CBD, a chemical found in the cannabis plant, is having its moment, after being seized on by the wellness empire for its rumored ability to help with a whole host of conditions, from anxiety to insomnia to depression. The CBD industry is estimated to grow to almost $2 billion by 2022, and cannabis use overall has increased 43 percent between 2007 and 2015; it’s now medicinally legal in 33 states. But despite how ubiquitous CBD lattes may be, they are not matched by an equal amount of research on their benefits for the mind.
A new review and meta-analysis published this week in The Lancet Psychiatry looked for the effects of cannabinoids on mental health in nearly 40 years of research and their findings sounded grim: They wrote there was “scarce evidence” to support that cannabis improves mental health symptoms, leading publications like The Guardian to publish an article titled “Risks of cannabis use for mental health treatment outweigh benefits,” and write that “the use of cannabis medicines to treat people with depression, anxiety, psychosis or other mental health issues cannot be justified because there is little evidence that they work or are safe.” Time similarly concluded that “There’s ‘Scarce Evidence’ That Cannabis Helps Mental Health Issues.”
This review reveals something many clinicians already knew: We don’t have enough evidence to say that cannabis can treat mental health disorders. That doesn’t necessarily mean weed doesn’t help at all—it means we just don’t know. (And since risks of long-term cannabis use have been well-documented, of course they would outweigh benefits we are unaware of.)
“The old adage that absence of evidence doesn’t necessarily mean absence of effectiveness is true here,” said Harry Sumnall, a professor of substance use at Liverpool John Moores Public Health Institute in the U.K., who was not involved in the review.
Finding a lack of evidence isn’t a reason to throw in the towel. It should be motivation to conduct more rigorous studies, especially given the rise in use of cannabis and cannabis-derived products specifically for mental health, and the large swaths of the public deciding on their own that cannabis does treat these symptoms.
People are widely using cannabis—both THC and CBD—for their mental health. In 2017, a study found that people perceive cannabis to be an effective way to treat many conditions, and that some substituted cannabis for prescription medications like benzodiazepines (often given for anxiety) or antidepressants. In a 2018 study of over 2,400 CBD users, 62 percent said they used CBD for a medical condition—the top three being pain, anxiety, and depression.
Just because your friend or your favorite Instagram influencer took CBD and it improved their anxiety better isn’t enough to determine whether cannabis is effective for that purpose. This kind of evidence is called anecdotal and it can feel immensely powerful, especially if the experience happened to you. But that’s not the way we decide that treatments are safe and effective. Even results from single studies might not be enough, especially when it comes to difficult areas like mental health. Consider the fact that researchers are still having debates about whether or not SSRIs are more effective than placebos for depression— and those medications have been around for decades and have no issues surrounding legality that result in limits on research. This is one of the reasons scientists write reviews and meta-analyses, to try and combine findings from many studies.
The authors of the new review searched for studies published between 1980 and 2018, including unpublished or ongoing studies, where medicinal cannabinoids were given to adults to treat depression, anxiety, attention-deficit hyperactivity disorder, Tourette’s syndrome, post-traumatic stress disorder, or psychosis. In the end, they included 83 studies, 30 of which were randomized controlled trials—considered the gold standard of study design.
The results were mixed. “Our analyses and conclusions are limited by the small amount of available data, small study sizes, and heterogeneity of findings across studies,” the authors wrote.
They found that pharmaceutical-grade THC made anxiety symptoms better, but only in people who had other medical conditions like chronic pain. This is an important caveat. If, for example, the primary outcome of a study was seeing if cannabis could help with chronic pain and a person’s depression also improved, it’s hard to say whether the cannabis treated the depression, or if their pain got better and made them feel less depressed.
In one study the review looked at, pharmaceutical cannabis made psychotic symptoms worse, while in others, pharmaceutical cannabis didn’t show any significant effect on mental disorders, but was linked to increased side effects. The authors noted that there were very few randomized controlled trials for them to review that tested pharmaceutical CBD or medicinal cannabis. Another issue is that many people don’t take pharmaceutical or medicinal cannabis, they buy it recreationally—the studies can’t account for that variability either.
“To make more confident conclusions we need more evidence; but at the moment there is not a lot that can support, guide or inform use of cannabinoids for mental disorders,” said Louisa Degenhardt, the deputy director at the National Drug and Alcohol Research Centre at The University of New South Wales in Sydney, and senior author on the review.
Kevin Hill, an addiction psychiatrist at Beth Israel Deaconess Medical Center and an assistant professor of psychiatry at Harvard Medical School, said that any clinician who treats patients who regularly use cannabis, either recreationally or medicinally, won’t be surprised at the mixed and sparse evidence the authors had to muddle through.
“There is much more that we don’t know about cannabis and CBD than we do know,” Hill said. “With such an intense interest in cannabis and CBD as treatments for medical conditions including psychiatric disorders, it is disappointing that the rate and scale [of research] has not kept pace with the interest.”
Cannabis is a Schedule 1 drug, which is a barrier to research, but funding is a bigger one, Hill said. He thinks that states and companies profiting from cannabis and CBD should contribute to the science. “For the most part, they have not,” Hill said. “A portion of profits from the sale of cannabis or CBD should be put toward finding the answers to important questions about efficacy and safety.” It’s a process we know can work, even for something like CBD: Large-scale trials were how we found that CBD could be helpful for pediatric epilepsy conditions, and it’s now FDA-approved for that use.
The reason why this all matters is because with mental health disorders, taking something that’s not helping could eventually end up doing harm. If someone with depression takes CBD or medical cannabis daily and it doesn’t work (or makes it worse), they won’t improve. This could affect their overall quality of life, and their ability to work or be social.
Without more study, we could also be missing some of the basic biology around cannabis use. Earlier this year, a small study looked at the medical records of 25 people who used cannabis and found that they needed more anesthesia to remain sedated during certain medical procedures. When the authors tried to look at existing research to see if other clinicians had found the same thing, they discovered that their study was the first on that topic. “We did these huge literature searches and found nothing,” Mark Twardowski, a doctor of osteopathic medicine, told VICE in April. “Really?”
And many CBD products continue to be notoriously under regulated: In 2017, a study in JAMA found that only 30 percent of CBD products sold online were accurately labeled, and last year, a study in Forensic Science International found synthetic marijuana and dextromethorphan, an ingredient in cough syrup, in CBD vape liquid.
“With millions of Americans using cannabis and CBD for myriad medical conditions, we should be conducting rigorously designed trials to see if cannabis and CBD actually are effective treatments for these conditions,” Hill said. The United States has the potential to lead the way in this work and we have not yet done so.”
Until more research is done, we should be wary of overblown claims around cannabis on both sides: that it does nothing, or that it’s a panacea—our gap in knowledge is too great for either.
Follow Shayla Love on Twitter.
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Stressed Students, Bridesmaids Drama, And More: An Advice Column From A Total Amateur
Hi! A while ago I asked the BuzzFeed Community to tell me a problem they’re having, so that I — a person with absolutely zero professional qualifications to help anyone — could give them advice. So, here are the results! NBC 1. “Dear Andy,I have NO idea where I should go to school… I’m applying…
Hi! A while ago I asked the BuzzFeed Community to tell me a problem they’re having, so that I — a person with absolutely zero professional qualifications to help anyone — could give them advice. So, here are the results!
I have NO idea where I should go to school… I’m applying to 12 schools, 10 on the west coast and two in BC. I’m a high achieving student (I’m in five AP classes, president of two clubs, volunteering and a job, etc.) and I don’t want to go somewhere that’s all about the pressure, but I still want a high quality education. I’m so lost, help!”
—The Overwhelmed Student
You posted this just to dunk on all of us academically, didn’t you?
Kidding. In all seriousness, you can get a very good education at a bunch of different schools. And when you’re done, you’ll have a degree that probably nobody will ever verify! In my completely amateur opinion, the only reason people think the “Ivy League” schools are better is because a lot of wealthy, well-connected people go there (and have gone there), and therefore when you graduate from one, you’re more likely to get in at some fancy law firm or whatever because of your connections. So if you aren’t planning on being like, IDK, the CFO of Waystar Royco or something, just pick the school that you really want to go to. Where are you going to be happy living? Is one of the schools in a city you already want to move to and/or the city that has jobs in your future profession? Is it important for you to be close to home? How many Wendy’s are there on campus, and do they carry Spicy Nuggets? These are the questions you should be asking.
Oh, wait, actually…forget all that. Go to the school that will cost the least when you factor in tuition, room & board, and any scholarships you might get. Student loans are a curse and you want as little of them as possible. In the end, you might not even end up doing the thing you studied in college. Wanna know what degree I have? A BFA in Theater Performance. An acting degree. And now here I am, writing for a website. You’ll be fine.
I got married this summer, and I decided to choose only family to be my bridesmaids. For me this included three female cousins and my (now) sister-in-law. My husband, on the other hand, decided to do a mix of family as well as friends from high school for his groomsmen. I had no problem with this at all.
I had a few friends who I knew would expect to be bridesmaids, so I made it clear to them from the very beginning that I would be choosing family only as to not have a huge wedding party, but I told them they were not any less important to me and that I still wanted them to be involved in the wedding as much as they felt comfortable with. Most of the friends I had this conversation with were very understanding, however one straight up told me that she was disappointed (this was two years before the wedding).
Now it’s been a few months since I got married and this friend (a friend from childhood) started talking about the wedding. She told me she felt left out of the wedding since she wasn’t part of the wedding party. It particularly bothered her that my husband included friends and I didn’t. She then proceeded to tell me that it was difficult for her to be there the day of my wedding because of these feelings. AT MY WEDDING. She also included the fact that she didn’t want to upset me and that it doesn’t change our friendship. But if that is the case then why say anything in the first place? I’ve already said one too many times the reason for my bridesmaid choices and how important she is to me regardless. And she says she understands. I just wish she would let it go. Ever since this conversation I feel like I’ve been seeing her in a whole new light.
I do care about her feelings, but I stick by my decision and I don’t regret anything. I feel like I’ve done everything I can to make her feel better.”
—The Besieged Bride
[TL;DR: Bride had only family as bridesmaids, groom had some friends in the mix, bride’s childhood friend felt left out and complained about it a few months after the wedding.]
Question one: How drunk was your friend when she brought this up to you? If she was like, a 6 or more out of 10, I say let’s give it a pass and hope she got it out of her system.
Question two: Has your friend had a wedding of her own yet? If yes, then she should’ve understood the situation, because wedding planning is a special kind of hell and inevitably you have to make difficult decisions like this one that might hurt people’s feelings. So if you’ve planned your own wedding, you know the deal and you’re able to say to yourself, “It’s their wedding, I’m just going to be supportive and have fun.” If she hasn’t gotten married yet, she’ll realize later that it was totally inappropriate to complain about this to you. Hopefully.
I have been taking so many of the relationship quizzes on BuzzFeed but they all say I’m single. The major problem is I have an S.O. Is she just faking or am I?? Help me!! Is my girlfriend not actually mine or are we real?”
—The Quizzical Quiz-Taker
You’re not real. This is all a simulation.
—Andy (or am I?)
I’m not sure where to live. I live in Milwaukee, WI, right now. Moved here three years ago for school, but that fell through because Milwaukee is friggin expensive. My family wants me to move back to the other side of the state, towards Minneapolis/St. Paul. What should I do?”
—Meandering the Midwest
Get the fuck out of there, it’s so cold! Listen, I used to live in Michigan, and it was depressing because it was grey and miserable nine months out of the year. Now I live in Southern California, it’s sunny and beautiful and my vitamin D levels are through the roof. Migrate south, seriously.
But if you HAVE to stay, I will say that everybody who lives in Minneapolis seems to LOVE Minneapolis for some reason.
My problem is that I struggle with feeling attractive. I started taking birth control when my boyfriend and I started dating (six years ago). I started gaining the weight right after. I’m now a size 12 and my boyfriend is a slender guy. I haven’t felt attractive in the last year. I gained so much weight at one point I was a size 16. I’m back to a 12 and trying to lose weight again. I don’t feel sexy or beautiful in any way. I prefer to keep my shirt on during sex now. I don’t know why my boyfriend still finds me attractive. I have a tummy, I have rolls when I sit down, I just don’t know what he sees anymore. Any advice you could give me would be much appreciated.”
—Struggling With Size
First off, don’t worry about your boyfriend. Clearly he finds you attractive, and when you actually care about someone, the size tags on their clothes don’t matter to you at all. Appreciate that fact and find some security there.
Now, consider the possibility that if your boyfriend finds you attractive at any size, you can too! It’s not easy. It requires shedding every bit of toxic influence that the media and our society overall has thrown at you for your entire life. That takes time and work.
But if you are worried about your physical health at all, consult a doctor. There are many different types of birth control and like 40 different pills, and everyone reacts to each one differently. It can take time to find the right one, and not every doctor is going to be helpful about it. Advocate for yourself if you’re unhappy with your medication. You may have done all of this already and I’m just sitting here mansplaining BC to you, but if so at least you can cross that off your Mansplaining Bingo Card.
That’s it for this week. But if you’re having a problem that you need advice about, let me know! It could be anything: petty arguments that you need a judge to decide who was right and who was wrong, help making life decisions, relationship issues — I’m your completely unqualified man. Email firstname.lastname@example.org (for total anonymity) or leave a comment here!