The first antipsychotic drug, chlorpromazine (trade name: Thorazine) was discovered in 1950 and since then drug therapy has become the major focus in the treatment of mental illness. This is because it works in many cases, although the biochemistry behind its efficacy is not well known, and because it is much cheaper than talk therapy. I have myself been the beneficiary of one of the countless additional drugs to treat mental illness which have come on the market since the 1950’s, although I do have the caveat that I also see an analyst, but talk therapy is for another blog.
But finding the right drug for a particular patient can be like a shot in the dark. There are patients who try several different drugs and do not find one that gives them the relief they need and may cause undesirable side effects. As a consequence there is now an interest in exploring alternative drugs— psychedelic mushrooms and marijuana .
In my memoir Examined Lives I offer a cautionary tale about just such an issue—the dramatic increase in the use of lobotomies in the late 1940’s and early 1950’s without the supporting adequate research and the consideration of the consequences. Research is desperately needed on psychedelic drugs and we need to refrain from jumping wholeheartedly on a bandwagon before we have the information we need not only to weigh general risks and benefits but to determine which people under what conditions for what medical issues are the likely beneficiaries. Psychedelic medicine is being explored for many more medical issues than mental illness, but it is on the latter which I am focusing here.
Researchers at major medical institutions have conducted carefully controlled studies of psilocybin, the psychedelic chemical in certain types of mushrooms, and found that a single trip—guided by trained professionals—has helped relieve individuals suffering from depression. The important caveat here is being under the guidance of trained professionals. The studies conducted so far, however, have been small and the subjects very carefully screened such that individuals with certain mental conditions, such as schizophrenia, were ruled out. Psilocybin can cause psychosis and lead to “bad trips,” sending individuals to the emergency room. It is not a panacea.
The situation in regard to marijuana use is far more complicated, both in terms of cannabis containing tetrahydrocannabinol, the psychedelic ingredient, and CBD (Cannabidiol), marijuana without the psychedelic effect. While great claims are being made for the psychological benefits of CBD there is unfortunately little or no research. What there is is mainly extrapolated from animal studies. Obviously much more testing and evaluation is needed here. I myself tried medical marijuana many years back, not for depression, but for irritable bowel syndrome. I only took one dosage as it made my mind whirl and the world seem out-of-skilter. As I was living by myself at the time on an isolated farm, I did not want the danger of possibly falling so I did not pursue taking it.
The greatest controversy and confusion surrounds the outright use of cannabis. Even medical professionals are at odds over the results of research. In 2017 the National Academies of Science, Engineering and Medicine published a landmark study: “The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.” I highly recommend reading at least the conclusions and recommendations for research.( https://www.nap.edu/read/24625/chapter/2#19).
Here is a sampling of their findings in regard to mental health.
There is substantial evidence of a statistical association between cannabis use and:
- The development of schizophrenia or other psychoses, with the highest risk among the most frequent users (12-1)
There is moderate evidence of a statistical association between cannabis use and:
- Better cognitive performance among individuals with psychotic disorders and a history of cannabis use (12-2a)
- Increased symptoms of mania and hypomania in individuals diagnosed with bipolar disorders (regular cannabis use) (12-4)
- A small increased risk for the development of depressive disorders (12-5)
- Increased incidence of suicidal ideation and suicide attempts with a higher incidence among heavier users (12-7a)
There was a rush to judgment in regard to the findings in regard to schizophrenia. As one of the authors of the report Dr. Ziva Cooper has pointed out, the report does not say that cannabis causes schizophrenia. It only says there is an association. Researchers do not know if individuals attracted to smoking marijuana on a regular basis are also individuals prone to mental illness. As Dr. Cooper also pointed out, the report also found a moderate correlation between cannabis use and “better cognitive outcomes in people diagnosed with psychotic disorders.” So they found a mixed bag. Dr. Cooper, however, does recommend that individuals who are predisposed to schizophrenia avoid cannabis.
Since this report there have been further studies which again reveal a mixed bag. Time magazine recently reported on the results of research on the potential mental health benefits published in the journal Clinical Psychology Review. In this article researchers found evidence that cannabis may benefit in cases of depression, social anxiety and post-traumatic stress disorder but not for cases of bipolar disorder. Meanwhile The Lancet recently included an article reporting that individuals using cannabis regularly with a potency greater than 10% increase their risk for psychotic disorders five-fold and those using cannabis daily with less potency increase it three-fold.
So to point out the obvious, more research is desperately called for before inappropriate use leads to a medical crisis. From what I have gathered we need clarify in the research about the age groups being studied, the potency of the cannabis used in the research, how often the subjects use the cannabis, and how it is administered (by smoking or in edibles). There is anecdotal evidence (see article below) that eating marijuana has a more deleterious effect than smoking it.
And we must also keep in mind that years ago smoking marijuana was seen as a possible means of alleviating glaucoma. I knew of someone with a severe form who was in fact in a trial study (which was the only way you could get marijuana legally at the time). The American Glaucoma Society no longer sees it as an efficacious treatment.