Just a quick comment tonight about an interesting report from the American Academy of Child and Adolescent Psychiatry 56th Annual Meeting– in Hawaii, of all places (gnashing my teeth in jealousy, but it should pass in a few minutes!). As you may or may not know, my practice is split between classic psychiatry (med management and/or psychotherapy from a psychodynamic perspective), treatment of addictions (primarily opiate dependence), and treatment at the interface of chronic pain, psychiatry, and addiction. Compared to the fatal nature of opiate dependence and the epidemic of cases locally and across the nation, I view pot-smoking as a relatively minor vice for most people. I have met a number of people who seem to be able to smoke pot fairly regularly without significant harmful sequelae– although I would not be surprised if the pot use is costing something– a reduction in marital intimacy or in one’s relationship with one’s children, for example.
On the other hand there are clearly people who have negative consequences from use of THC. One thing that has always stood out, at least in patients I have followed, is that people who are depressed and who are regular pot smokers do not seem to benefit all that well from SSRI‘s– or from other treatments, for that matter. I have assumed that the reason is more psychological than chemical– that since pot-smokers tend to be more sedentary, and tend to lack good coping skills other than smoking marijuana to deal with stress (whereas non-pot-smokers may deal with stress by exercising, meditating, or taking up a new hobby), they are simply harder to pull out of the ‘funk’ that depressed people are in. But at the meeting in Hawaii, docs from the University of Pittsburgh School of Medicine reported partial data from a larger study that showed a reduced treatment response to antidepressants by patients using moderate amounts of alcohol or marijuana.
File this report in the ‘evidence backing up common sense’ drawer. It was not a huge surprise, but it is always a good thing when the science is consistent with the general opinion on a topic. This was not the case, as some of you may remember, when it came to breast implants and autoimmune conditions– and about a million other things that the media warns us about, that eventually turns out to be a bunch of baloney. In the case of pot smoking and reduced response to antidepressants, seems that there isn’t much baloney going around.
JJ
Casual Cannabis, Alcohol Use Reduces Treatment Efficacy in Adolescents With Major Depression
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{ 3 comments… read them below or add one }
14-year-old daughter is depressed, and in counseling with a Psy.D., who recommended a trial with an SSRI, to be prescribed by daughter’s pediatrician. One of the problems daughter needs to address is use of alcohol, marijuana, and other recreational drugs for “self-medicating” (per the Psy.D.). In conversation with pediatrician and daughter regarding prospective prescription, I inquire of pediatrician whether such use would be inappropriate while taking SSRIs. She replies, “No, there is no evidence that this would be a problem.” Thanks, Doc. Not only are you giving the 14-year-old permission to use, but you’re apparently dead wrong. Why can’t a doctor say “I don’t know?” At least now I can print out this article to show daughter. But then her doc is contradicted… 14-year-olds especially need to know whom to trust. Any ideas?
Just to clarify (I think you are being sarcastic but want to be clear for everyone), my point is that common sense tells me that regular smoking of marijuana is NOT consistent with a life of personal growth, high self-esteem, and happiness… and so the finding that SSRI’s do not work well in pot-smokers is not a surprise.
I don’t agree with the idea that depressed people are ‘self medicating’ by smoking pot. From my personal history of pot-smoking, my personal experience with addiction to other drugs, my own severe social anxiety during college and med school (a consequence, I believe, of low self esteem related to my pot smoking, and lack of development of social skills from the same), I have concluded that people are depressed or anxious because they smoke pot– not smoking pot because they are depressed and anxious.
As the father of a 14-y-o, I am aware of how hard it is to introduce insight. All I know is that the more talking, the better. I would resist sending my daughter to a person who I am at the same time criticising, but if the therapist is promoting things that you know are not in your daughter’s best interests, a change may be warranted. There are, unfortunately, bad therapists (and psychiatrists) out there. Perhaps the lesson for your daughter is that it is a challenge to avoid the pitfalls in life, and we each have a responsibility to make our own best decisions. As I write that it doesn’t sound like something that my own daughter would be too impressed by…
Maybe the lesson is for you in this case– that you, as a caring and involved mother, know more than the ‘experts’ about what is best for your daughter.
Keep talking with your daughter– not just about discipline, not just about warnings, but about what she likes, and about what you like about her. Be sure to spend as much time talking about her successes as her problems. I think some parents fear they will stregthen the will of a rebellious child if they complement them, but what I see more is that as the parent speaks highly of the teen, the teen rebels less.
I wish I had more answers– for both of us. That is a tough age, and I wish you the best.
JJ
I have to agree with Dr. Junig completely here, when he speaks about the causality link between cannabis use and mental illness, especially anxiety disorders.
I know from my own history and the history of several people I have known: those who do not follow the ‘normal path’ and quit smoking pot by the middle of their third decade of life tend to be in for a mediocre life at best.
Cannabis smoking is not self-medication – opioid use, alcoholism, benzodiazepine addiction – these all may be, but hallucinogens are not. Someone with low self-esteem or an anxiety issue is going to become more self-aware and more anxious after smoking pot or using any other hallucinogen.
But I remember several people, from my teenage years, and several patients, who started out smoking cannabis without any notable mental illness of which to speak, and after around a year of daily cannabis use, began to display symptoms of depression, generalized anxiety disorder, panic disorder, psychosis, et al.
Not to mention the good 20% of people who took stronger hallucinogens (i.e. LSD-25, 4-HO-DMT) that ended up with some form of mental quirkiness (generally a form of PTSD, sometimes severe) after just one use, and the small minority who burned out completely (ala Ozzie Ozbourne) after repeated use.
In my nonprofessional opinion, the whole “causality constellation” theory of the link of pot smoking with anxiety and psychotic disorders is a bunch of pure, unadulterated BS – it’s clear in all my experience that the causality goes one way – smoking pot to mental illness – not the other way around.
I’ve never once treated a patient with an anxiety disorder or psychotic disorder that would touch pot with a ten-foot-pole, and most depressives had a quick and easy remission of symptoms once they quit smoking.
Not to mention no form of drug use should be condoned among such a young child, where it will forever alter the developing brain and make the chances of developing a more severe mental illness or addiction – such as the opioid addiction that eventually cost me my license and practice – grow exponentially. All that should be tolerated for a child of fourteen is immediate abstention from all psychoactives (notwithstanding a BZO detox if a physical addiction to ethanol has been formed) and a trip to rehab if relapse occurs.
Cannabis is just as damaging to the developing brain as any other drug, and more damaging to the ego and sense of self than most. I never fail to be surprised when a medical ‘professional’ rates cannabis as one of the least-harmful drugs for some-reason-or-another: I have found it to be every bit as damaging to the user’s psyche – if not more so – as cocaine or heroin, when used daily – possibly only paralleled in damage caused by drugs such as LSD-25 and 4-HO-DMT – and exceeded only by MDMA and alcoholism.
L Marchese PhD PharmD