Learn About Cannabis

Science-based information for the general public.

Mental Health and Cannabis

Learn About Cannabis 5 Health Risks 5 Mental Health and Cannabis
Arms of someone leaning on a railing overlooking peace lakeThe link between cannabis use and mental health receives a great deal of attention from research and the media. Although severe illnesses such as schizophrenia are often discussed, there is also debate about how cannabis use affects more common psychiatric disorders such as depression and anxiety. Some people report that cannabis helps alleviate symptoms caused by mental health problems, while others report that cannabis use makes their symptoms worse. In Washington State, 44% of people who have used cannabis in the past month say they use it to manage symptoms of anxiety, 34% to manage depression, and 21% to manage symptoms of PTSD.4 People with a mental health diagnosis are more likely to use different cannabis product types, including high-THC products, and to use cannabis more often than people without a diagnosis.5

Researchers are working hard to untangle how cannabis affects common mental health conditions. In this article, we describe what studies have revealed about the effects of cannabis use on depression, anxiety, and Post-Traumatic Stress Disorder (PTSD).

For more information about cannabis use and psychosis, visit our cannabis and psychosis page.

Cannabis and Depression

Cannabis use and depression are connected in a bi-directional way.

Research on the relationship between cannabis use and depression has produced mixed results, likely due to differences in how the studies were conducted. Despite this, certain trends emerge when good quality studies are looked at together. There is consistent evidence that cannabis use is related to depression in the general population. It is likely that this relationship is bidirectional, meaning that cannabis use can lead to depression and that people with depression are more likely to use cannabis in an attempt to manage their symptoms.7-9 About a third of people who use cannabis medicinally say they use it to treat symptoms of depression.10

People who use cannabis are between 17% and 62% more likely to have depression than people who don’t use cannabis, and it appears this relationship is stronger among people who use cannabis more frequently.8,11

WHAT IS CLINICAL DEPRESSION?

Everyone experiences sadness at times. Major depressive disorder, or clinical depression, is a mood disorder that causes ongoing feelings of sadness and lack of interest that last for at least two weeks and are accompanied by at least five of the following symptoms:

·       Sleeping poorly – either too much or too little

·       Feeling tired and without energy

·       Change in appetite or losing or gaining weight

·       Thinking and moving more slowly or more quickly (in an agitated way)

·       Feeling worthless or guilty

·       Having trouble concentrating or making decisions

·       Frequently thinking about death or suicide

These feelings make normal day-to-day activities more difficult and are not caused by drug use or another medical condition.

 

HOW IS DEPRESSION TREATED?

Medication and psychotherapy are effective for most people with depression.

Medications include selective serotonin reuptake inhibitor (SSRIs), Serotonin-norepinephrine reuptake inhibitor (SNRIs), and other antidepressants.

Several kinds of psychotherapy have been shown to be effective for treating depression, including cognitive behavioral therapy (CBT) and interpersonal therapy. Therapists help patients reframe their thinking to find better ways to cope and solve problems with a goal of regaining a sense of satisfaction in life.

Other therapies include electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS), both of which impact neurotransmitters in the brain to relieve depression. These treatments are typically used for people who don’t respond to medications and therapy.

If you are experiencing symptoms of depression, there are many treatment options that could help. Start by talking to your doctor about what might work best for you. 

Some people are more at risk of experiencing depression than others.

Those who start using cannabis earlier (early adolescence) are 37% more likely to experience depression and 3.5 times more likely to attempt suicide later in life,9,12 and early heavy cannabis use may increase the risk of earlier onset of depression.8 For more information on cannabis and adolescents, see our Adolescents page.

Frequent use or having a cannabis use disorder (CUD) makes the relationship between cannabis use and depression stronger and seems to make depressive symptoms worse6,8,11,13,14  with one study reporting people with CUD being 2.6 times as likely to also have a major depressive disorder as non-cannabis users.11

Females who use cannabis regularly appear to be somewhat more susceptible to cannabis related depressive symptoms, psychological distress, and suicidality than males,7,15-17 possibly due to sex differences in how the endocannabinoid system develops.18 The endocannabinoid system is a system in the human body that helps regulate mood, among other processes, and is activated by chemicals found in the cannabis plant. However, animal studies suggest that both males and females are equally at risk of experiencing emotional changes when they start using cannabis before puberty, especially when they are also experiencing high levels of stress.19

There is not solid evidence that cannabis works to treat depression.

Animal studies have shown that low doses of THC and CBD may have an anti-depressant effect, but that higher doses have the opposite effect, making certain depression symptoms worse.8

In humans, there is no evidence that cannabis is an effective treatment for depression. One study found that people using cannabis medicinally felt that their depression and anxiety symptoms were improved in the short-term, but that continued use seemed to make depression symptoms worse.20 Similarly, other studies indicate that cannabis use, especially frequent and extended use of high-THC cannabis, worsens depression symptoms in people with major depressive disorder.8,21 The National Academies of Sciences, Engineering, & Medicine22 found that cannabis was not effective for treating depression symptoms but noted that research was limited. Another systematic review similarly found no evidence that cannabis was therapeutic for depression.23

Notably, symptoms of cannabis withdrawal include low mood and sleep problems, which are also symptoms of depression, so it may feel like depression symptoms worsen when first stopping cannabis use. Brain imaging studies suggest that it may take a month of no cannabis use for symptoms to improve.8

Cannabis and Anxiety

It’s unclear whether cannabis use increases the risk of an anxiety disorder.

Use of products with high levels of THC is clearly related to increases in anxiety, panic attacks, and paranoia within hours of use.7,24,25 In Washington state, panic reactions are the most frequent negative effect reported by people who consume cannabis. What is less certain is whether cannabis use can lead to long-term anxiety. Some studies suggest that cannabis use, especially frequent use, increases the risk of experiencing anxiety disorders later. However, other studies showed no relationship, or that cannabis with lower amounts of THC may decrease anxiety.12,25-29,

At least one study showed that a reduction in cannabis use decreased symptoms of anxiety three months later.30 While infrequent cannabis use does not appear to be related to an anxiety diagnosis later, frequent use of THC may increase the odds of social anxiety disorder31 or generalized anxiety disorder,11 and more frequent use of cannabis is generally associated with poorer outcomes in people with an anxiety disorder.7

Generalized Anxiety Disorder (GAD) involves chronic, excessive worry about various aspects of everyday life, such as health, work, or finances, often without a specific trigger.

Social Anxiety Disorder (SAD) is characterized by an intense fear of social or performance situations, where one fears being judged, embarrassed, or criticized by others.

Medications and psychotherapy have been shown to be effective for treating anxiety.

Cognitive behavioral therapy (CBT) is the most effective form of therapy for treating anxiety disorders. It teaches skills for managing anxiety that allow people to return to activities or situations that they may have avoided.

Several types of medications may be prescribed to treat anxiety, depending on the type of anxiety disorder. Certain antidepressants can help with anxiety. Anti-anxiety medications are available, and sort-term options, such as sedatives or beta blockers may be prescribed.

Talk to your doctor to get a diagnosis and to discuss which treatment might work best for you.

CBD shows some promise for treating anxiety.

50% of people who use cannabis medicinally report using it to treat anxiety,10 however research on whether cannabis works to reduce anxiety symptoms is in its infancy.24,32 Over 84% of people who use cannabis to treat anxiety report that their symptoms are improved following cannabis use, with the largest symptom reduction reported with use of high cannabidiol (CBD) products. Only a handful of randomized controlled trials have been conducted, but some have shown promise that CBD could be effective in treating anxiety.1,24

Cannabis affects the system in our body that helps regulate mood and lower anxiety, the endocannabinoid system. Studies have shown that disrupting this system increases anxiety, so some scientists have wondered if stimulating it with cannabis, particularly CBD, could help reduce anxiety.7,17,33 Several studies have shown that CBD decreases anxiety in mice immediately after administration,24 but none examined the effects of CBD on anxiety over time.32,34 In humans, there is some evidence that CBD can reduce anxiety in people when they are experiencing an anxiety-causing event, like giving a speech, but only at certain doses.24 Fewer studies have examined CBD in people with generalized anxiety disorder, and less is known about whether CBD could help people with chronic anxiety.32,34 However, there is some indication that CBD can help to reduce symptoms in people experiencing an anxiety disorder in the short-term.2,3

Studies that have evaluated the effects of THC-based medications on anxiety have produced mixed results,24 and researchers are in the process of testing whether different CBD:THC ratios affect anxiety differently.

The National Academies of Sciences, Engineering, & Medicine22 examined the therapeutic effects of cannabinoids and cannabis and found some evidence to suggest cannabinoids may be beneficial for treating social anxiety but for not for other anxiety disorders. It may be that cannabis affects different types of anxiety in different ways.31

While there is some potential for CBD to help with anxiety, questions remain about whether different people are affected differently, whether THC is beneficial or harmful, and what doses people might need and in what form. Talk to your doctor if you are considering trying CBD to help with symptoms of anxiety.

Cannabis and PTSD

While PTSD is an eligible condition for using medicinal cannabis in WA state, we don’t have enough information to know whether cannabis use helps or hurts people with PTSD.

Post-Traumatic Stress Disorder (PTSD) can occur when a person experiences or witnesses an emotionally traumatic or life-threatening event. People with PTSD may re-live these events through intrusive memories, flashbacks, or nightmares and may experience anxiety or depression related to their past trauma. Cannabis use is common among people with PTSD. One study found that 65% of people who had ever been diagnosed with PTSD used cannabis in their lifetime, and current cannabis use was higher among people with PTSD than people without a PTSD diagnosis (14% compared to 9.2%).35 In addition, people with cannabis use disorder (CUD) are about 4 times more likely to also have a PTSD diagnosis than people without CUD.36

First-line treatment for PTSD includes medications, such as selective serotonin reuptake inhibitors (SSRIs) and trauma-focused interventions including cognitive processing therapy and exposure therapy. While effective for many people, these treatments don’t work for everyone. Many people who are looking for relief try cannabis,37 and patients and clinicians are interested in finding new therapies for the treatment of PTSD. Cannabis or cannabis extracts have been considered because they act on the receptors associated with memory, emotion, and fear responses,38 the same receptors that are connected to PTSD.

The research available so far is based on observational studies or very small trials, use different forms of cannabis, and are lower quality than the randomized controlled trials needed to make confident recommendations.39 Until better quality studies are conducted, researchers can’t say for sure whether cannabis use helps people with PTSD.

What follows is what we know so far.

Cannabis may affect different symptoms of PTSD differently.
  • Observational studies have shown that cannabis use may help reduce some PTSD symptoms, such as reducing anxiety, decreasing nightmares, and improving sleep.37,39,40
  • There is mixed evidence about whether more complex symptoms of PTSD, such as feelings of detachment from one’s own thoughts or from the environment or re-experiencing traumatic events, are relieved by cannabis use. Some studies have shown that cannabis may help relieve these symptoms, however others showed no change in symptoms with cannabis use.39,40
There are risks associated with using cannabis to treat PTSD.
  • There is some evidence that long-term cannabis use increases the likelihood of suicidal behavior in people with PTSD.37
  • 100% of studies in one systematic review found that in people with cannabis use disorder (CUD) and PTSD, use of cannabis contributed to worsening PTSD symptoms overall.37
  • People with PTSD who use cannabis are more likely to experience CUD and to report more cannabis-related problems that people without PTSD.38
  • One study found that veterans with PTSD who quit using cannabis experienced worse withdrawal symptoms that veterans without PTSD, making quitting more challenging.41

If you have PTSD and use cannabis frequently, or think you may have CUD, cannabis use may make your PTSD symptoms worse. Learn more about Cannabis Use Disorder, and find help for CUD on our Get Help page.

While cannabis may prove to help some people with anxiety or PTSD symptoms, we have a long way to go before we understand who it works best for, in what form and what dose, and how to best avoid side-effects and long-term harm, such as developing CUD or cannabis related psychosis. Sometimes people who use cannabis stop participating in other treatments recommended by their providers.38 It’s important to not let cannabis use stop you from getting care that has more evidence supporting its effectiveness

If you seem to be frequently depressed or anxious, or experience suicidal thoughts after using cannabis, then cannabis may not be safe for you. Pay attention to your body and emotional responses. 

Help is available.

Depression, anxiety, and PTSD are treatable. Drug and alcohol services and mental health services are available in most areas. Using a coordinated approach that will tackle both issues at the same time is ideal. Both psychosocial therapy and medications have been found effective for treating these conditions. Start by talking with your primary care provider to find out what treatment options are available and what might work best for you. If you need immediate help, call or text 988.

For specific information on where to get help for cannabis use, visit our Get Help webpage.

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Last updated June 2024.