Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
5.3 Major clinical issues with depression and cannabis/ hallucinogen use
Table of contents
- Acknowledgments
- Abbreviations
- Preface
- Introduction
1. Levels of evidence- 2. Management of people with comorbidity of mental disorders and substance use
- 3. The common drug groups
- 4. Tobacco
5. Depression and substance use- 5.1 Depression
- 5.2 Comorbidity with depression
- 5.3 Major clinical issues with depression and cannabis/ hallucinogen use
- 5.4 Major clinical issues with depression and alcohol use
- 5.5 Major clinical issues with depression and opioid use
- 5.6 Major clinical issues with depression and stimulant (including methamphetamine) use
- 5.7 Major clinical issues with depression and benzodiazepine use
- 5.8 Major clinical issues with depression and inhalant/ solvent use
- 6. Anxiety disorders and substance use
- 7. Psychosis (schizophrenia and bipolar disorder) and substance use
- 8. Personality disorders and substance use
- 9. Eating disorders and substance use
- 10. Somatoform disorders and substance use
- 11. Gambling and substance use
- 12. Brain injury, mental disorders and substance use
- 13. Bibliography
- 14. Appendices
- Since cannabis use appears to be a predictor of depression, cessation of cannabis use is important as a first step so that depressive symptoms can be better evaluated.
- However, abstinence from cannabis is a difficult goal to achieve in cannabis dependent people.
- In the absence of other proven forms of treatment, CBT is, at present, the most widely employed form of treatment for cannabis use.
5.3.1 Effect of cannabis and other hallucinogens on depression
- Depression is more common in people who use cannabis, particularly with those who commenced at a young age(4-6).
- There is little support for the self-edication hypothesis of cannabis being used to relieve symptoms of depression(4) and a greater evidence base suggesting cannabis to be a predictor of depression(126).
- The association between cannabis use and depression may be due to common factors that lead individuals to develop depression and use cannabis(4).
- Higher quantities of cannabis use predict more severe depressive symptoms(4).
5.3.2 Interactions between cannabis and hallucinogens and therapeutic agents for depression
- Cannabis can exacerbate the sedative effects of tricyclic antidepressants which increases the risk of impaired driving and injury as well as overdosex.
- LSD may induce a serotonin syndrome (Appendix 1) therefore, caution should be exercised when prescribing SSRIs or MAO-Ix(127).
- Cannabis and antidepressants are metabolised by CYP 450 enzymes which may result in the inhibition or induction of either drug group. Therefore, individuals should be monitored closely to ensure outcomes are appropriatex.
5.3.3 Management approaches to comorbid depression and cannabis use
- Since cannabis use appears to be a predictor of depression, cessation of cannabis use is important as a first step wherever possible so that depressive symptoms can be better evaluated.
- However, abstinence from cannabis is a difficult goal to achieve in cannabis-dependent people(128).
- In the absence of other proven forms of treatment, CBT is, at present, the most widely employed form of treatment for cannabis use****(128).
