, but essentially “pain that will stop” seems to help in general. Ice showers, fasting, new challenging activity, giving up caffeine/alcohol.
All these things suck in the short term, and make you feel more good in the medium term. Maybe because your default becomes “not in so much pain”, rather than “feeling worse than when briefly enhanced by substance X”
Edit: I’m referring more to the “self medication” approach. Please don’t take any of this as medical advice.
> It's easy to mistake substances that temporarily boost your mood or calm your nerves for effective treatments for an underlying condition.
Perhaps the temporary boost can be used in such a way to effect change that lasts? Sometimes all a person needs is something small to change how their brain is processing things, and with structure perhaps that can be leveraged.
But then again, many people think that all brains work the same, and this underlies 99% of the failings of mental health care.
Isn't the problem with psychological dependency that drugs generate basically a artifical depression, so more drugs are needed to basically feel normal again? Thus saddling a already existing problem with the same on top?
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.
Sadly, I have witnessed three of my friends who started THC product to deal with anxiety, developed paranoia. Two of them quit THC and got better but one got way worse and now is in process of divorce. His personality is completely different, he was pretty chill guy but now he is talking way too much, easily distracted, and always worried about macro events.
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.
Beyond the semantics, this is what the meta analysis(1) actually says in the abstract
> 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. Meta-analysis revealed higher odds of all-cause adverse events (OR 1·75, 95% CI 1·25 to 2·46) among those using cannabis versus control group
The paper says there's no evidence of effectiveness in treatment, and evidence of harm.
It sounds to me like you didn't understand the paper at all, or are worse willfully misrepresenting.
The paper says "insufficient data" for helpfulness for most positive categories (but leans more positive than negative just doesn't reach 95% confidence), but also insufficient data on most negative categories. It finds 5 conditions it's helpful for, and 3 it hurts for.
The abstract is not the full study. This is why people should have training in research methods before saying they know how to understand research papers
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.
They have some more useful figures in the paper, but for a lot of things they're essentially saying there is not enough evidence to support using cannabis yet.
The strongest claim is the lack of significant effects for anxiety, ptsd etc. but it varies a bit whether that's because the effect is too small or because it is not studied enough.
For anxiety for instance the effect they list in the paper is quite big but the error bars are even bigger so the net result is inconclusive. This is quite different from PTSD where they note little to no effect with small error bars.
The paper is just listing studies that happened. There might be a political agenda behind it, but identifying a study about cannabis use for PTSD and drawing conclusions about the results is what you would expect this review to do. Leaving studies out is much more suspicious.
How many veterans do you know? How many veterans that you know use cannabis to treat their PTS? I guess I might be living in a bubble but there are plenty of videos of veterans and others talking about how exactly it is that they use cannabis for PTS. I recommend watching some.
> Title says "helps" but the summary says "it doesn’t effectively treat anxiety, depression, or PTSD". Big difference between the two IMO.
Exactly.
People looking for long term solutions to those issues need to address the root cause(s), which often requires therapy, lifestyle alterations, and work on the self. Change doesn't happen overnight, and it might even take a few tries to find the right therapist.
> Plenty of people use cannabis to alleviate symptoms. I don't think they expect to be cured entirely.
Obviously can't speak for everyone, but I know people who do think literally that. They think that weed will actually cure their depression, and they'll allude to some studies about it that I'm pretty sure don't exist and that they just made up.
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.
Where are you seeing it be encouraged any more than other harmful things? My US state despite legalizing has a lot of programs to tell people not to use it.
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.
What an intellectually bankrupt take; Extremely convincing until you realize less than 50% of people in the 60s even finished high school, and less than 8% of them even attempted post secondary education. Rejection of traditional values post 95 is attributable to any number of side effects of humans participating in the internet. We realized the scale of antiquated regulation. Something the “traditional media” would’ve never bothered to cover. This post is about weed not some soap box for your silent generation tears.
No sources, pure bullshit. This is a common right-wing conspiracy theory: just throwing words like "Frankfurt school" or "post-modernism" without understanding them, accusing "the Left" (with a capital L, as if it was a secret cabal) of orchestrating a decades-spanning Grand Plan to indoctrinate children, etc. Insanity.
Also makes me laugh whenever I see right wingers accuse the left of post-modernism, when Trump is the most post-modernist guy I know. The man literally never says the truth: according to him, we destroyed 100% of Iran's armament [1], Iran were the ones to strike their own girls school and oil prices are as low as ever.
Students in the 90s had also lived their entire lives under the counter-productive and utterly racist War on Drugs. That might have colored their attitude more than the leftist indoctrination bogeyman.
The college indoctrination boogieman exists because it is coincidentally the first time in their lives a lot of people live away from their parents fulltime.
How much your opinions change once you're not in that environment can be amazing to both yourself and to the people who think they understand you because you were financially dependent on them.
New ideas or diversity or whatever: living by yourself 24/7 is a huge liberator of thought.
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.
I think there’s probably some adjacency to other things which make people feel good, but are ultimately bad for them. Gambling, alcohol, porn, infinite scroll social media. There are a few people making a ton of money on this stuff and the social costs aren’t something they care about.
Frying the reward centers in your brain on anything can create unhealthy dependencies. That some people may see it as a good for social engineering purposes is orthogonal to its effect on consumers.
I am not sure I'd say I'm "against" it since broadly speaking I don't think it should be illegal, but I am against it in the sense that I really think that absolutely no one should be smoking weed. It's kind of an unearned opinion; I don't know anything about medicine or health or anything like that, but I hated what it would seemingly do to my friends in high school.
I'd have friends that would be more or less down to earth, start smoking weed, then start finding and watching videos of Alan Watts and Carl Sagan and convince themselves that they knew everything in the world about physics and philosophy, and they became utterly insufferable in the process, and whenever anything negative about weed was ever said, they would provide me a lecture about how weed is a cure to pretty much everything and how no one has ever had a negative effect from it ever in history.
I think there's been a huge over correction; there was so much bullshit about the dangers of weed that people started acting like it's some miraculous cure-all and ignoring actual issues.
This was such a visceral turn-off for me that I to this day have never used weed, and the idea of using it still kind of makes me viscerally annoyed. It's entirely possible that my friends were insufferable teenagers purely because teenagers can be insufferable, and that's not even unlikely, but the way I remember it is the weed making them annoying it. Not saying it's rational, just that memory and human brains are weird.
> American media has really been shockingly pro weed/cannabis for the past 20 or so years
Really? I think the opposite is true.
Given 1/6 adults admit to using it, I think it's totally underrepresented in media -- in theory 1/6 characters would be using it.
It's only very recently that I see characters who just casually say something like "I take a gummy for a long flight" or whatever, rather than be a stereotypical comedic stoner character.
I feel like really it's alcohol that's glamorized in the media, and before that it was smoking.
Seriously though, by the time I was 15 several of my classmates were drunk most weekends and smoked cigarettes regularly, but even decades later I have still never seen or heard of anyone I know smoking weed. That's why it sticks out so much to me.
If 1/6 is true it would be interesting to see how it has changed over the past say 20 years or so.
I think cigarettes and alcohol were established vices when media became a thing so media can be semi-excused from those. It would be interesting to know if the same is true for weed. Has it just gotten so common that media has to show it to be realistic, or did it get more common after media started to show it?
Cigarette smoking is an interesting counterexample, it has been extremely de-glamorized since the heydays and sales of cigarettes have halved since 2000.
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.
Without getting too much into the sativa/indica dichotomy - in my personal experience, I find the secondary metabolite profiles (terpinolene as opposed to the beta Caryophyllene dominant profiles associated typical with 8 week “indica dominant hybrids”) associated with longer flowering cultivars to be preferred by those dealing with what would might be undiagnosed ASD related things.
Would love to hear your experiences. What is the longest flowering cultivar you’ve tried, versus the shortest, and difference in effects on your ASD?
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?
Why would you not have to try each and every combination of features known to create a different effect on the outcome?
There are what, 500 different psycho-active chemicals in cannabis? And how many different kinds of neuro-chemicals can our brains create in synapses? And how do we even begin to organize the ways that that information is transmitted to the structure (topology) of the neural systems? And their firing action logic? And the behavior of the whole organism in question?
Seems like like multiple, multi-linear variable spaces composed within each other. None of which are understandable independently of the other. None of which are perfectly mapped or traverscible landscapes. Why wouldn’t you have to try each and every possible configuration of the system in order to understand how it works?
We are not even working with a strong philosophical foundation or definition of consciousness. We must explore every possibility, leave no stone unturned.
> There are what, 500 different psycho-active chemicals in cannabis?
I think you're extrapolating from exaggerated factoids. There are only a small number of compounds in cannabis that exist at the intersection of:
- Present in high enough quantities to matter
- Not destroyed during smoking/vaping/processing
- Bioavailable enough to enter the bloodstream
- With the correct chemical structure to penetrate the blood-brain barrier
- Potent enough to elicit effects at the concentrations achieved in human consumption
There are not 500 compounds in cannabis that fit this criteria. The number is much smaller.
If there was some combination that achieved dramatic antidepressant effects where typical cannabis failed, don't you think someone would have noticed by now?
There's no reason to assume that some combination of 500 different variables exists to do something that we haven't observed yet. There are much more fruitful paths to research than endlessly researching every variation of cannabis for the sake of researching cannabis.
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.
>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.
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.
As a middle aged guy who has used pot on and off for decades and no longer really enjoys the high, I'll say weed is good for two things:
Old man joint pains. Not headaches, broken bones, etc. But it nearly erases achy joint pain for me.
Being angry. I am much less angry in general when I'm smoking a bit every couple of days. That said, when I take a break I feel like my testosterone goes through the roof. I get more irritable and, TMI, I get a lot more spontaneous boners.
Weed is great for my anger and sleep. I’ve never found as good of a sleep medicine for someone who wakes up too early.
I also had debilitating anger in my teens and weed really helped calm that down. I’ve been off it for years at a time and I still can’t get past my anger without it.
I found it used to disrupt my ability to fall asleep, and I didn't dream, or at least didn't remember doing so. It also impacted my memory when awake, which makes sense if it was messing with my sleep cycles.
However, I was able to fix all of those problems by consistently ceasing use 4 hours prior to going to sleep.
Emphasizing this for anyone that reads it. Ceasing use 4 hours prior to going to sleep really helps - and yes, you can “use it for sleep” that many hours before and still be in a more sleep ready State than otherwise.
Anyone reading this far looking to optimize sleep, don't forget the basics of consistent schedules/meals and regular exercise. Personally, I can't exercise or eat too close to bed, as it keeps me awake. If you have the flexibility to wake without an alarm, that can be good as well to prevent sleep cycle intrusion. Stay away from blue wavelengths of light as bedtime approaches (use redshift/f.lux/etc on screens).
Agree. For different reasons, I cut THC a week ago after taking it before bed for years. This whole week my sleep was horrible. I’d fall asleep fine but wake up around 4 and not able to fall back asleep. Until someone recommended tart cherry juice. After two days of having it, I’m falling back asleep fine and having a great quality sleep. Try it out. YMMV.
It has at times worked well for sleep. One thing I've noticed though is that nothing works consistently for me. While weed and/or melatonin helps me get good sleep, both can leave me groggy/hungover during the day. What's weird is that I don't mean it varies night-to-night, but like for a period of, say, 9 months I'll sleep better on melatonin then it starts to leave me hungover so I'll switch it up and try weed and maybe it works fine for a few months then I get daytime sleepy/sluggish.
Recently I just quit everything yet again and now I sleep well for 6.5 hours, wake up refreshed, and have a lot more alertness and motivation during the day. My past experience says this will last for a while until I yet again find I need weed or melatonin to get more than 4 hours. I don't get it.. probably other factors in my life affecting my sleep.
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
Of course it's not. There is no direct relation. Alcohol is a solvent for nerves and causes chemical damage. Depending on the state of the brain, the effects follow.
Not entirely on topic: If pot is illegal people will grow extremely potent variaties. If it's normal you get very tasty variaties that give a mild buzz even if you smoke pure joints all day.
It's like comparing a casual light beer with the 90% moonshine or 45% bathtub gin sold during prohibition.
We can acknowledge that weed might be bad for people while also acknowledging that it probably shouldn't be illegal. There's no contradiction.
I think alcohol is bad for people but I don't think it should be illegal. I also think weed is probably bad for people but probably shouldn't be illegal.
I have found the exact opposite of that. Illegal weed was mild buzz and fun. Legal weed is EXTREMELY potent. They want to pack as much THC into the legal limit as they can.
For people using cannabis as medicine in both legal and illegal markets, the trend to buy higher THC potency products is all about stretching their medicine with their limited budget.
To continue your analogy, it’d be like buying 90% moonshine, diluting it 20:1, and then drinking it as a mixed drink the same potency as a casual light beer.
Of course, if only 90% moonshine is available, cuz of Prohibition or Post-Prohibition, then you’re going to have more people “binging” as opposed to “budgeting.”
The THC percentage variation in different varieties varies from say 0-35%. The better analogy for prohibition’s effects are for the explosion in concentrated forms like hash oil specifically. That is the same prohibition pressure that turned opium into heroin.
Idk, you can still find outrageously potent weed in states where it's recreationally legal. But maybe it's just a residual from the fact that it was illegal not that long ago and binge consuming it is still quite normalized?
- 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.
From the paper itself: "54 trials were identified for inclusion (2477 participants...) ....24 (44%) of these trials had a high risk of bias, and the certainty of evidence for most outcomes was low."
I’m digging through the paper. It’s a meta analysis paper.. they have six studies they analyze on anxiety treatment and they (footnotes 40-46) have positive results in terms of cbd showing a significant effect on anxiety reduction. I’m not invested in figuring out exactly how this study came to represent what it claims but it seems like a joke
Ok I see so they have six studies that they found to indicate effective treatment of anxiety with cannibanoids but their meta study only found six trials with 50 people so the significance / n count is not high enough. So the study is a null result ie they don’t have enough data not they’ve disproved it. In fact their data supports the hypothesis. Then the coverage on science daily misrepresented this. Here's citaiton 40: https://www.nature.com/articles/npp20116 "Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Naïve Social Phobia Patients" Pretreatment with CBD significantly reduced anxiety, cognitive impairment and discomfort in their speech performance, and significantly decreased alert in their anticipatory speech. The placebo group presented higher anxiety, cognitive impairment, discomfort, and alert levels when compared with the control group as assessed with the VAMS.
This is not entirely surprising, as the evidence was always weakly correlated. I say this as a proponent of legalization, mind you.
Cannabis, like alcohol and tobacco, is a vice. It definitely helps with some physical ailments (like helping stimulate hunger in cancer patients), just like alcohol and tobacco can with other ailments, but it’s not a panacea for mental health disorders.
We need to stop marketing these things as curatives when they’re mostly just coping mechanisms or social lubricants. We’re doing more harm than good by leaning into the “legitimate pharmaceutical” angle.
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. "The error bars are too big to say it works, so we shouldn't tell people it works" is a pretty good thing to inform people about if that's the case.
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. Maybe it really does work and a really good study could shrink the error bars but that's more hope than anything.
> The data being all over the place on benefits, but pretty clear on harms
Uhhh... no? Did you even read it? This research actually found more benefits than harms. I see it only identified two harms both graded very low.
Let's just quote here the researcher's own conclusions:
"Interpretation There was some evidence that cannabinoids can reduce symptoms of cannabis use disorder, insomnia,
tic or Tourette’s syndrome, and autism spectrum disorder, but the quality of this evidence was generally low.
Cannabinoids were associated with a greater risk of any adverse events but not of serious adverse events. Overall,
there is a crucial need for more high-quality research. Given the scarcity of evidence, the routine use of cannabinoids
for the treatment of mental disorders and SUDs is currently rarely justified"
>>> "The error bars are too big to say it works, so we shouldn't tell people it works"
I can see you didn't really understand my comment. There's a huge difference between not saying something is proven to work, and saying it's proven not to work. This study falls in the former category, by the authors own words.
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.
> “Though our paper didn’t specifically look at this, the routine use of medicinal cannabis could be doing more harm than good by worsening mental health outcomes, for example a greater risk of psychotic symptoms and developing cannabis use disorder, and delaying the use of more effective treatments,” he said.
I like how confident the author is to just say stuff that’s not covered by his study while promoting his study.
“I didn’t look into this but I bet pot is bad!” doesn’t solicit a lot of confidence in the neutrality of the guy who previously brought us hits like “Does smoking weed lead to doing heroin?” and “Is ChatGPT good for doing medical research?”
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.
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…
Cannabis had never an official indication for any psychiatric disease. At least in my country medical cannabis is prescribed only for chronic pain. Irrelevant fact is that 95% of people take it just to get high. The mechanism of action suggests its effects. There are enough other substances for this purpose.
That seems biased: if you only notice the people who act out due to their mental health issues, you will not notice the people who use cannabis but don’t have any issues with mental health.
Furthermore, people with mental health issues are known to self-medicate, which will introduce a bias if the correlation is seen as causation.
”The findings are based on a systematic review and meta-analysis of 54 randomized controlled trials (RCTs) conducted worldwide over a 45 year period (1980-2025).”
This review seems dubious considering the huge gap in motivations and scientific rigor between 1980 and 2025.
It would be easy, too. Find all studies on the subject, find correlations between some parameters and the results you want/don’t want, add those parameters in your inclusion/exclusion criteria.
There some evidence that nicotine may be inadvertantly used as a self-medication for schizophrenia and/or adhd
Cocaine is a party drug afaik, I'll give you that one.
Hallucinogens have the ability change people's perspectives on the world, often for the positive. Now the current psychiatry lens is you can only have "medicine" if you have a "disorder" but that doesn't really seem to make sense. Why can't you take medicine to move something from average to above-average? So I agree it's not prescribed for treating many disorders, but that doesn't mean it isn't therapeutic.
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.
Millions of people use it because it helps them, but trust some edgy scientists who say nope it doesn't.
These gaslighting studies are unhelpful. For me cannabis has been life changing, no more pain killers and I live very much pain free. But I read studies claiming cannabis doesn't help with pain.
Then you'll have anti-drug crusaders taking these headlines and abuse people for whom cannabis made massive positive difference.
The entire point of the drug research is to make them palatable to authorities through plausible lies. American culture does not permit enjoyment for the sake of it. So you have to make up some stories and say “there is some evidence that psilocybin helps depression” or whatever and then slowly leak it towards legality.
I mean if I told you I wanted to have fun you’d lose your mind. But if I told you I needed to heal you’re fine with it. So I make it so I’m always ill and needing pharmacological therapy.
To be fair, ever since I’ve started weekly psilocybin microdoses for depression I’ve been able to stop my regular anti-depressants which had some nasty side effects. And in those 3 years, I’ve had exactly zero depressive breakdowns like I used to have.
I don’t really enjoy the feeling of a normal dose of shrooms, but with a microdose below a noticeable effect (sometimes I overshoot a little and it gets a little warm and tingly), I have in fact had a huge quality of life increase.
I guess in some ways “not wanting to die regularly” could be seen as “having fun” by some people, and I’m sure that if a proper study was done the result would be inconclusive. I mostly think that the inconclusiveness in these depression studies has much to do with a lack of understanding of what depression even is and thus a lot of them have people with very different root causes of their pathology all being labeled “depression.”
But it works for me, and it works very well. (And 2g of shrooms per month is also dirt cheap compared to expensive anti-depressants.)
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.
> anyone who understands the scientific publishing landscape.
Anyone genuinely familiar with the scientific publishing process probably holds the most skepticism around publications. I could probably get ANYTHING published if I wrote it well enough.
IMO, publications are mostly useful if you're already a bit of an SME in the field so that you can parse snake oil from gold. Certain publishers and institutions also hold more credibility, depending on the topic. Broadly speaking, there's a ton of crap in the journal space and the ratio of crap/good grows by the year.
The above view is independent of the current article. But it's embarrassing to see people praise the heck out of publications in 2026 in a vacuum. Reeks of young PhD student vibes. Even nature is not what it was even 10 years prior.
> Anyone genuinely familiar with the scientific publishing process probably holds the most skepticism around publications
Healthy skepticism is a good idea
The silly notion that being published means it should be dismissed or that we should assume the opposite is true is not healthy though.
> The above view is independent of the current article. But it's embarrassing to see people praise the heck out of publications in 2026 in a vacuum. Reeks of young PhD student vibes.
I was responding to a comment above mine that said this journal was untrustworthy because of a single news bite they recalled.
I specifically said that not everything published in a journal is true!
Your condescending “young PhD student vibes” attempt at an insult is rich considering you didn’t even try to acknowledge what I actually said or the context in which I was delivering it.
Discussing anything science and research related on HN is such a slog because so many commenters are in such a rush to deliver some contrarian smug take that they’re not even reading what’s written.
> I specifically said that not everything published in a journal is true!
Yes, but the undertone of your message was towards them being generally good and useful. Which my post disagrees with. This view hardens with every new year.
The entirety of your comment just now is predicated on this one point, which is treating your words at face value, rather than their implication. To act like I didn't understand your words, let alone read them, is an insult to the both of us - notably you. Because if you believed what you had typed, you would not expect a real response from you typing it, which would make you typing it pointless in the first place.
> Yes, but the undertone of your message was towards them being generally good and useful. Which my post disagrees with.
Research published in journals like The Lancet is generally useful. I don't agree that it's reasonable to dismiss everything published like that. What are you even left with at that point, other than knee-jerk contrarian takes?
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.
Working with ayahuasca for several years in a traditional (Shipibo) context has showed me just how bad cannabis can be- it is more difficult to clean out of the body (energetically/spiritually) than any other drug. It creates so many associations in our mind- memories, relationships, pains, emotions, etc.. When "on the path" (meaning, apprenticing and learning how to work with ayahuasca), it really needs to be cleaned out for useful visions to open up (to work on other people) and to be able to cleanly connect to and call in the medicinal spirits/doctors (through the icaros/songs). It can really blunt dreams, intuition and senses.
(Yah this probably sounded woo-woo, but I am speaking from a different, non-western context/lens that views this as a spiritual malady. So take that as you will)
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...
The fact that someone had a negative reaction to an overdose has nothing to do with how (properly dosed) THC/CBD affects unhealthy (and healthy) people.
Many substances can be overdosed on, even though they may not be harmful - or may even be beneficial - in appropriate amounts.
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.