Though the rates of antidepressant use are climbing, so are the rates of suicide. The FDA’s warnings for SSRIs explain that the drugs may actually increase the risk of suicide and increase suicidal ideation.
Just this year [2016], the largest review to date has found that antidepressants may actually increase suicide risk. Even worse, many trials that suggest that SSRIs do not increase the risk of suicide may have been misreported.
The study is a meta-analysis of over 70 trials, which included over 18,000 people. The results found that antidepressants more than doubled the risk of suicide in those under 18.
Such striking results were not found in adults, though the study authors suggest that a misrepresentation of trial data may have lead to a “serious underestimation of the harms”.
Tarang Sharma, one of the study authors, explains the implications of this analysis to The Telegraph,
"The analysis suggests that clinical study reports, on which decisions about market authorisation are based, are likely to underestimate the extent of drug related harms."
Lead study author Professor Peter Gøtzsche states,
"Antidepressants don’t work in children, that is pretty clear, in the randomised trials children say that they don’t work for them, but they increase their risk of suicide. What I get out of this colossal underreporting of suicides is that SSRIs likely increase suicides in all ages."
Unfortunately, there has yet to be some serious hard-hitting investigations into cannabis and suicide. However, recent research suggests that suicide rates are lower in states with medical cannabis. In fact, once states legalised medical cannabis, they saw overall suicide rates fall by 10%. The study authors concluded:
"The negative relationship between legalization and suicides among young men is consistent with the hypothesis that marijuana can be used to cope with stressful life events." – Anderson et al.
Another 2009 longitudinal study looked at whether or not cannabis was associated with an increased suicide risk, but found no correlation after addressing confounding variables such as psychological and behavioral problems.
"These results suggest that cannabis use is unlikely to have a strong effect on risk of completed suicide, either directly or as a consequence of mental health problems secondary to its use." – Price et al.
Antidepressant withdrawal is often called “discontinuation syndrome”. If you’ve been on an antidepressant for a while and you decide you’d like to stop, you face a significant risk of severe depression symptoms after you stop taking the drug. In many cases, this depression is worse than your primary complaint.
There is also evidence that long-term antidepressant use changes the way that cell receptors in your brain function, making it particularly difficult to heal after long-term antidepressant use.
A 2015 study by Chouinard and Chouinard advocates for the reclassification of “discontinuation syndrome” for what it actually is: straight up withdrawal. They write,
"New and rebound symptoms can occur for up to 6 weeks after drug withdrawal, depending on the drug elimination half-life, while persistent postwithdrawal or tardive disorders associated with longlasting receptor changes may persist for more than 6 weeks after drug discontinuation." – Chouinard and Chouinard
Simply stated, once you discontinue an antidepressant, the brain changes associated with long-term use can cause lasting symptoms, including more depression. These symptoms can last longer than 6 weeks. Other studies have suggested that you begin to see these brain changes after a single dose of an antidepressant.
It is possible to go through cannabis withdrawal, though there has yet to be any evidence that the herb causes lasting changes in the adult brain. Though researchers have been trying to figure out whether or not the plant can permanently change brain structure, the evidence has been highly contradictory thus far.
In fact, cannabis seems like it promotes brain health in aging adults.
Most recently, a 2015 study found that cannabis use was not associated with brain morphology in either adults or adolescents. This was after controlling for alcohol, tobacco, and other substance use which many studies fail to differentiate. Other recent studies have found no association between cannabis use and lower IQ.
Further, cannabis withdrawal is fairly mild. 50% of cannabis consumers who decide to stop experience no symptoms or only mild symptoms. Though, some individuals with cannabis dependence may some uncomfortable experiences, though less severe than those from antidepressants.
A 2015 review explains,
"Chronic cannabis users typically experience unpleasant withdrawal symptoms when use is discontinued. These symptoms are much less severe than those associated with withdrawal from chronic opioid or depressant use, but aversive enough to encourage continued cannabis use and interfere with cessation attempts in some individual."
It’s important to note that these symptoms are associated with THC withdrawal, and are not reflective of other cannabinoids. Omega-3 fatty acid supplementation may also be helpful in withdrawal.
The most common type of antidepressant is a SSRI (selective serotonin reuptake inhibitor). SSRIs create a surplus of serotonin for your brain to use. We are often told that serotonin is a feel-good chemical that promotes calmness and happiness. However, recent research has found something new.
Serotonin can actually increase feelings of fear and anxiety. In fact, the neurotransmitter engages parts of the brain that control your fear response. These findings were presented in a 2016 study published inNature. The study hypothesized that this mechanism is why those with anxiety disorders can have negative reactions to SSRIs.
High doses of psychoactive THC may increase anxiety in some people. However, in low doses, the compound is a potent anxiolytic. Yet, another cannabis compound, non-psychoactive CBD is a powerful anti-anxiety and antipsychotic.
In fact, CBD was successful in calming psychotic and anxious behavior in an early trial of patients with treatment-resistant schizophrenia.
CBD can even negate some of the negative impacts of THC. If you have consumed THC and are having a bad experience, trying a little CBD oil or a high-CBD strain can quell anxiety and raciness caused by the psychoactive. The cannabinoid may even be helpful during some awkward moments of everyday anxiety.
Five of the top 10 legal drugs linked to violent behavior are antidepressants. Have you or a loved one acting a little extra aggressive lately? It really might be the drugs. Here’s how the top five pan out:
Why might this be the case? Well, it turns out that people process serotonin differently. It also turns out that too much serotonin might make people unusually aggressive. A small 2011 study examined the role antidepressants play in homicide. The study examined 10 patients with symptoms of serotonin toxicity.
Serotonin toxicity is caused when levels of the neurotransmitter are too high. All 10 patients had been treated with antidepressants. 8 of the patients had committed homicide and two of the patients became violent after beginning antidepressants.
The study found that patients with toxicity had a greater likelihood of having a certain gene mutation that changed how their body metabolizes serotonin. Antidepressants increased serotonin and triggered toxicity.
After discontinuing antidepressants, patients returned to normal mood. Doctors do not check for this gene mutation prior to prescribing antidepressants.
This is a very small study, but the implications are certainly horrifying enough to deserve greater attention.
This is another one where, unfortunately, there isn’t a whole lot of clinical research to tell us just how exactly cannabis affects aggressive behavior. However, anyone who has tried a little herb knows that it can calm you right down.
Thus far, research has found that there is no correlation between cannabis use and delinquency.
New animal research suggests that the body’s natural endocannabinoids (the human version of marijuana) may play a role in aggression. Mice with blocked cannabinoid receptors showed an increase in offensive aggression. When the mice were treated with a synthetic cannabinoid, their aggressive behavior decreased.
This led the researchers to conclude that endocannabinoid system plays an important role in regulating social behavior and aggression. And let’s face it. Even back in the 1970s, the U.S. federally commissioned report suggested that cannabis halts aggression.
The report suggests,
"Rather than inducing violent or aggressive behaviour… marihuana was usually found to inhibit the expression of aggressive impulses by pacifying the user."
Further, anecdotal reports have shown that cannabis actually reduces agitation, violent, and self-harmful behavior in children and adults with severe autism. Violent behavior in autism can now earn you a medical cannabis card in a few states, including California, Pensylvania, and Delaware.
In popular media, depression and low serotonin go hand-in-hand. But, new evidence suggests that this may not be the case. A 2015 review found that high levels of serotonin were associated with depression. The paper suggests that serotonin may be a response to the depression, rather than an indicator of depression itself.
Further, when patients do begin to feel relief, evidence suggests that it may be because their body is responding to overcome the effects of the antidepressants, rather than be helped by the drugs directly.
Lead study author Paul Andrews tells Science Daily,
"It’s time we rethink what we are doing. We are taking people who are suffering from the most common forms of depression, and instead of helping them, it appears we are putting an obstacle in their path to recovery."
Small doses of cannabis can cause a boost in serotonin, but that is not the herb’s primary mechanism of action. Rather, compounds in cannabis engage the endocannabinoid system. The endocannabinoid system is responsible for maintaining homeostasis (optimum balance) in the body.
The most common form of antidepressant, a SSRI, targets a very specific type of cell receptor and alters its function in a very specific way. In contrast, compounds in cannabis interact with multiple cell receptors and enzyme proteins throughout the body.
Cannabinoids engage the immune system, improve energy metabolism, reduce pain, and boost mood through the regulation of various different neurotransmitters in the central nervous system. All of these areas are associated with depression.
Cannabis compounds have polypharmacological effects. This means that they act on more than one disease pathway at the same time. Simply stated, they address the issue from various angles, rather than just one.
This may sound like blasphemy to some, but there are different causes of depression. Some people sink into depression after a significant loss or trauma. Others experience depression postpartum.
Nutrient deficiencies (particularly vitamin B-12) can also trigger depression and changes in mood. So do food intolerances, chronic stress, thyroid issues, and infection.
Cannabis won’t heal food intolerances or make up for a vitamin deficiency, but it may provide effective symptom relief in a different way. New theories about depression suggest that inflammation in the brain could be a major contributor. In that case, the anti-inflammatory properties of cannabis may explain why so many people find relief with the herb.
There are lots of reasons why a person may choose to take antidepressant medication. Whatever your reason is, it is just fine to need some extra help. It’s incredibly disorienting to feel trapped in a funk with no obvious escape route.
If you find something that helps you live a normal life again, that’s wonderful. However, it’s always important to know what you are consenting to before you head down a path without clear vision.
However, you’re the only person that can make that decision for yourself. Always work with a doctor before making changes to your treatment plan.
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