Hostname: page-component-89b8bd64d-4ws75 Total loading time: 0 Render date: 2026-05-06T11:31:59.588Z Has data issue: false hasContentIssue false
  • English
  • Français

The association between cannabis use and depression: a systematic review and meta-analysis of longitudinal studies

Published online by Cambridge University Press:  24 June 2013

S. Lev-Ran ,
M. Roerecke ,
B. Le Foll ,
T. P. George ,
K. McKenzie  and
J. Rehm
S. Lev-Ran*
Affiliation:
Social Aetiology of Mental Illness (SAMI) CIHR Training Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada Addiction Medicine Services, Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
M. Roerecke
Affiliation:
Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
B. Le Foll
Affiliation:
Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, Ontario, Canada Departments of Family and Community Medicine, Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
T. P. George
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
K. McKenzie
Affiliation:
Social Aetiology of Mental Illness (SAMI) CIHR Training Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Social Equity and Health Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
J. Rehm
Affiliation:
Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
*
* Address for correspondence: S. Lev-Ran, Addiction Medicine Services, Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel. (Email: shauli.levran@gmail.com)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Longitudinal studies reporting the association between cannabis use and developing depression provide mixed results. The objective of this study was to establish the extent to which different patterns of use of cannabis are associated with the development of depression using meta-analysis of longitudinal studies.

Method

Peer-reviewed publications reporting the risk of developing depression in cannabis users were located using searches of EMBASE, Medline, PsychINFO and ISI Web of Science. Only longitudinal studies that controlled for depression at baseline were included. Data on several study characteristics, including measures of cannabis use, measures of depression and control variables, were extracted. Odds ratios (ORs) were extracted by age and length of follow-up.

Results

After screening for 4764 articles, 57 articles were selected for full-text review, of which 14 were included in the quantitative analysis (total number of subjects = 76058). The OR for cannabis users developing depression compared with controls was 1.17 [95% confidence interval (CI) 1.05–1.30]. The OR for heavy cannabis users developing depression was 1.62 (95% CI 1.21–2.16), compared with non-users or light users. Meta-regression revealed no significant differences in effect based on age of subjects and marginal difference in effect based on length of follow-up in the individual studies. There was large heterogeneity in the number and type of control variables in the different studies.

Conclusions

Cannabis use, and particularly heavy cannabis use, may be associated with an increased risk for developing depressive disorders. There is need for further longitudinal exploration of the association between cannabis use and developing depression, particularly taking into account cumulative exposure to cannabis and potentially significant confounding factors.

Keywords

Cannabisdepressionepidemiologymeta-analysispsychiatry

Information

Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 4 , March 2014 , pp. 797 - 810
Copyright
Copyright © Cambridge University Press 2013 

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.)

Article purchase

Temporarily unavailable

References

Anstey, KJ, Christensen, H, Butterworth, P, Easteal, S, Mackinnon, A, Jacomb, T, Maxwell, K, Rodgers, B, Windsor, T, Cherbuin, N, Jorm, AF (2012). Cohort profile: the PATH through life project. International Journal of Epidemiology 41, 951–960.Google Scholar
Beard, JR, Dietrich, UC, Brooks, LO, Brooks, RT, Heathcote, K, Kelly, B (2006). Incidence and outcomes of mental disorders in a regional population: the Northern Rivers Mental Health Study. Australian and New Zealand Journal of Psychiatry 40, 674–682.CrossRefGoogle Scholar
Block, JH, Gjerde, PF (1991). Personality antecedents of depressive tendencies in 18-year-olds: a prospective study. Journal of Personality and Social Psychology 60, 726–738.CrossRefGoogle ScholarPubMed
Bovasso, GB (2001). Cannabis abuse as a risk factor for depressive symptoms. American Journal of Psychiatry 158, 2033–2037.Google Scholar
Brook, DW, Brook, JS, Zhang, C, Cohen, P, Whiteman, M (2002). Drug use and the risk of major depressive disorder, alcohol dependence, and substance use disorders. Archives of General Psychiatry 59, 1039–1044.CrossRefGoogle ScholarPubMed
Brook, JS, Cohen, P, Brook, DW (1998). Longitudinal study of co-occurring psychiatric disorders and substance use. Journal of the American Academy of Child and Adolescent Psychiatry 37, 322–330.Google Scholar
Brook, JS, Lee, JY, Brown, EN, Finch, SJ, Brook, DW (2011). Developmental trajectories of marijuana use from adolescence to adulthood: personality and social role outcomes. Psychological Reports 108, 339–357.Google Scholar
Brook, JS, Rosen, Z, Brook, DW (2001). The effect of early marijuana use on later anxiety and depressive symptoms. NYS Psychologist 13, 35–40.Google Scholar
Chen, CY, Wagner, FA, Anthony, JC (2002). Marijuana use and the risk of major depressive episode – epidemiological evidence from the United States National Comorbidity Survey. Social Psychiatry and Psychiatric Epidemiology 37, 199–206.Google Scholar
Compton, WM, Grant, BF, Colliver, JD, Glantz, MD, Stinson, FS (2004). Prevalence of marijuana use disorders in the United States: 1991–1992 and 2001–2002. Journal of the American Medical Association 291, 2114–2121.Google Scholar
Degenhardt, L, Coffey, C, Romaniuk, H, Swift, W, Carlin, JB, Hall, WD, Patton, GC (2013). The persistence of the association between adolescent cannabis use and common mental disorders into young adulthood. Addiction 108, 124–133.Google Scholar
Degenhardt, L, Hall, W, Lynskey, M (2001). Alcohol, cannabis and tobacco use among Australians: a comparison of their associations with other drug use and use disorders, affective and anxiety disorders, and psychosis. Addiction 96, 1603–1614.Google Scholar
Degenhardt, L, Hall, W, Lynskey, M (2003). Exploring the association between cannabis use and depression. Addiction 98, 1493–1504.CrossRefGoogle ScholarPubMed
Degenhardt, L, Lynskey, M, Hall, W (2000). Cohort trends in the age of initiation of drug use in Australia. Australian and New Zealand Journal of Public Health 24, 421–426.Google Scholar
Derogatis, LR (1994). Symptoms Checklist-90-R (SCL-90-R): Administration Scoring and Procedures Manual. National Computer Systems: Minneapolis, MN.Google Scholar
Derogatis, LR, Lipman, RS, Richels, K, Uhlenhuth, EH, Covi, L (1974). The Hopkins Symptom Checklist: a self-report symptom inventory. Behavioral Science 19, 1–15.Google Scholar
DerSimonian, R, Laird, N (1986). Meta-analysis in clinical trials. Controlled Clinical Trials 7, 177–188.Google Scholar
Duval, S, Tweedie, R (2000). Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56, 455–463.CrossRefGoogle ScholarPubMed
Egger, M, Davey Smith, G, Schneider, M, Minder, C (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal 315, 629–634.Google Scholar
ElSohly, MA, Ross, SA, Mehmedic, Z, Arafat, R, Yi, B, Banahan, BF 3rd (2000). Potency trends of Δ9-THC and other cannabinoids in confiscated marijuana from 1980–1997. Journal of Forensic Sciences 45, 24–30.CrossRefGoogle ScholarPubMed
European Monitoring Centre for Drugs and Drug Addiction (2011). 2011 Annual Report on the State of the Drugs Problem in Europe. EMCDDA: Lisbon.Google Scholar
Fergusson, DM, Horwood, LJ (1997). Early onset cannabis use and psychosocial adjustment in young adults. Addiction 92, 279–296.Google Scholar
Fergusson, DM, Horwood, LJ, Swain-Campbell, N (2002). Cannabis use and psychosocial adjustment in adolescence and young adulthood. Addiction 97, 1123–1135.Google Scholar
Fergusson, DM, Lynskey, MT, Horwood, LJ (1996). The short-term consequences of early onset cannabis use. Journal of Abnormal Child Psychology 24, 499–512.CrossRefGoogle ScholarPubMed
Georgiades, K, Boyle, MH (2007). Adolescent tobacco and cannabis use: young adult outcomes from the Ontario Child Health Study. Journal of Child Psychology and Psychiatry and Allied Disciplines 48, 724–731.Google Scholar
Grant, BF (1995). Comorbidity between DSM-IV drug use disorders and major depression: results of a national survey of adults. Journal of Substance Abuse 7, 481–497.CrossRefGoogle ScholarPubMed
Grant, BF, Pickering, R (1998). The relationship between cannabis use and DSM-IV cannabis abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey. Journal of Substance Abuse 10, 255–264.Google Scholar
Grant, BF, Stinson, FS, Dawson, DA, Chou, SP, Dufour, MC, Compton, W, Pickering, RP, Kaplan, K (2004). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 61, 807–816.Google Scholar
Hall, W, Babor, TF (2000). Cannabis use and public health: assessing the burden. Addiction 95, 485–490.Google Scholar
Hall, W, Degenhardt, L (2009). Adverse health effects of non-medical cannabis use. Lancet 374, 1383–1391.Google Scholar
Hall, W, Solowij, N (1998). Adverse effects of cannabis. Lancet 352, 1611–1616.CrossRefGoogle ScholarPubMed
Harder, VS, Morral, AR, Arkes, J (2006). Marijuana use and depression among adults: testing for causal associations. Addiction 101, 1463–1472.Google Scholar
Harder, VS, Stuart, EA, Anthony, JC (2008). Adolescent cannabis problems and young adult depression: male–female stratified propensity score analyses. American Journal of Epidemiology 168, 592–601.Google Scholar
Hill, MN, Gorzalka, BB (2009). Impairments in endocannabinoid signaling and depressive illness. Journal of the American Medical Association 301, 1165–1166.Google Scholar
Horder, J, Harmer, CJ, Cowen, PJ, McCabe, C (2010). Reduced neural response to reward following 7 days treatment with the cannabinoid CB1 antagonist rimonabant in healthy volunteers. International Journal of Neuropsychopharmacology 13, 1103–1113.Google Scholar
Horwood, LJ, Fergusson, DM, Coffey, C, Patton, GC, Tait, R, Smart, D, Letcher, P, Silins, E, Hutchinson, DM (2012). Cannabis and depression: an integrative data analysis of four Australasian cohorts. Drug and Alcohol Dependence 126, 369–378.Google Scholar
Jané-Llopis, E, Matytsina, I (2006). Mental health and alcohol, drugs and tobacco: a review of the co-morbidity between mental disorders and the use of alcohol, tobacco and illicit drugs. Drug and Alcohol Review 25, 515–536.Google Scholar
Kandel, DB, Davies, M (1982). Epidemiology of depressive mood in adolescents: an empirical study. Archives of General Psychiatry 39, 1205–1212.Google Scholar
Kandel, DB, Davies, M (1986). Adult sequelae of adolescent depressive symptoms. Archives of General Psychiatry 43, 255–262.Google Scholar
Kendler, KS, Heath, AC, Neale, MC, Kessler, RC, Eaves, LJ (1993). Alcoholism and major depression in women. A twin study of the causes of comorbidity. Archives of General Psychiatry 50, 690–698.Google Scholar
Le Foll, B, Gorelick, DA, Goldberg, SR (2009). The future of endocannabinoid-oriented clinical research after CB1 antagonists. Psychopharmacology 205, 171–174.Google Scholar
Lipsey, MW, Wilson, DB (2001). Practical Meta-Analysis. SAGE Publications, Inc.: Thousand Oaks, CA.Google Scholar
Manheimer, DI, Mellinger, G, Somers, R, Kleman, MK (1972). Technical and ethical considerations in data collection. In Student Drug Surveys (ed. Einstein, S. and Allen, S.), pp. 205–214. Baywood: Farmingdale, NY.Google Scholar
Manrique-Garcia, E, Zammit, S, Dalman, C, Hemmingsson, T, Allebeck, P (2012). Cannabis use and depression: a longitudinal study of a national cohort of Swedish conscripts. BMC Psychiatry 12, 112.Google Scholar
Marmorstein, NR, Iacono, WG (2011). Explaining associations between cannabis use disorders in adolescence and later major depression: a test of the psychosocial failure model. Addictive Behaviors 36, 773–776.Google Scholar
McGee, R, Williams, S, Poulton, R, Moffitt, T (2000). A longitudinal study of cannabis use and mental health from adolescence to early adulthood. Addiction 95, 491–503.Google Scholar
Moore, TH, Zammit, S, Lingford-Hughes, A, Barnes, TR, Jones, PB, Burke, M, Lewis, G (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 370, 319–328.Google Scholar
Moussavi, S, Chatterji, S, Verdes, E, Tandon, A, Patel, V, Ustun, B (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370, 851–858.CrossRefGoogle ScholarPubMed
Paton, S, Kessler, R, Kandel, D (1977). Depressive mood and adolescent illicit drug use: a longitudinal analysis. Journal of Genetic Psychology 131, 267–289.Google Scholar
Patten, SB, Williams, JV, Lavorato, DH, Bulloch, AG, MacQueen, G (2012). Depressive episode characteristics and subsequent recurrence risk. Journal of Affective Disorders 140, 277–284.Google Scholar
Patton, GC, Coffey, C, Carlin, JB, Degenhardt, L, Lynskey, M, Hall, W (2002). Cannabis use and mental health in young people: cohort study. British Medical Journal 325, 1195–1198.Google Scholar
Pedersen, W (2008). Does cannabis use lead to depression and suicidal behaviours? A population-based longitudinal study. Acta Psychiatrica Scandinavica 118, 395–403.Google Scholar
Prior, M, Sanson, A, Smart, D, Oberklaid, F (2000). Pathways from infancy to adolescence: Australian Temperament Project 1983–2000. Australian Institute of Family Studies: Melbourne, Australia.Google Scholar
Rehm, J, Arminger, G, Kohlmeier, L (1992). Using follow-up data to avoid omitted variable bias: an application to cardiovascular epidemiology. Statistics in Medicine 11, 1195–1208.Google Scholar
Rehm, J, Room, R, Monteiro, M, Gmel, G, Graham, K, Rehn, N, Sempos, CT, Frick, U, Jernigan, D (2004). Alcohol use. In Comparative Quantification of Health Risks. Global and Regional Burden of Disease Attributable to Selected Major Risk Factors (ed. Ezzati, M., Lopez, A. D., Rodgers, A. and Murray, C. J. L.), pp. 959–1108. World Health Organization: Geneva.Google Scholar
Robins, LN, Helzer, JE, Groughan, J (1981). National Institute of Mental Health Diagnostic Interview Schedule, version III: PHS Publication ADM-T-42-3. NIMH: Rockville, MD.Google Scholar
Stroup, DF, Berlin, JA, Morton, SC, Olkin, I, Williamson, GD, Rennie, D, Moher, D, Becker, BJ, Sipe, TA, Thacker, SB (2000). Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. Journal of the American Medical Association 283, 2008–2012.Google Scholar
United Nations Office on Drugs and Crime (2011). World Drug Report. United Nations Office on Drugs and Crime: Vienna.Google Scholar
Ustün, TB, Ayuso-Mateos, JL, Chatterji, S, Mathers, C, Murray, CJ (2004). Global burden of depressive disorders in the year 2000. British Journal of Psychiatry 184, 386–392.Google Scholar
van Laar, M, van Dorsselaer, S, Monshouwer, K, de Graaf, R (2007). Does cannabis use predict the first incidence of mood and anxiety disorders in the adult population? Addiction 102, 1251–1260.Google Scholar
Weissman, MM, Bland, RC, Canino, GJ, Faravelli, C, Greenwald, S, Hwu, HG, Joyce, PR, Karam, EG, Lee, CK, Lellouch, J, Lepine, JP, Newman, SC, Rubio-Stipec, M, Wells, JE, Wickramaratne, PJ, Wittchen, H, Yeh, EK (1996). Cross-national epidemiology of major depression and bipolar disorder. Journal of the American Medical Association 276, 293–299.Google Scholar
Wells, G, Shea, B, O'Connell, D, Peterson, J, Welch, V, Losos, M, Tugwell, P (2005). Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-analysis (http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm). Accessed 10 February 2012.Google Scholar
Windle, M, Wiesner, M (2004). Trajectories of marijuana use from adolescence to young adulthood: predictors and outcomes. Development and Psychopathology 16, 1007–1027.Google Scholar