Can Cannabis Help With Depression?

[A Zoom screen with the three panelists and BTW Peer Educator Catherine Romero.]

Catherine Romero: Thank you for all your answers. So the next question is gonna be directed to Tom but as always just feel free to chime in. If you feel like you have an answer some more response to this. So the question is can cannabis help with depression?

[Catherine Romero leaves the Zoom screen]

Tom Fontana: Thank you. And I'd be grateful for Dr. Gruber's response and anyone else? I would just say depression. So depression is from the, from a medical it's a cluster of symptoms that that we've come to define as one thing, it can really it can be seen in neurotransmitter into the brain. It can be seen and held in our body in the way that we hold trauma and other symptoms of depression. So it's very real. And yet it's also intangible in many ways. And so I would say that there are many symptoms of depression of which cannabis can certainly in the moment treat some of those. So, absolutely. So yes, I think the thing that I would say really in conversation with any person as I'm talking to a student or someone else. If someone tells me their smoking weed's helping them with depression. I'm like, thank God, depression is terrible. I'm glad you found something that helps. The question is really, will it help tomorrow? Will it help the next day? And how does that work? There absolutely is something particularly cumulative about cannabis, probably within the way THC stored in the body and other things that all drugs have a tolerance that we build, but cannabis certainly has that. And so the effectiveness goes down and the question is how do you continue to have something to be helpful? And then we bring in particularly on a traditional college stage group people whose brains aren't done developing at 25 there are particular challenges then not to the it still helps, if you like smoking weed smoking weed still great in the moment. The challenge is they only high for a few hours. The cannabinoids are in your system for many hours. The brain's receptors are pulling back and responding to that. And it fundamentally changes some aspects of brain development. We don't fully know that that's actually what Dr. Chris was doing a lot of good research and other people on that. But we just know that just say with anxiety if it helps you feel less anxious in the moment you perhaps returned to a state where you're less able to tolerate that anxiety. And that becomes a challenge, same thing with depression. So I think it does help with symptoms. The challenge is how do we keep it effective particularly for people under the age of 20?

Dr. Staci Gruber: Yeah, I would just, I think that's great. That's a great answer. I would add two quick things. One as Tom very eloquently points out depression isn't one thing, it's a constellation of symptoms. And the truth of the matter is there are many, many different things. When we talk about cannabis it's not one thing. And so what we have to be really mindful of THC as the primary quote, intoxicating or psychoactive constituent and what that may do especially to the developing brain. We spent the first 20 plus years of my lab looking at that. Versus some of the other cannabinoids, which actually may not be, they may not only be not harmful. They may actually be helpful. So there's a real distinction here between what I call the what's in your weed factor, right? We analyze exactly what patients are using and calculate sort of the relationships, if you will between different individual constituents and symptoms. That's why we like to do clinical trials because we can formulate exactly what we're testing and then look at the impact on specific clinical symptoms but depression, for example, versus anxiety. It's a really, really important thing to remember. You may feel okay for a while. With regard to THC, there is increasing evidence from preclinical that is animal studies and clinical studies with people that can have a dial in concert with other cannabinoids in very small amounts is actually really helpful for people with anxiety. There is not the same level of priming. if you will, over time in terms of neuro-transmitters and mechanisms of action. How it all happens in your brain and throughout your body very different with cannabidiol and THC, super important. We tend to think of these things as a bigger bang for the buck when they're not just one extracted compound like not pure CBD by itself may not be as efficacious for things as CBD along with lots of its other friends in smaller amounts, even THC. But when I say small amounts, I don't mean 10 MIGS. I don't mean five MIGS. I don't even mean two MIGS. I mean, 0.3 MIGS per mil, not 0.3% by weight. That's the standard definition of industrial hemp and legal in this country. It's not what I mean. That translates to three milligrams per milliliter in a sublingual solution. That can get you high just saying, I don't care who you are, it can. Doesn't usually for most people, but still the idea is you should understand what's in your weed. That's the big thing, and be very mindful about the idea that there is a dose-related response especially for anxiety at low doses. THC can be anxiolytic. That is it relaxes you. At high doses it is absolutely anorexigenic for lots of people. And that is when you see these people who are too high for the, you know, what streets, right? They can't leave their apartments they can't do this, they can't do that. And that's not a place anybody wants to be. So be very, very mindful of it. That said clinical trials specifically designed to create combinations of constituents interpreters, et cetera, not THC free, but just super, super super low doses may be the key because you just want to unlock that receptor and leave it there may be the key. So it's a little bit different from some of these products that might be 30, 40, 50% THC. The so-called concentrate products that I unfortunately hear a lot of people turn to because they think of a little is good. A lot must be better.

Will Jones III: Now I want to just briefly talk from a policy perspective on what Tom and Stacy just shared. That was the medical perspective. I think this is where policy has failed us in many ways with the industry, we have to understand that this is a very lucrative industry for certain individuals and organizations that are investing in this. And so just as Stacy was breaking down what the different components do the different doses do and whatnot. Unfortunately we've seen kind of medical recreational in these things conflated in different states in terms of policy, without distinctions between types of use for recreational and between potency, potency caps and different things like that. And so that's where, for example with the alcohol industry they make 75% of their revenue from 10% of the users. That's people that drink on average 10 drinks a day or more. So if what happened at the end of their commercials drink responsibly actually happened. They would lose about 75% of their revenue. And so when you have a similar industry and similar investors, Heineken, Blue Moon, Molson Coors, Corona, they've all invested hundreds of millions in the cannabis industry. We have to be aware that of the tactics that they use to get people to use more and more often, because that increases their bottom line. And while this doesn't happen for everyone we do see some extremely high potency concentrates in some states that are legal, which, you know, the data from the Colorado Department of Revenue shows similar a similar disparity in the amount and where the revenue is coming from. Meaning that about 70% of the revenue is coming from 10 to 20% of the users again. And that's the people that are using heavily and many times some of the high concentrates play a factor in heavy use for certain individuals. And so we have to be aware of that when we're making policies that's regulated in a way that's respectful of public health.

[Leah Berkenwald and BTW Peer Educator Denezia Fahie appear on the Zoom screen.]