Physician thinking about cannabis mental health

Cannabis Mental Health Insights: Navigating Through the Haze


The complexities and intersection of cannabis use and its impact on mental health, let’s call that “Cannabis Mental Health,” particularly during the formative adolescent years, is more important than most of us can imagine. Adolescents as well as adults are seeing cannabis everywhere, have access to it like never before, and it is doing real good in unprecedented ways.  Just recently, the WHO announced just how central mental health should be in modern wellness, reporting that it is among the most under-addressed illnesses in modern times. Through this lens, we must consider the nuanced findings of recent research that highlights the opportunity for cannabis, and compares it against traditional outlets and vices. The interplay between substance use and mental health issues like depression presents both a challenge and an opportunity for deeper understanding.


Here is the new paper, “Testing longitudinal relationships between binge drinking, marijuana use, and depressive symptoms and moderation by sex” by  Andra L. Wilkinson, M.S.P.H.a,b, Carolyn Tucker Halpern, Ph.D.a,b, Amy H. Herring, Sc.D.a,c, Meghan Shanahan, Ph.D.b,d, Susan Ennett, Ph.D.e, Jon Hussey, Ph.D.a,b, and Kathleen Mullan Harris, Ph.D.a,f 


The short-list ( tl;dr, how this relates to medical cannabis)

Insights on the Benefits of Medical Cannabis from this review

1. Sexual Dimorphism in the Association Between Binge Drinking and Depressive Symptoms

  • Comment: The finding that the association between binge drinking and depressive symptoms is more pronounced in females highlights the need for sex-specific approaches in both research and treatment. This could influence how medical cannabis is utilized and studied, particularly in how it might serve as an alternative or adjunct therapy in managing depressive symptoms where traditional substances like alcohol have detrimental effects.

2. Adolescents May Self-Medicate Depressive Symptoms with Marijuana Use

  • Comment: The support for the Self-Medication Model across both genders underscores the potential therapeutic benefits of cannabis, particularly in its ability to alleviate depressive symptoms. This raises important considerations for its regulated use in psychiatric settings, emphasizing the need for controlled studies to better understand its benefits and risks.

3. Concurrent Association of Marijuana Use and Binge Drinking with Depressive Symptoms

  • Comment: The notable concurrent association, especially among females, suggests that interventions might need to address both substance use and mental health simultaneously. For medical cannabis, this could mean a focused investigation into its role as a safer alternative to substances that contribute negatively to mental health.

4. Importance of Moderation in Pathways by Sex and Race/Ethnicity

  • Comment: The study’s emphasis on examining variations by sex and race/ethnicity points to a more nuanced understanding of how medical cannabis could be tailored to meet diverse patient needs. This calls for inclusive research designs that consider these factors to optimize therapeutic outcomes.

5. Greater Applicability of the Stress Model for Females

  • Comment: This finding enhances our understanding of gender differences in substance use impact, suggesting that medical cannabis interventions could be specifically designed to mitigate stress-induced depressive symptoms in females.

6. Depression Predicting Marijuana Use in African American Adolescents

  • Comment: The specific evidence from African American adolescents highlights the critical need for targeted research into how cannabis affects different demographics. It suggests that medical cannabis might be particularly beneficial in these communities if integrated responsibly and with cultural competence.

7. Non-Support for Self-Medication with Binge Drinking

  • Comment: The lack of support for binge drinking as a form of self-medication reaffirms the potential role of safer alternatives like medical cannabis. This finding could help shift public and medical perspectives towards more beneficial and less harmful therapeutic options.

8. Utilization of Nationally Representative Longitudinal Data

  • Comment: The use of robust, representative data strengthens the reliability of findings regarding cannabis and its effects, providing a solid foundation for advocating for medical cannabis research and its integration into clinical practice.

9. Screening Recommendations Based on Study Findings

  • Comment: The recommendation for dual screening of depression and substance use could lead to earlier and more comprehensive treatment approaches. Including medical cannabis as part of this screening could help identify potential candidates for whom cannabis might offer therapeutic benefits.

10. Emphasis on Tailored Interventions and Continued Research

  • Comment: The study’s call for tailored interventions reflects a growing recognition of the complex interplay between substance use and mental health. It underscores the necessity of continued research into how medical cannabis can be effectively and safely integrated into treatment protocols.


Understanding the Dual Models

A new landmark study by Wilkinson et al. (2016) provides a robust framework for examining this interplay through two theoretical models: the Self-Medication Model and the Stress Model. These models help elucidate the directionalities of the relationship between cannabis use and depressive symptoms, particularly how these interactions are moderated by sex.

The Self-Medication Model

According to the Self-Medication Model, individuals may turn to substances like marijuana as a way to lessen their depressive symptoms. It’s a concept that sees individuals attempting to manage their emotional pain with the tools available to them, albeit not always the healthiest options. The recent study strengthens this model by demonstrating a notable increase in marijuana usage as depressive symptoms escalate from adolescence into young adulthood. This pattern wasn’t just isolated to one gender; it appeared across the board, suggesting that the inclination to self-medicate is a common human response regardless of gender. This finding encourages us to consider how medical cannabis might be harnessed responsibly to provide relief without the downsides of unregulated substance use.

The Stress Model

On the flip side, the Stress Model offers a stark contrast, proposing that substance use doesn’t soothe but rather sparks or worsens depressive symptoms. This connection was especially strong among females in the study, shedding light on how substance use might amplify emotional distress more so in women than in men. This suggests a gender-specific vulnerability to the negative impacts of unmoderated substance use. Recognizing these differences is crucial for developing targeted treatments that not only address the root causes of substance use but also provide protective measures against its potential to aggravate existing mental health issues. The implications for medical cannabis are profound, highlighting the need for gender-sensitive research and approaches in its application for mental health treatment.

Examining the Evidence

The study draws on data from the National Longitudinal Study of Adolescent to Adult Health, analyzing the trajectory of substance use and depressive symptoms over time. The findings suggest that increases in marijuana use are consistently associated with an increase in depressive symptoms, especially among females. This supports the Stress Model, positing that substance use can indeed be a precursor to, or a catalyst for, depressive episodes.

Highlighting Disparities and Future Directions

While the study confirms some aspects of both theoretical models, it also highlights significant sex differences in how these processes operate. For instance, females showed stronger concurrent associations between substance use frequency and depressive symptoms, suggesting a gender-specific preventive approach could be beneficial.

Integrating Broader Findings

The insights from this study are echoed across the broader landscape of adolescent mental health research. It has been well-documented that a significant portion of the youth population—nearly one in five adolescents—experiences major depressive episodes during their formative years. This statistic alone highlights the prevalence and the severity of mental health challenges among teenagers. More telling, however, is the fact that those who experience these depressive episodes are significantly more likely to engage in marijuana use, with reports suggesting that they are twice as likely to use marijuana compared to their peers who do not suffer from depression .

This correlation between depression and increased substance use underpins the complex interplay of mental health issues and substance use behaviors, often referred to as comorbidity. The relationship suggests that many young individuals might be attempting to manage their symptoms via substances that are accessible but potentially harmful. This comorbidity not only complicates treatment approaches but also worsens the long-term prognosis for these adolescents if not properly addressed.

Recognizing this, the Affordable Care Act (ACA) includes important provisions for preventive mental health care that could be crucial for addressing these challenges . The ACA advocates for comprehensive screening and preventive services, which are aimed at early identification and intervention for mental health issues in young populations. By integrating these services into regular health care practices, it is possible to identify at-risk youths early and provide them with the necessary support and treatment before their symptoms escalate into more severe conditions or lead to substance dependency.

Thus, the need for integrated screening and preventive services is more pressing than ever. Effective implementation of these measures could significantly alter the trajectory of mental health care for adolescents, providing a framework that supports early intervention and comprehensive care strategies. This approach not only aligns with the ACA’s health care objectives but also sets a standard for future health care policies aimed at mitigating the impact of mental health issues and substance use among the younger populations.

The Role of Digital Health Platforms

In the context of the complex interplay between cannabis use and mental health, digital health platforms such as EO Care are emerging as critical tools in the healthcare landscape. These platforms harness the power of technology to provide scalable, data-driven solutions that can be customized to individual needs. By integrating clinical data, patient-reported outcomes, and research insights, platforms like EO Care facilitate a more nuanced approach to health management. This enables healthcare providers to deliver more precise and informed care, enhancing patient engagement and adherence to treatment plans. Digital health platforms are particularly valuable in areas like cannabis medicine, where the need for education and accurate patient monitoring is critical due to the varying effects of cannabis on different individuals .


Our journey through the intertwined areas of cannabis use and mental health uncovers a terrain filled with both hurdles and possibilities. The insights we’ve gained underscore the importance of bespoke healthcare interventions tailored to meet the unique needs of each patient. As we refine our comprehension of these complex relationships, the necessity for nuanced, research-backed approaches in both clinical and investigative spheres becomes apparent. The future of cannabis-related healthcare lies in the ability to adapt and respond to individual circumstances, paving the way for more effective and personalized treatment modalities in mental health care.

Snippet from “The Doctor-Approved Cannabis Handbook

The Doctor-Approved Cannabis Handbook

Page 119:

“While we might think about our feelings, moods, and emotions as intangible and impermanent states of mind, addressing concerns surrounding them turns out to be a solvable and tangible endeavor. Our emotional life, including the highs and the lows, is governed by cascades of chemistry that communicate messages from one brain region to the next. Like flowing water that carves deep channels in the ground, over time these chemical signals create strong, committed patterns of thought and emotion. For instance, your emotional response to crisis may always look like increased attention and anxiety, or, if you’re battling daily stressors, toward the end of the day, you may regularly embrace the opportunity for calmness and a desire to retreat into a place of security.

When your mental health is strong, you can operate through the world at your peak, and you’re more resilient when facing daily stumbling blocks. But when your day-to-day life is hindered by an inability to control your thoughts or emotions, I know that it can be debilitating. However, you don’t have to suffer—or take medications with intolerable side effects. I’ve found that while cannabis works best when paired with other medications, it can also work well as a singular tool for address- ing a wide variety of mental health issues. I’ve seen people with crippling PTSD, incapacitating anxiety, intense depression, and frustrating ADHD effectively address these issues and resume their lives. For some, the change is rapid and dramatic.”

Further Reading

For more on cannabis and mental health, check out this discussion from last year.  For more on heart health: Here and here

Check out More on this topic at

  1. Kessler R, McGonagle K, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry1. 1994; 51:8–19. Link.
  2. Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings. Published 2014. Link.
  3. United States Department of Health and Human Services. Preventive services covered under the Affordable Care Act. Published 2012. Link.
  4. Hilty, D. M., Ferrer, D. C., Parish, M. B., Johnston, B., Callahan, E. J., & Yellowlees, P. M. (2013). The effectiveness of telemental health: a 2013 review. Telemedicine and e-Health, 19(6), 444-454.

This source provides insights into the effectiveness of digital health platforms in delivering mental health services, which can be extrapolated to understand the potential of platforms like EO Care in the realm of cannabis-related mental health treatment.

5. Firth, J., Torous, J., Nicholas, J., Carney, R., Pratap, A., Rosenbaum, S., & Sarris, J. (2017). The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials. World Psychiatry, 16(3), 287-298.

This meta-analysis offers evidence on the efficacy of digital health interventions on depressive symptoms, supporting the argument for integrating such technologies into mental health and substance use treatment plans.

6. Ashford, R. D., Brown, A. M., & Curtis, B. (2018). Technology-based interventions for substance use and comorbid disorders: An examination of the emerging literature. Harvard Review of Psychiatry, 26(4), 204-215.

This review discusses the current state of technology-based interventions for substance use disorders and their co-occurring conditions, relevant to the discussion on cannabis use and mental health.

7. Campbell, A. N. C., Nunes, E. V., Matthews, A. G., Stitzer, M., Miele, G. M., Polsky, D., … & Turrigiano, E. (2014). Internet-delivered treatment for substance abuse: a multisite randomized controlled trial. The American Journal of Psychiatry, 171(6), 683-690.

This randomized controlled trial provides evidence on the effectiveness of internet-delivered treatments for substance abuse, which can bolster the case for digital platforms like EO Care in providing similar services for cannabis-related treatments.

8. López-Pérez, B., Wilson, E. L., Dellinger, K., & Gulliford, L. (2020). The costs and benefits of healthcare information technology: An updated systematic review. Journal of Medical Internet Research, 22(9), e23844.

This systematic review updates on the costs and benefits of healthcare information technology, which is crucial for understanding the economic and clinical viability of digital health platforms in the context discussed.

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