The association between cannabis use and depression: a review of the evidence

doi:10.1017/CBO9780511543630.006

4 - The association between cannabis use and depression: a review of the evidence

Published online by Cambridge University Press: 07 December 2009

Louisa Degenhardt ,

Wayne Hall ,

Michael Lynskey ,

Carolyn Coffey and

George Patton

Edited by

David Castle and

Robin Murray

Show author details

David Castle: Affiliation:
Mental Health Research Institute, Melbourne
Robin Murray: Affiliation:
Institute of Psychiatry, London

Book contents

Get access

Summary

Introduction

The association between cannabis and depression has not received as much attention as the links between cannabis use and psychosis. One of the reasons may be that the depressed are much less likely to come to the attention of treatment services than are those who are psychotic. Furthermore, some symptoms of cannabis dependence may mimic those of depression and so comorbid depression may go undiagnosed.

Rising rates of cannabis use (Donnelly and Hall, 1994; Hall et al., 1999; Degenhardt et al., 2000; Johns, 2001), depression (Andrews et al., 1998; Cicchetti and Toth, 1998) and suicide among young adults (Diekstra et al., 1995; Lynskey et al., 2000) have increased public concern about the role of substance abuse, including cannabis, in non-psychotic mental disorders. There has also been increasing advocacy for interventions to prevent and treat problematic cannabis use and depressed mood among young people. Given these parallel rises, recent speculation that the two may be linked is understandable.

Given the high prevalence of both cannabis use and depression there remains a question why any comorbid relationship has received little clinical attention? It may reflect a lack of association between the two. However, until recently, there was disagreement as to whether cannabis dependence (or problematic cannabis use) existed, with few treatments available. A lack of clinical attention may therefore have simply reflected a lack of services that might have detected an association. Lastly, due to its illegal status, cannabis use may remain unreported by clients presenting with depression.

Information

Type: Chapter
Information: Marijuana and Madness
Psychiatry and Neurobiology
, pp. 54 - 74

DOI: https://doi.org/10.1017/CBO9780511543630.006 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Abel, E. (1971). Changes in anxiety feelings following marihuana smoking. Br. J. Addict., 66, 185–187CrossRef Google Scholar PubMed

Ablon, S. L. and Goodwin, F. K. (1974). High frequency of dysphoric reactions to tetrahydrocannabinol among depressed patients. Am. J. Psychiatry, 131, 448–453Google Scholar PubMed

Alpert, J., Maddocks, A., Rosenbaum, J. and Fava, M. (1994). Childhood psychopathology retrospectively assessed among adults with early onset depression. J. Affect. Disord., 31, 165–171CrossRef Google Scholar

American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn revised (DSM-IV;-R). Washington, DC: American Psychiatric Association

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association

Andrews, G., Mathers, C. and Sanderson, K. (1998). The burden of disease. Med. J. Aust., 169, 156–158Google Scholar PubMed

Angst, J. (1996). Comorbidity of mood disorders: a longitudinal prospective study. Br. J. Psychiatry, 168 (suppl. 30) 31–37Google Scholar

Anthony, J. C. and Helzer, J. (1991). Syndromes of drug abuse and dependence. In Psychiatric Disorders in America, ed. L. N. Robins and D. A. Regier, pp. 116–154. New York: The Free Press

Bardone, A.Moffitt, T., Caspi, A.et al. (1998). Adult physical health outcomes of adolescent girls with conduct disorder, depression, and anxiety. J. Am. Acad. Child Adolescent Psychiatry, 37, 594–601CrossRef Google Scholar PubMed

Beautrais, A. L., Joyce, P. R. and Mulder, R. T. (1999). Cannabis abuse and serious suicide attempts. Addiction, 94, 1155–1164CrossRef Google Scholar PubMed

Bell, J., Ward, J., Mattick, R. P. et al. (1995) An Evaluation of Private Methadone Clinics. Canberra: Australian Government Publishing Service

Berkson, J. (1946). Limitations of the application of fourfold table analysis to hospital data. Biometrics Bull., 2, 47–53CrossRef Google Scholar PubMed

Best, D., Gossop, M., Greenood, J.et al. (1999). Cannabis use in relation to illicit drug use and health problems among opiate users in treatment. Drug Alcohol Rev., 18, 31–38CrossRef Google Scholar

Blazer, D. (1995). Mood disorders: epidemiology. In Comprehensive Textbook of Psychiatry, VIth edn., vol. 1, ed. H. Kaplan and B. Sadock, pp. 1079–1089. Baltimore, MD: Williams and Wilkins

Bovasso, G. (2001). Cannabis abuse as risk factor for depressive symptoms. Am. J. Psychiatry, 158, 2033–2037CrossRef Google Scholar PubMed

Bowers, M. (1998). Family history and early psychotogenic response to marijuana. J. Clin. Psychiatry, 59, 198–199CrossRef Google Scholar PubMed

Boyd, J. H., Burke, J. D., Gruenberg, E.et al. (1984). Exclusion criteria of DSM-III: a study of co-occurrence of hierarchy-free syndromes. Arch. Gen. Psychiatry, 41, 983–989CrossRef Google Scholar PubMed

Brady, K. T., Casto, S., Lydiard, R. B.et al. (1991). Substance abuse in an inpatient psychiatric sample. Am. J. Drug Alcohol Abuse, 17, 389–397CrossRef Google Scholar

Brook, J. S., Cohen, P. and Brook, D. W. (1998). Longitudinal study of co-occurring psychiatric disorders and substance use. J. Am. Acad. Child Adolescent Psychiatry, 37, 322–330CrossRef Google Scholar PubMed

Caron, C. and Rutter, M. (1991). Comorbidity in child psychopathology: concepts, issues and research strategies. J. Child Psychol. Psychiatry, 32, 1063–1080CrossRef Google Scholar PubMed

Chen, C.-Y., Wagner, F. and Anthony, J. (2002). Marijuana use and the risk of major depressive episode: epidemiological evidence from the United States National Comorbidity Survey. Social Psychiatry Psychiatric Epidemiol., 37, 199–206CrossRef Google Scholar PubMed

Cicchetti, D. and Toth, S. (1998). The development of depression in children and adolescents. Am. Psychol., 53, 221–241CrossRef Google Scholar PubMed

Degenhardt, L., Lynskey, M. and Hall, W. (2000). Cohort trends in the age of initiation of drug use in Australia. Aust. NZ J. Public Health, 24, 421–426CrossRef Google Scholar PubMed

Degenhardt, L., Hall, W. and Lynskey, M. (2001). The relationship between cannabis use, depression and anxiety among Australian adults: findings from the National Survey of Mental Health Well-Being. Social Psychiatry Psychiatric Epidemiol., 36, 219–227CrossRef Google Scholar

Dhossche, D., Rich, C. and Isacsson, G. (2001). Psychoactive substances in suicides: comparison of toxicologic findings in two samples. Am. J. Forensic Med. Pathol., 22, 239–243CrossRef Google Scholar PubMed

Diekstra, R., Kienhorst, C. and de Wilde, E. (1995). Suicide and suicidal behaviour among adolescents. In Psychosocial Disorders Among Young People: Time Trends and their Causes, ed. M. Rutter and D. J. Smith, pp. 686–761. Chichester: John Wiley

Donnelly, N. and Hall, W. (1994). Patterns of Cannabis Use in Australia. NCADA Monograph Series no. 27. Canberra: Australian Government Publishing Service

Estroff, T., Dackis, C., Gold, M. and Pottash, A. (1985). Drug abuse and bipolar disorders. Int. J. Psychiatry Med., 15, 37–40CrossRef Google Scholar PubMed

Feinstein, A. R. (1970). The pre-therapeutic classification of comorbidity in chronic disease. J. Chronic Dis., 23, 455–468CrossRef Google Scholar PubMed

Fergusson, D. M. and Horwood, L. J. (1997). Early onset cannabis use and psychosocial adjustment in young adults. Addiction, 92, 279–296CrossRef Google Scholar PubMed

Fergusson, D. M. and Horwood, L. J. (2001). The Christchurch Health and Development Study: review of findings on child and adolescent mental health. Aust. NZ J. Psychiatry, 35, 287–296CrossRef Google Scholar PubMed

Fergusson, D., Horwood, J. and Lawton, M. (1990). Vulnerability to childhood problems and family social background. J. Child Psychol. Psychiatry, 31, 1145–1160CrossRef Google Scholar PubMed

Fergusson, D., Horwood, L. and Lynskey, M. (1994). Parental separation, adolescent psychopathology and problem behaviours. J. Am. Acad. Child Adolescent Psychiatry, 33, 1122–1131CrossRef Google Scholar

Fergusson, D. M., Horwood, J. and Swain-Campbell, N. (2002). Cannabis use and psychosocial adjustment in adolescence and young adulthood. Addiction, 97, 1123–1135CrossRef Google Scholar PubMed

Field, T., Diego, M. and Sanders, C. (2001). Adolescent suicidal ideation. Adolescence, 36, 241–248Google Scholar PubMed

Fu, Q., Heath, A. C., Bucholz, K. K.et al. (2002). Shared genetic risk of major depression, alcohol dependence and marijuana dependence: the contribution from antisocial personality disorder in men. Arch. Gen. Psychiatry, 59, 1125–1132CrossRef Google Scholar PubMed

Galaif, E., Chou, C.-P., Sussman, S. and Dent, C. (1998). Depression, suicidal ideation, and substance use among continuation high school students. J. Youth Adolescence, 27, 275–299CrossRef Google Scholar

Galbaud Du Fort, G., Newman, S. and Bland, R. (1993). Psychiatric comorbidity and treatment seeking: sources of selection bias in the study of clinical populations. J. Nerv. Ment. Dis., 181, 464–474Google Scholar

Gale, E. N. and Guenther, G. (1971). Motivational factors associated with the use of cannabis (marihuana). Br. J. Addict., 66, 188–194CrossRef Google Scholar

Grant, B. F. (1995). Comorbidity between DSM-IV drug use disorders and major depression: results of a national survey of adults. J. Substance Abuse, 7, 481–497CrossRef Google Scholar PubMed

Green, B. E. and Ritter, C. (2000). Marijuana use and depression. J. Health Social Behav., 41, 40–49CrossRef Google Scholar PubMed

Grinspoon, L. and Bakalar, J. B. (1998). The use of cannabis as a mood stabilizer in bipolar disorder: anecdotal evidence and the need for clinical research. J. Psychoactive Drugs, 30, 171–177CrossRef Google Scholar PubMed

Gruber, A. J., Pope, H. G. and Oliva, P. (1997). Very long-term users of marijuana in the United States: a pilot study. Substance Use Misuse, 32, 249–264CrossRef Google Scholar PubMed

Hall, W., Johnston, L. and Donnelly, N. (1999). Epidemiology of cannabis use and its consequences. In The Health Effects of Cannabis, ed. H. Kalant, W. Corrigall, W. Hall and R. Smart, pp. 71–125. Toronto, Canada: Centre for Addiction and Mental Health

Hall, W., Degenhardt, L. and Lynskey, M. (2001). The Health and Psychological Consequences of Cannabis Use. NCADA Monongraph no. 44. Canberra: Australian Publishing Service

Hofstra, M., Ende, J. and Verhultz, F. (2002). Child and adolescent problems predict DSM-IV disorders in adulthood: a 14-year follow-up of a Dutch epidemiological sample. J. Am. Acad. Child Adolescent Psychiatry, 41, 182–189CrossRef Google Scholar PubMed

Holden, R. and Pakula, I. (2001). Marijuana, stress and suicide: a neuroimmunological explanation. Aust. NZ J. Psychiatry, 36, 465–466Google Scholar

Institute of Medicine (1996). Pathways of Addiction. Washington, DC: National Academy Press

Jablensky, A.Sartorius, N. and Ernberg, G. (1991). Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychol. Med. (suppl. 20)Google Scholar

Johns, A. (2001). Psychiatric effects of cannabis. Br. J. Psychiatry, 178, 116–122CrossRef Google Scholar PubMed

Kandel, D. B. (1984). Marijuana users in young adulthood. Arch. Gen. Psychiatry, 41, 200–209CrossRef Google Scholar PubMed

Kandel, D. and Chen, K. (2000). Types of marijuana users by longitudinal course. J. Studies Alcohol, 61, 367–378CrossRef Google Scholar PubMed

Kandel, D. and Davies, M. (1986). Adult sequelae of adolescent depressive symptoms. Arch. Gen. Psychiatry, 43, 255–262CrossRef Google Scholar PubMed

Kandel, D. B., Davies, M., Karus, D. and Yamaguchi, K. (1986). The consequences in young adulthood of adolescent drug involvement. Arch. Gen. Psychiatry, 43, 746–754CrossRef Google Scholar PubMed

Kandel, D., Chen, K., Warner, L. A., Kessler, R. C. and Grant, B. (1997). Prevalence and demographic correlates of symptoms of last year dependence on alcohol, nicotine, marijuana and cocaine in the U.S. population. Drug Alcohol Dependence, 44, 11–29CrossRef Google Scholar PubMed

Kelder, S., Murray, N., Orpinas, P.et al. (2001). Depression and substance use among minority middle-school students. Am. J. Public Health, 91, 761–766Google Scholar PubMed

Kendler, K. S. (2001). Twin studies of psychiatric illness: an update. Arch. Gen. Psychiatry, 58, 1005–1014CrossRef Google Scholar PubMed

Kendler, K. S. and Prescott, C. A. (1998). Cannabis use, abuse, and dependence in a population-based sample of female twins. Am. J. Psychiatry, 155, 1016–1022CrossRef Google Scholar

Kendler, K., Neale, M., MacLean, C.et al. (1993a). Smoking and major depression: a causal analysis. Arch. Gen. Psychiatry, 50, 36–43CrossRef Google Scholar

Kendler, K. S., Heath, A. C., Neale, M. C., Kessler, R. C. and Eaves, L. J. (1993b). Alcoholism and major depression in women. A twin study of the causes of comorbidity. Arch. Gen. Psychiatry, 50, 690–698CrossRef Google Scholar

Kendler, K., Karkowski, L., Neale, M. and Prescott, C. (2000). Illicit psychoactive substance use, heavy use, abuse and dependence in a US population-based sample of male twins. Arch. Gen. Psychiatry, 57, 261–269CrossRef Google Scholar

Kessler, R. C. (1995). Epidemiology of psychiatric comorbidity. In Textbook in Psychiatric Epidemiology, ed. M. T. Tsuang, M. Tohen and G. E. P. Zahner, pp. 179–197. New York: Wiley

Kessler, R. C., McGonagle, K. A., Zhao, S.et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch. Gen. Psychiatry, 51, 8–19CrossRef Google Scholar PubMed

Kessler, R. C., Nelson, C. B., McGonagle, K. A., et al. (1996). The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilization. Am. J. Orthopsychiatry, 66, 17–31CrossRef Google Scholar PubMed

Klein, D. and Riso, L. (1994). Psychiatric disorders: problems of boundaries and comorbidity. In Basic Issues in Psychopathology, ed. G. Costello, pp. 19–66. New York: Guilford

Kotin, J., Post, R. and Goodwin, F. (1973). Δ9-Tetrahydrocannabinol in depressed outpatients. Arch. Gen. Psychiatry, 28, 345–348CrossRef Google Scholar

Kouri, E., Pope, H., Yurgelun-Todd, D. and Gruber, S. (1995). Attributes of heavy vs. occasional marjiuana smokers in a college population. Biol. Psychiatry, 38, 475–481CrossRef Google Scholar

Lynskey, M. and Hall, W. (2000). The effects of adolescent cannabis use on educational attainment: a review. Addiction, 95, 1621–1630CrossRef Google Scholar PubMed

Lynskey, M., Degenhardt, L. and Hall, W. (2000). Cohort trends in youth suicide in Australia 1964 to 1997. Aust. NZ J. Psychiatry, 34, 408–412Google Scholar

Lynskey, M. T., Heath, A. C., Nelson, E. C.et al. (2002). Genetic and environmental contributions to cannabis dependence in a national young adult twin sample. Psychol. Med., 32, 195–207CrossRef Google Scholar

Marken, P., Stanislav, S.et al. (1992). Profile of a sample of subjects admitted to an acute care psychiatric facility with manic symptoms. Psychopharmacol. Bull., 28, 201–205Google Scholar

Mathew, R., Wilson, W. and Tant, S. (1989). Acute changes in cerebral blood flow associated with marijuana smoking. Acta Psychiatr. Scand., 79, 118–128CrossRef Google Scholar PubMed

McGee, R., Williams, S., Poulton, R. and Moffitt, T. (2000). A longitudinal study of cannabis use and mental health from adolescence to early adulthood. Addiction, 95, 491–503CrossRef Google Scholar PubMed

Merikangas, K. and Angst, J. (1995). The challenge of depressive disorders in adolescence. In Psychosocial Disturbances in Young People, ed. M. Rutter, Cambridge: Cambridge University Press

Milich, R., Lynam, D.Zimmerman, R.et al. (2000). Differences in young adult psychopathology among drug abstainers, experimenters, and frequent users. J. Substance Abuse, 11, 69–88CrossRef Google Scholar PubMed

Miller, F., Busch, F. and Tanenbaum, J. (1989). Drug abuse in schizophrenia and bipolar disorder. Am. J. Drug Alcohol Abuse, 15, 291–295CrossRef Google Scholar PubMed

Miller-Johnson, S., Lochman, J., Coie, J., Terry, R. and Hyman, C. (1998). Comorbidity of conduct and depressive problems at sixth grade: substance use outcomes across adolescence. J. Abnormal Child Psychol., 26, 221–232CrossRef Google Scholar PubMed

Mueser, K., Yarnold, P. and Bellack, A. (1992). Diagnostic and demographic correlates of substance abuse in schizophrenia and major affective disorder. Acta Psychiatr. Scand., 85, 48–55CrossRef Google Scholar PubMed

Mueser, K. T., Drake, R. E. and Wallach, M. A. (1998). Dual diagnosis: a review of etiological theories. Addict. Behav., 23, 717–734CrossRef Google Scholar PubMed

Musty, R. E. and Kaback, L. (1995). Relationships between motivation and depression in chronic marijuana users. Life Sci., 56, 2151–2158CrossRef Google Scholar PubMed

Neale, M. C. and Kendler, K. S. (1995). Models of comorbidity for multifactorial disorders. Am. J. Hum. Genet., 57, 935–953Google Scholar PubMed

Paton, S., Kessler, R. and Kandel, D. (1977). Depressive mood and adolescent illicit drug use: a longitudinal analysis. J. Genet. Psychol., 131, 267–289CrossRef Google Scholar PubMed

Patton, G., Coffey, C., Carlin, J.et al. (2002). Cannabis use and mental health in young people: cohort study. Br. Med. J., 325, 1195–1198CrossRef Google Scholar PubMed

Pond, D. (1948). Psychological effects in depressive patients of the marijuana homologue, synhexyl. J. Neurol., Neurosurg. Psychiatry, 11, 271–279CrossRef Google Scholar PubMed

Rey, J., Sawyer, M., Clark, J. and Baghurst, P. (2001). Depression among Australian adolescents. Med. J. Aust., 175, 19–23Google Scholar PubMed

Rey, J., Sawyer, M., Raphael, B., Patton, G. and Lynskey, M. (2002). Mental health of teenagers who use cannabis: results of an Australian survey. Br. J. Psychiatry, 180, 216–221CrossRef Google Scholar PubMed

Roberts, R. S., Spitzer, W. O., Delmore, T. and Sackett, D. L. (1978). An empirical demonstration of Berkson's bias. J. Chron. Dis., 31, 119–128CrossRef Google Scholar PubMed

Rowe, M., Fleming, M., Barry, K., Manwell, L. and Kropp, S. (1995). Correlates of depression in primary care. J. Fam. Pract., 41, 551–558Google Scholar PubMed

Rutter, M. (1987). Parental mental disorder as a psychiatric risk factor. In Psychiatric Update: American Psychiatric Association: Annual Review, vol. 6, ed. R. Hales and A. Frances, pp. 647–663. Washington, DC: American Psychiatric Press

Rutter, M., Pickles, A., Murray, R. and Eaves, L. (2001). Testing hypotheses on specific environmental causal effects on behavior. Psychol. Bull., 127, 291–324CrossRef Google Scholar PubMed

Shedler, J. and Block, J. (1990). Adolescent drug use and psychological health: a longitudinal inquiry. Am. Psychol., 45, 612–630CrossRef Google Scholar PubMed

Sonne, S., Brady, K. and Morton, W. (1994). Substance abuse and bipolar affective disorder. J. Nerv. Ment. Dis., 182, 349–352CrossRef Google Scholar PubMed

Stoll, A., Cole, J. and Lukas, S. (1991). A case of mania as a result of fluoxetine–marijuana interaction. J. Clin. Psychiatry, 52, 280–281Google Scholar PubMed

Sullivan, P. F., Neale, M. C. and Kendler, K. S. (2000). Genetic epidemiology of major depression: review and meta-analysis. Am. J. Psychiatry, 157, 1552–1562CrossRef Google Scholar PubMed

Troisi, A., Pasini, A., Saracco, M. and Spalletta, G. (1998). Psychiatric symptoms in male cannabis users not using other illicit drugs. Addiction, 93, 487–492CrossRef Google Scholar

Velez, C., Johnson, J. and Cohen, P. (1989). A longitudinal analysis of selected risk factors for childhood psychopathology. J. Am. Acad. Child Adolescent Psychiatry, 28, 861–864CrossRef Google Scholar PubMed

Warner, R., Taylor, D. and Wright, J. (1994). Substance use among the mentally ill: prevalence, reasons for use and effects on illness. Am. J. Orthopsychiatry, 74, 30–39CrossRef Google Scholar

Weissman, M. Livingston Bruce, M., Leaf, P. Florio, L. and Holzer, C. (1991). Affective disorders. In Psychiatric Disorders in America, ed. L. Robins and D. Regier, pp. 53–80. New York: MacMillan

Weissman, M. M., Wolk, S., Wickramaratne, P.et al. (1999). Children with prepubertal-onset major depressive disorder and anxiety grown up. Arch. Gen. Psychiatry, 56, 794–801CrossRef Google Scholar PubMed

Zablocki, B., Aidala, A., Hansell, S. and White, H. (1991). Marijuana use, introspectiveness, and mental health. J. Health Social Behav., 32, 65–79CrossRef Google Scholar PubMed

Zelwer, A. (1994). Depression and marijuana. Aust. and NZ J. Psychiatry, 28, 528Google Scholar PubMed

Accessibility standard: Unknown

Accessibility compliance for the PDF of this book is currently unknown and may be updated in the future.