Experts, insights, and experiences: Medical cannabis and mental health

Mental health is something that affects everyone, it’s something each individual in society has - all year round. But, this week, it’s Mental Health Awareness Week. 

Between the 13th and 19th of May, an extra effort is made to discuss the importance of mental health and how we can take care of it. And we wanted to join suit.

To round off the week, we’ve provided an overview of how diagnosed mental health conditions, like anxiety, post-traumatic stress disorder, and depression respond to cannabis-based treatments. 

We’ve also included insights from Graham Woodward, our Chief Medical Officer, and registered psychiatric nurse with over 20 years of experience, and shared the experiences of Daisy, a Releaf patient using medical cannabis to treat PTSD, to highlight how healthcare services can evolve to ensure their patients receive the best treatment, from both their prescriber and their prescription.

Mental Health Awareness

In the UK, the most commonly diagnosed mental health conditions are classed as either anxiety or depressive disorders, and it's estimated that 1 in every 6 adults have experienced anxiety or depression in the last week. 

It’s said between 2022 and 2023, the NHS prescribed approximately 86 million antidepressants in England alone, and spent around £16 billion on funding mental health services, which equates to about 14% of all local NHS funding allocations. 

But still, in the UK, many report receiving less than adequate treatment for their mental health disorders -  and the proportion of young people with a probable mental health condition has continued to rise, along with the expected wait list times attached to receiving NHS funded talking therapies. 

Our own research also shows an overwhelming proportion (59%) of the population remains unaware that medical cannabis treatments are available on prescription in the UK. Of those that did know, only 38% were aware this includes treatment options for diagnosis’ like anxiety, and even less knew this included depression (21%).

Which is why we felt as well as raising awareness for mental health conditions, we should also advocate for alternative treatment options like medical cannabis and spread awareness of these too, to try to help as many people as possible. 

Prescribed cannabis treatments for mental health conditions. 

Some would argue the legalisation of medical cannabis is one of Britain’s best kept secrets because of the vast percentage of the population that remain uninformed about these approaches. But in reality, medical cannabis has been a legally accessible treatment option in the UK since 2018. 

Available on private prescription for a wide range of conditions known to respond positively to cannabis-based treatments, bespoke medical cannabis treatment plans can be created by medical cannabis clinics like us, for patients who have exhausted conventional or licensed approaches. 

This includes patients who have not responded to conventional treatments for mental health conditions, such as: 

• Anxiety
• Depression
• Eating Disorders 
• Mood Disorders 
• Obsessive Compulsive Disorder (OCD)
• Post Traumatic Stress Disorder

The relationship between medical cannabis and mental health

The relationship between medical cannabis and mental health is a topic that recently has been gaining more and more attention, and thankfully, there is now reputable data and evidence that explores how these interactions work. 

To put it simply, cannabis contains a class of chemical compounds called cannabinoids - or phytocannabinoids. Our bodies produce a similar class of chemical compound called endocannabinoids, and these play an incredibly vital role in maintaining homeostasis, or balance, within the body. 

This includes, but is not limited to, regulating biological responses to triggers or stressors, impacting mood and emotion, and interacting with the production and regulation of hormones like dopamine and serotonin. 

When cannabis cannabinoids, like THC and CBD, enter the bloodstream, they can mimic the endocannabinoids our bodies naturally produce and gain access to these functions, influencing the responses our endocannabinoids typically dictate. 

How can medical cannabis benefit mental health symptoms?

Because of their ability to interfere or influence the responses our bodies usually evoke in times of stress or low mood, phytocannabinoids like CBD and THC can be utilised in mental health treatment plans to help alleviate the common symptoms associated with conditions like anxiety, depression, and PTSD.

Stress and anxiety

It’s now well accepted that CBD, or cannabidiol, has stress-relieving and relaxing qualities, and so, it can be a very useful component when treating anxiety. 

Serotonin is a neurotransmitter responsible for stabilising mood, and often, for those with mental health conditions like anxiety, their serotonin production is typically dysregulated.

But, experimental evidence shows cannabinoids can interact with the brain’s natural serotonin production cycle, and alter anxiety responses in a dose dependent manner. There’s also evidence to suggest that medical cannabis can also interact with the amygdala - which is the part of the brain responsible for regulating fear responses, and when applied appropriately, can reduce stress like responses to distressing stimuli.

This could prove particularly helpful for patients with anxiety, panic disorders and post-traumatic stress disorder who encounter rapid changes in emotion and stress levels.

In fact, one open-label phase 2 clinical trial using CBD showed significant improvements were noted after just 4 weeks. Another study from 2018, this time analysing responses to a survey sent out to medical cannabis patients, discovered their cohort experienced, on average, a 58% reduction in anxiety and stress after starting cannabis-based treatments.

Low mood

Another area, in which cannabis-based treatments have shown a lot of potential, is in the treatment of depression. 

Much like patients with anxiety, people who experience depression typically have lower levels of serotonin, and so CBD can be a useful component in helping to improve mood over a sustained period of time because of its relaxing and mood uplifting effects. 

Some patients report feeling less irritable after starting cannabis-based treatments as well, and many report improvements in their quality of life because their symptoms have become less of a hindrance in dealing with day to day life - which also often contributes to an improvement in mood. 

In terms of evidence, an analysis of the PHQ-9 questionnaire data submitted to the UK’s largest medical cannabis observational study shows, on average, depression symptom severity scores are halved within three months of using cannabis-based medicines. 

Poor Sleep

Another common symptom experienced by people with mental health conditions, is issues with their sleep. 

This can include having trouble falling asleep because they struggle to unwind or relax, or issues staying asleep due to unwanted or distressing nightmares, thoughts, or feeling - but this all contributes to having poor sleep quality, which can then have a knock on effect on physical and mental health. 

But, data shows medical cannabis may be able to assist with this as well. One placebo controlled trial shows the patients who received a medical cannabis oil treatment reported an 80% improvement in their sleep quality during the trial, and another placebo controlled study showed insomnia severity scores fell by over ¼ when patients used medical cannabis. 

Tailored treatment plans

For patients with mental health conditions like anxiety, depression and post-traumatic stress disorder, bespoke medical cannabis treatment plans can be carefully curated by expert clinicians that work for Releaf, where cannabinoid concentrations and complimentary terpene profiles are tailored to best suit each individual, their symptoms, and, their lifestyle. 

What mental health conditions are not deemed suitable for cannabis-based treatments?

While some reports suggest that CBD, the prominent non-psychoactive cannabinoid found in cannabis, may be able to alleviate some symptoms suffered by those with schizophrenia such as anxiety, it’s well accepted that patients with schizophrenia should avoid any and all products with THC - cannabis’ psychoactive component. 

This is because THC can have psychoactive effects - meaning it can alter a person's sense of consciousness, their perceptions, and mental processes that influence mood and emotion. For patients with schizophrenia, this could exacerbate symptoms like paranoia, and could potentially trigger psychotic episodes if they are prone to experiencing these, or if they are genetically predisposed.

Therefore, medical cannabis is not a recommended treatment option for mental health conditions like psychosis or schizophrenia, and currently, the evidence regarding cannabis’ therapeutic ability in treating bipolar disorder also remains contradictory, and so most medical cannabis clinics in the UK will not prescribe medical cannabis to a patient with a history of these diagnoses’. 

How is patient safety monitored in medical cannabis treatment plans? 

Because of the psychoactive effects associated with cannabis, it is essential that medical cannabis treatment plans for any condition are overseen and monitored by a qualified, and experienced, healthcare professional. 

While medical cannabis can have remarkable results for many patients with mental health conditions, regular check-ins are required to ensure that each patient’s progress, and experience with their new treatment plan, remains positive. 

Our expert Psychiatrist, Dr Imran Ali, explains: 

"Many patients have reported that medical cannabis may provide excellent mood uplifting effects, while at the same time reducing the crippling effects of anxiety.

When prescribed in a controlled manner in a clinical setting such as here at Releaf, patients have a clinical touchpoint with a Consultant so that, should their mental health change whilst in receipt of a prescription, their condition may be expertly managed without undue delay."

Adjustments to concentrations, dosing routines, administration methods can be made during these follow-up appointments should patients experience any unwanted side effects, or adverse reactions, but generally speaking, cannabis-based medicines are well tolerated by the individuals who have been deemed suitable for their applications. At Releaf, after a patient has been with us for two months, follow-up appointments are required at 120 day intervals. 

Sharing perspectives: Insights from Graham Woodward

To get more insight, we also spoke to Graham Woodward, our Chief Medical Officer and a registered psychiatric nurse, about the experiences he’s shared with patients who have depression, anxiety and post-traumatic stress disorder, over the years. 

Graham said: 

“Typically, when I speak to a person who has a mental health condition, they’ve cycled through a number of licensed SSRIs, or have been back and forth to their doctor to have their dosages altered, and polypharmacy is common.

When they first start a course of SSRIs it usually takes about a month to settle into the system, and people often report either feeling quite hyper, or feeling low and numb during this time. This can be really challenging to deal with - especially considering the motivation for taking these medications, and a lot of patients struggle with conventional SSRIs for this reason.

But, I’ve seen people who suffer with anxiety, depression, PTSD or C-PTSD whose lives have literally changed when they’ve started medical cannabis treatment. 

I've seen their lives turn around within a week, they feel calmer, they’re more outgoing, their sleeping and eating often improves, and the world doesn’t feel as ‘against’ them any more. There is so much global, real-world evidence that cannabis works as a medication for these conditions. 

Some examples that spring to mind include two patients who both had severe social anxiety. Both lived on opposite ends of the country, they were different genders and they had different lifestyles, but, neither of them ever left the house. They were both only 18 years old, and they wanted to be out and about, but their crippling anxiety just wouldn’t let them.

We started them both on a course of medical cannabis treatment. One of these patients, who had never left their house, or gone to school, started driving lessons. The other, began working for the census, and was knocking on people’s doors on a daily basis, speaking to strangers.

After 27 years of working in psychiatry, I’ve never seen anything like it, and I’m honestly still amazed at how effective medical cannabis can be, especially for the conditions we’ve just discussed.”

Sharing perspectives: Daisy’s story with medical cannabis

Last month we also spoke to Daisy, a 47-year-old Chief Social Worker and medical health and addiction specialist, about her first-hand experiences of using prescribed medical cannabis to treat post-traumatic stress disorder. 

Daisy told us: 

“My trauma history is multi-generational, and it means I have to live a double life for all intents and purposes - on the one hand I’m a professional, but on the other I’m also somebody who has got lived experience, and walking that line is really, really difficult. I have been prescribed all sorts of stuff over the years, and it usually knocks you out or makes you not feel anything, but medical cannabis allows me to walk that line.

Before trying cannabis, I was very anxious. I had a series of panic attacks every day and was very depressed. I would get motion sickness simply by getting out of bed in the morning because of the balance disorder [I also have], and I would be vomiting several times a day. It was miserable. Over the years, I’ve tried lots of medications and nothing really touched me. Medical cannabis does.”

We also asked Daisy if there were any challenges she’d faced along her journey of using medical cannabis. 

She said: 

“Certainly from wider society - without a doubt, the stigma is massive. When my work colleagues tried to report me, I got asked by someone who had known me for 10 years if I'd been intoxicated at work - that’s the automatic response. 

For some people, medical cannabis makes all the difference - it means that you can function and actually just focus on your wellness and health, rather than the politics and social justice issues often associated with it…..

Cannabis users can actually be productive members of society. I've got a 30-year career. I've published nine textbooks. I run my own business and have done so for nearly 15 years. I was an NHS executive director, the Mental Capacity Lead for the College of Social Work - and I am a medical cannabis user. And those two things work together. If anybody doubts that, just look at me.