Depression and other mood disorders - grinspoon

Depression and other mood disorders - Grinspoon Disaster & ScienceDrugs & society homeIntroductionBackgroundNews indexAnalysesResourcesSearch Depression And Other Mood Disorders
From the revised edition of Marihuana: The Forbidden
Medicine (Harvard University Press), by Dr. Lester
Grinspoon, Associate Professor of Psychiatry at
Harvard Medical School; and James B. Bakalar,
Associate Editor of the Harvard Mental Health Letter
and a Lecturer in Law in the Department of Psychiatry
at Harvard Medical School. Originally published in
1993; revised edition published in 1997.
For most people, depression is a passing mood; for some,it is a debilitating chronic illness with severe physical aswell as emotional symptoms. When it is deep andpersistent enough to interfere with work, friendships, familylife, or even physical health, depression is regarded as apsychiatric disorder -- one of the most common and one ofthe most serious.
An episode of severe, or major, depression may lastseveral weeks to several years. One set of symptoms isinconsolable misery accompanied by despair and guilt.
Victims feel worthless and inadequate; they have no hopefor the future and ruminate about death and suicide. Theymay think that they have lost all their money, or are beingpunished for grave sins, or dying of incurable diseases.
Some depressed persons do not admit sadness or guilt;instead they withdraw from human contacts, lose allinterest in life, and become incapable of feeling pleasure.
Time passes slowly for them and the world seems drearyand meaningless. Normal emotional responses, evenordinary despondency or grief, become impossible. Theyare fretful and irritable. They cannot concentrate or makeeven minor decisions. They turn the same few ideas overand over in their minds. Some depressed patients arelistless and lethargic, with slow movements, tonelessspeech, and an expressionless face -- in extreme cases,muteness and immobility resembling catatonic stupor.
Others pace, weep, moan, and wring their hands inanxious agitation.
Depression is not simply a disorder of mood. Depressedpeople lack energy in every sense, physical as well asemotional and intellectual. The dominant symptoms maybe loss of appetite and insomnia (or, sometimes,oversleeping and a ravenous appetite), backaches,headaches, upset stomachs, constipation, and above allchronic fatigue. People who claim to be "tired all the time"may be depressed even if they acknowledge no sadnessor despair. Manic persons, on the other hand, aresleepless and tireless -- until they become exhausted andbreak down.
file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon The standard treatments for depression are the manyantidepressant drugs introduced in the last forty years. Fora long time the most popular group of antidepressantswas the tricyclics, including imipramine (Tofranil),amitryptiline (Elavil), desipramine (Norpramin), and severalother drugs. Their most common side effects are drymouth and blurred vision. Others are weight gain,constipation, difficulty in urinating, and orthostatic orpostural hypotension (dizziness caused by a reducedblood flow to the brain on sitting up or standing up). Theycan be risky for patients with cardiovascular disease,because they increase the heart rate and may disturbcardiac rhythm.
Another group of antidepressants is the monoamineoxidase (MAO) inhibitors: isocarboxazid (Marplan),tranylcypromine (Parnate) and phenelzine (Nardil). Theymay cause dizziness, insomnia, and impotence, and whenused in combination with foods such as red wines, pickles,and certain cheeses which contain the substancetyramine, can produce dangerously high blood pressure.
Because of these potentially serious side effects, they arerarely a first choice in treating depression, but they maybe helpful for some patients who do not improve on otherdrugs.
An increasingly popular new group of antidepressants withfewer and less serious side effects is the selectiveserotonin reuptake inhibitors (SSRIs). The most popular ofthese drugs are fluoxetine (Prozac), sertraline (Zoloft), andparoxetine (Paxil). Their side effects include nausea,weight loss, and agitation (or, in some cases, drowsiness),and loss of sexual interest or capacity.
In bipolar or manic-depressive disorder, the inconsolablemisery of major depression alternates with mania oruncontrolled elation. In the manic phase people withbipolar disorder are cheerful, gregarious, talkative,energetic, and hyperactive. Their spending is oftenextravagant and their behavior reckless. They may imaginethat they have extraordinary talents and are or soon willbe rich and powerful. This reckless, restless cheerfulnessand expansiveness can suddenly turn into incoherentagitation, irritability, rage, paranoia, or grandiose delusions.
Antidepressants alone are not a good treatment for bipolardisorder and may even make it worse. Lithium carbonate,introduced into medicine at about the same time astricyclics, has revolutionized the treatment of bipolardisorder. It prevents mania and to a lesser extent bipolardepression. Although lithium takes several weeks to startworking, its success rate is about 70 percent and 20percent of patients are completely freed of their symptoms.
Patients generally require long-term maintenancetreatment, and because lithium can be toxic it must beused carefully. Chronic use may endanger the heart,kidneys, and thyroid gland. Usually the dose is graduallyincreased until the drug begins to work and thenperiodically readjusted according to the patient's age,medical condition, and psychiatric symptoms. The amountof lithium in the blood must be checked regularly because file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon it is ineffective if too low and risky if too high. Some sideeffects are weight gain, hand tremors, drowsiness, andexcessive thirst or urination. Patients often cannot toleratelithium either because of the side effects or because ittakes some of the joy from their lives along with the manicepisodes. It has been described as a "loose-fittingemotional straitjacket." Only 20 percent of patients withbipolar disorder take lithium alone. Other drugs used inthe treatment of bipolar disorder are the anticonvulsantscarbamazepine (Tegretol) and valproic acid (Depakote),which may be used either alone or in combination withlithium.
Cannabis first appeared in the Western medical literatureas a suggested treatment for depression in the middle ofthe nineteenth century. In 1845, Jacques-Joseph Moreaude Tours proposed its use in melancholia (especially withobsessive rumination) and chronic mental illness ingeneral. In the next hundred years medical paperssupported and disputed the utility of cannabis in thetreatment of depression. In 1947 G.T. Stockings, anEnglish physician, administered a synthetic THC to fiftydepressed patients and thirty-six showed definiteimprovement. Obsessive ruminations were significantlyreduced in six out of seven patients. 1948, D.A. Pondfailed to replicate these results. In 1950 C.S. Parker andF.W. Wrigley conducted a double-blind study involvingfifty-seven patients suffering from severe melancholia ormilder depression, and found no difference between thesynthetic THC and a placebo, but they used a smallerdose than Stockings, 10-20 mg as opposed to 15-90 mg.
The most recent study on cannabis and depression wasundertaken in 1973. Eight hospitalized patients were giveneither THC or a placebo for up to a week. The THC didnot relieve their depression, and in four of the patients itproduced discomfort and anxiety so serious it had to bewithdrawn. The authors questioned whether "differenteffects might be observed in other settings or in patientswith less severe depressive symptoms." They also notedthat "the administration of THC under double-blindconditions in this trial precluded the establishment of anypositive expectations in the patient. The fact that thepatients could not have prepared themselves for theexperience of an altered state of consciousness may alsohave contributed to the predominantly negative effects ofthe drug in these depressed patients. Finally, the relativelybrief duration of the trial (one week) must be kept in mindsince standard antidepressants require two to three weeksto produce clinical improvement." Today, among the minority of depressed patients who donot respond to any of the standard antidepressants or findthe side effects unbearable, some have discovered thatcannabis is more useful than any legal drug. We firstlearned about the following patient's use of cannabis fromher psychiatrist. She called us because she was puzzledto find that marihuana was more useful than the drugs shehad prescribed, and she wanted to be reassured of itssafety. The patient gives her account below: file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon I am a thirty-nine-year-old healthprofessional who suffers from chronicdepression. I have been able to graduatefrom college, receive a postgraduate degreewith highest honors, and establish asuccessful professional career, but it hasbeen a constant struggle. No matter howmuch I accomplished, how much praise Ireceived, none of it registered. I could onlyruminate about my shortcomings, and Iseemed to have no control over myunrealistic negative thoughts. My first major episode of depressionoccurred in 1969, when I went away tocollege. I withdrew halfway through myfreshman year and began semi-weeklytherapy sessions with a psychiatrist. With herhelp and the use of a tricyclic antidepressant,I was able to return to a college closer tohome the following September. I continuedto see her once a week until I left the East inAugust of 1976. While at school in theMidwest, I saw a psychiatrist renowned forhis expertise in the pharmacologicaltreatment of depression. Since I returned tothe East in 1981, I have been in therapyonce again with my original psychiatrist,either once a week or every two weeks. Under the guidance of these therapists Ihave tried more than a dozen differentdrugs, including several types of tricyclicantidepressants, Prozac, lithium, Ritalin[methylphenidate, a stimulant related toamphetamine], synthetic thyroid hormone,and probably others I have forgotten. Theonly ones that have affected my moodssignificantly are Elavil at high doses, andcombinations of Dexedrine[dextroamphetamine] and a barbiturate.
Elavil works only during an incapacitatingepisode of depression, and its side effects,especially constipation, are distressing. Sinceuse of Dexedrine and barbiturates asantidepressants is considered unorthodox,my therapist and I have been uneasy aboutit, but it was the only medication thatworked. Several prominent psychiatrists haveverified this and recommended that I usewhatever helps. But now I am becomingtolerant to both of these drugs (I have beencareful not to increase the dose, because Iknow the dangers). In the spring of 1990 I smoked marihuana forthe first time since 1973. To my amazement,a quarter of a joint changed my self-perception to match the person others saw.
It was like night and day. I had experienceda similar change only a few times before, file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon when Elavil kicked in and lifted me out of thedepths. But with Elavil it took four days ofrapidly increasing doses; with marihuana ittook less than five minutes, every time.
Since then I have been using marihuana tothink clearly, to concentrate, and simply toenjoy the beauty of the world in a way Icouldn't for years. I try to carry the same positive feelings withme while I am not directly under theinfluence of marihuana. I now use marihuanaas an antidepressant once or at most twice aday. No one realizes I am smoking it,because I don't act stoned. I have beencutting back on my other medications andoften forget to take them. After smokingsome cannabis in the morning, I no longerdread the responsibility of going to work butactually look forward to it. I have alwaysawakened in the morning more exhaustedthan when I went to sleep. Even duringweekends and vacations, I have found itdifficult to get dressed and get moving.
Immediately after I smoke marihuana, allthat changes. I feel energetic and loquacious;I want to socialize, exercise, or do whateverneeds to be done. I feel a passion for life. Ieven see myself differently in the mirror, andrealize that I am not the homely beast Iusually see. While using marihuana Irealized that I was not spending time withthe person I wanted to be with, so I endedan unsatisfying relationship of two and a halfyears. I am now with someone I love dearly.
Without marihuana I have an orgasm onlythrough masturbation or after heroic effortsduring intercourse. Cannabis transforms meinto a fully developed sexual human being. Ican easily shut out inappropriate thoughtsand enjoy what I am feeling. I can haveorgasms by stimulation practically anywhereon my body, even just through kissing --amazing! It is unfair and cruel that the antidepressantthat helps me most (and is probably, in itspure form, least toxic) is unavailable for legalprescription. I have to break the law to obtainit and pay exorbitant prices for a drug whosecost of production is minimal. Another patient who suffers from episodic depressionwrites as follows: I am a forty-seven-year-old white male, apartner in a multi-million dollar company. . . .
As soon as I started school my emotionalproblems became apparent, and an endlesstrek to various health professionals began. file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon My school phobia made me sneak awayfrom school, sometimes by climbing outwindows. I spent much time beinginterviewed by "special ed" teachers andsocial workers. From early on I wasexamined by a continuous flow of physicians.
My earliest recollection is the one whoprescribed special arches for my shoes (torelieve headaches) and a syrup at night tomake me sleep. The headaches persisted; the depressionsbecame paralyzing episodes that occurredseveral times a year and lasted days toweeks. Because of them I missed much ofgrade school and junior high. In my sophomore year of high school thingsgot worse. I was given a prescription forMiltown [meprobamate, an anti-anxiety drug].
I took it in varying dosages for severalmonths. It caused me to become drowsy anddizzy; my speech slurred, and I developedchronic diarrhea. My poor performance inschool worsened. I started to lose mycoordination. My depressions continued,perhaps made worse. I was glad to stopusing it. My experience with Miltown was sounpleasant that I refused to take any other"mental" drugs for the next two years. I didsee a therapist on a weekly basis. Hisdiagnosis was "episodes of acutedepression." During this period I managed to just barelycomplete high school, and got accepted at asmall local college. During my secondsemester I attempted suicide. I was told by adoctor that I had an "obsessive-compulsivepersonality." It was suggested that I takeLibrium. I started taking this drug and foundmyself in a continuing state of depression,confusion, and lethargy. I had to leaveschool. When my speech started slurring Iabandoned the Librium. I got a job driving a truck, and started seeinga new doctor, a psychiatrist. After ninemonths I reapplied to college and wasaccepted. The doctor convinced me to tryanother drug, Tofranil, that he said was veryeffective in treating depression. I startedusing it and soon found I was losing allpower of concentration. I became restless,full of anxiety. It became almost impossibleto urinate. I developed a lump the size of amarble in my left nipple. The doctor ascribedthese symptoms to the Tofranil. I stoppedusing it and again left school. My depression file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon was still there, and I was desperate for somerelief. I also started getting pains in mystomach. A GI series revealed a duodenalulcer. I constantly chewed antacids and tooktablets called Zantac [ranitidine, an ulcertreatment]. Life was becoming more difficult, and thedoctor suggested another medicine, Vivactil[protriptyline, a tricyclic antidepressant].
Again, the side effects were disastrous. Ibecame more agitated than before, hadgreat trouble urinating, and a chronic skindisease I have (atopic dermatitis) started toitch with a fury. I developed a peculiar tastein my mouth that would not leave and had acontinual feeling of nausea. Shortly afterdiscontinuing Vivactil I was in the psychiatricward of a New York hospital, suffering from"atypical depression." In the hospital I was put on lithium. After twodays my hands started to shake. This tremorbecame so intense that after one week I wasunable to write, or hold a glass withoutspilling the contents. I had diarrhea andnausea; my vision started to blur. I ceased using the lithium and left thehospital after a stay of two weeks. When Isaw my therapist again he made an unusualstatement: "I'm not suggesting this," he said,"if I did I could lose my license, but have youever tried marihuana?" I had smokedsomething alleged to be marihuana once inhigh school and had been unaffected. Ithought it might be worth another try. I calleda friend I suspected would know where orhow to obtain some, and the next day shebrought me two joints. I later learned that herhusband (who is a dentist) used marihuanato ease the pain of chronic depression. Remembering my previous experience, I hadlow expectations. Alone in my room I lit thefirst joint. Soon I found myself lost in reverie.
Previously, when I was depressed, thesadness became the focal point of myexistence. Now my mind was beingdistracted by neutral, and even funny orpleasant thoughts. The constant pain of thedepression was reduced to an occasionalnagging ache. I slept well and awoke feelingrefreshed, not "doped up" and lethargic. Itsoon became apparent that when I was inthe throes of a depressive episode, amarihuana cigarette was a greater source ofrelief than anything I had ever tried before --not a cure, but something that diluted thepain. The marihuana permitted me tofunction better than any licit drug. I didn't file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon become drowsy, develop tremors, or haveany of the side effects associated with thedrugs I had previously taken. I gained anappetite I never had, and put needed weighton an emaciated frame. I found myselfhaving ideas that would not ordinarily havecome to me, some practical, some not. I wasable to pierce the black cloud thatsurrounded me and climb out far enough tomeet my responsibilities. The use ofmarihuana makes it impossible fordepressive thoughts to become the totalfocus of my life. The fact that marihuana is illegal made mesearch for a licit medicine that was at leastas effective. The next one I was given wasNorpramin. This chemical offered no reliefand came with an assortment of side effectsthat aggravated my prostate, gave mediarrhea, left a terrible, lingering taste in mymouth, and colored my tongue black. Forabout a year I was given Adapin [doxepin,another tricyclic] with only minor side effects,but it did little or nothing to change mycondition. I was also given Buspar[buspirone, an anti-anxiety drug], whichseems to have no effect at all. Perhaps thevery worst of them all was Prozac, whichactually made me more anxious, nauseous,dizzy to the point of fainting, and unable toachieve orgasm. I have also had Desyrel[trazodone], which causes only minor sideeffects, but again seems to do little good. As of this writing, I have smoked marihuanafor more than two decades. In addition todampening the pain of depression, I havefound it reduces nausea and burning in thestomach due to the production of acid. Itallows me to sleep peacefully. It stimulatesmy imagination when working on creativeprojects. It enhances simple joys, such aseating M&Ms or walking in the woods. Sinceits use jeopardizes my freedom, I wouldprefer a legal substitute. So far I have foundnone. I use no other illicit substances. I do not usetobacco. My alcohol intake is no more thanan occasional drink on a Saturday night out.
I usually have one cup of tea a day, and twoglasses of Coca-Cola. I take several aspirinsa week. Ron Leifer, M.D., is a psychiatrist who practices in Ithaca,New York. He reports on two of his patients who foundcannabis useful for the treatment of depression: In more than thirty years of practicing file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon psychiatry in a small university town, I haveencountered many patients who usemarihuana, and in most cases this use isunrelated to the problem for which they seektherapy. But a few of my patients have usedmarihuana for the relief of chronicdepression, as the following examplesindicate. Mr. T was a forty-four-year-old historyteacher at a local college who came inlooking unhappy and complaining about allaspects of his life -- his work, his marriage,his house, his finances. He said he saw nohope of improving his situation. He wasangry, cynical, and critical of others. Hestated half in jest that he often thought ofcommitting homicide or suicide. He asked formedication to relieve his depression. Mr. T's father was a Polish Jew whoescaped before World War II, while his ownfather died at Auschwitz. He worked as anupholsterer in Florida. The patient wasterrified of his stern father but also greatlyloved him. In 1958, when the patient waseight years old, his father became depressedand was given electroshock therapy. He diedof a heart attack five years later, when thepatient was fourteen, and he traces his owndepression to that time. He first consulted a psychiatrist in 1970, andsince then has been given Desyrel[trazodone], Elavil [amitryptiline], Prozac[fluoxetine], Wellbutrin [bupropion], lithium,and three or four other antidepressantswhose names he cannot remember. None ofthem brought relief. He first tried marihuanain 1986, when he was in Amsterdam with hiswife and her dance troupe. It gave himimmediate relief, but he was reluctant tocontinue using it because it irritated hislungs. The day after his initial consultation, Mr. B.T.
called for an emergency appointment andbegged for anxiety medication. I prescribedValium [diazepam]. At the next meeting aweek later he said he did not like Valium andasked for an antidepressant. I nowprescribed Prozac [fluoxetine] along withXanax [alprazolam] for anxiety. He said theProzac made him jumpy and within a monthhad stopped taking it. He now asked forMarinol, saying he did not want to smokemarihuana because he feared the legalconsequences and because it aggravated hisbronchial problems. I arranged a consultation with Dr. Grinspoon, file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon who prescribed Marinol, 5 mg twice a day.
Three days later he called to say he wasfeeling much better. He was more energeticand thinking more clearly. A month later hereported that he felt great; his depressionwas gone, his negative thoughts haddisappeared, and he was no longer crankyand angry. He loved his work, he wasgetting along with his wife, and he wassleeping well. Since he was no longeranxious, he had stopped taking Xanax.
Three months after the initial consultation hedescribed Marinol (which he was now takingthree times a day) as a "miracle drug." After six months his insurance ran out andhe was unable to afford Marinol. He turnedto street marihuana, although he wasunhappy about this because of the expenseand the bronchial irritation. Then he wasgranted Medicaid and asked me to prescribeMarinol again, but I was reluctant because Icould not get prior approval and feared thereaction of the state government. Mr. T isstill successfully using street marihuana totreat his depression. Mr. F, a sixty-five-year-old retired collegeprofessor, was referred by apsychopharmacologist from New York City.
Dr. Grinspoon had recommended Marinol,and the patient was looking for a physiciancloser to his home who would prescribe it forhim. Mr. F said that he had been depressed forthe past twenty years. He had been inpsychotherapy all that time with a localpsychiatrist who says that he suffers from"characterological depression." He had beenunsuccessfully treated with a variety ofantidepressants including Prozac, Tofranil[imipramine], and desipramine. He had beenin psychiatric hospitals several times, andnine months before seeing me he hadreceived ECT [electroconvulsive treatment],which was also ineffective. When he first tried marihuana, in 1975, ithad no effect. But later it was given to himby fellow patients on the psychiatric ward ofa local hospital, producing "the first authenticdepression-free moment of my life." He didnot want to use marihuana habituallybecause it was difficult to obtain and legallyrisky and he was worried about the effect onhis heart and lungs. He says the Marinolprescribed by Dr. Grinspoon gave him instantrelief from his depression. He calls it "a file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon He had an angioplasty in July of this year,and since that time has been following astrict low-fat diet with yogic exercises. Hehas chronic atrial fibrillation, for which he hasrefused all prescribed medication. After consulting with Dr. Grinspoon, Iprescribed 5 mg of Marinol three times aday. The patient says he is no longerdepressed and suffers from no confusion,memory loss, or other negative side effects. Thirty to 40 percent of patients with bipolar disorder arenot consistently helped by conventional treatment. Forsome of them cannabis may be useful in ameliorating thesymptoms, reducing side effects of lithium, or both. Thefollowing account is written by a forty-one-year-old womanwith apparent bipolar disorder: I was born on Friday, October 13, 1950, afew months before my father had his firstserious bout with manic depression. Mymother said he was taking valuable artobjects they owned and throwing them downthe trash chute in their New York apartmentbuilding. I enjoyed my youth with a great deal ofabandon. How much of this would be mooddisorder I could not tell you. As a singleperson I didn't notice; I just rode the wavesof emotional highs and lows and didn't thinkmuch about it. I was an old pro at this by thetime I was nineteen and met my husband. Itwas only through my association with himthat I came to terms with my moodproblems, although right before I met him Ihad checked myself in at a mental healthclinic complaining that I sometimes feltunable to concentrate on one thing at a time. I think I was twenty-two years old when mytroubles cropped up again. At one point myhusband and I went to see a psychologist.
We talked about my mood swings and spellsof nervousness, anger, and depression. Thetiniest negative thing happening would causelong-lasting rage, very hard to quell. We toldthe psychologist of my father's history, evenlonger and grislier by then. He must havebeen in every state mental institution alongthe east coast. My grandmother, his mother,was wasting away by this time, losing herlifelong battle with chronic depression. I don'tknow much about her case except that shewas chronically sad and starved herself todeath after her husband passed away. This man said my husband and I needed to file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon lose weight; that was the extent of hisadvice. We did not see him much longer. Bythis time I was experiencing most of thesymptoms I have today, although they havestrengthened year by year. Sometimes I feelelated, exhilarated, with a great deal ofenergy. It sounds great, but you can get tobe feeling so good that you scare the peoplearound you, believe me! This isaccompanied by light sleeping and nocturnalhabits. I tend to become angry or aggressivewhen it is not appropriate, or just talk tooloud. I often have a low self-image or feelsad. I sometimes have a hard time gettingup to work, a heaviness that keeps me frommoving. I get racing thoughts that makeconcentration hard. I have strong emotionsthat change rapidly. I tend to be physicallyclumsy. I develop unexplained skin rashes,and sometimes feel like I'm generatingelectricity and shooting it out my fingers andtoes. My judgment is often poor. It was in my early twenties that I first usedthe herb cannabis for my condition. I hadbeen exposed to it several times, the firstwhen I was quite young. My mother hadtaken me to a mental health center after myinitial signs of trouble as a child. After agroup therapy session there some of theother kids took me riding and gave me ajoint. Nothing at all happened, and Iconcluded it must be a mild drug. When I was exposed to it later, I wouldactually choose it over alcohol because itdidn't have such strong and negative effectson me. This is how I discovered that it waseffective against most of my symptoms.
Suppose I am in a fit of manic rage -- themost destructive behavior of all. A few puffsof this herb and I can be calm. My husbandand I have both noticed this; it is quitedramatic. One minute out of control in a madrage over a meaningless detail, seemingly inneed of a strait jacket, and somewhere, deepin my mind, asking myself why this ishappening and why I can't get a handle onmy own emotions. Then, within a fewminutes, the time it takes to smoke a fewpinches -- why, I could even, after a round ofapologies, laugh at myself! But this herb is illegal and I have a strongdesire to abide by the law. My father washaving great success with a new drug,lithium carbonate. I saw my father'sphysician and he recommended that I try it. Itook lithium for six months and experiencedseveral adverse side effects -- shaking, skinrashes, and loss of control over my speech. file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon But I would still be taking it if it had workedfor me as it did for my father. It literallyrestored his life. I had gotten worse, ifanything. The combination of lithium side effects andincreased manic depressive symptoms droveme back to the use of cannabis. Some yearslater I tried to go without it again, this timebecause of increased social pressure againstillegal drug use. It was a very difficult timefor my family. Whenever I started to becomemanic, my husband and son would getscared and cower, triggering rage andmaking matters worse. When depressionstruck it was a black funk on our household.
And I can tell you from the experience withmy father that this can really destroy afamily. After a while the knowledge that alittle bit of herb would help me so muchbecame irresistible. At first I tried eatingcannabis, but soon returned to smokingbecause I could control the dose better. The legal situation now is worse than ever. Ijeopardize my freedom and property in orderto control my condition. Do I have a choice?I don't at all consider myself a drug abuser. Iam doing what any rational person in myposition would do. Cannabis does not curemy condition and over the years it hasprobably continued to worsen. But withjudicious use of this medicine my life is fine.
I can control things with this drug that seemsso harmless compared to the others I'vetried, including tranquilizers as well aslithium. I am constantly concerned that I willbe cut off from my supply of marihuana orcaught with it in my possession. I feel mysanity may depend on it. Cannabis lessenswhat is troubling me and returns me to amore normal state. Often I do not experiencea "high" at all, just a return to normal. Here is the account of another woman who suffers frombipolar disorder and finds that cannabis is more usefulthan conventional medications: I am a thirty-five-year-old woman withsevere manic depression. When I wasgrowing up I was hypersensitive, cried all thetime, and fought with my brothers and sister.
My parents always said they had to handleme with kid gloves. I had more energy thanmost and used it to the hilt. I was an agilegymnast and one of the fastest swimmers inmy school. I was also at the top of my classin algebra and good at art and creativewriting. I used to stay awake at night anddream up stories. file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon Around age fourteen my mood swings beganto get more intense. I was agitated, restless,and constantly fighting at home. I lay awakeat night and lost a lot of weight. Eventually Isnapped and was sent to a mental hospital,where I was diagnosed as having manic-depressive disorder. They put me on lithiumand told me I would have take it the rest ofmy life. But lithium made me lethargic. I hadtrouble communicating and lost all myanimation and creativity. Eventually I quittaking it. Recently I have also tried Tegretol[carbamazepine] and Depakote [valproicacid], neither of which helped. Tegretolstarted a manic episode, and Depakote hadsome very bad side effects. I'd like to findsomething else, but I don't have healthinsurance or the money to spend trying outnew medications. Since the age of fourteen I have had manicepisodes regularly about once every sixmonths. It would always start with not beingable to sleep or eat. After two weeks I wouldjust break down and seem to trip out intoanother world. Usually I ended up in amental hospital. I smoked marihuana for the first time in highschool and couldn't believe how good itmade me feel. My normally chaotic emotionssubsided and I had a sudden sense of calm,peace, and well-being. My perceptions ofothers and life changed dramatically. Theworld no longer seemed hostile but morewithin my control. I could sleep easily andactually had cravings for food. There werepractically no side effects. When I hadenough marihuana I would just naturallystop, because once you've gotten a certaineffect you really don't want any more. Only another manic-depressive usingmarihuana could possibly know how muchthis has changed the quality of my life.
Although they don't know it, my familyactually like me better when I'm stoned thanwhen I'm taking lithium or not takinganything. When I'm stoned they can predictmy moods and actually get close to me. ButI can't tell my family or the doctors becauseit's illegal. I have to live a double life to getalong. I've often tried to quit marihuana, but I havea manic episode every time. Last year Idecided I could control my emotional upsand downs without marihuana, but it led toone of the worst episodes I've everexperienced. I had been having troublesleeping as usual. I began to get super clear file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon vision that a disastrous earthquake wasgoing to hit Los Angeles. I was feeling sogood I was sure I was right. Soon I had myroommate convinced that we didn't havemuch time and would have to buy as manysupplies as possible and then leave. Wethought that after the quake the New WorldOrder would be implemented and everyonewould have to take the number thatRevelations talks about in the Bible. Weplanned to go to El Salvador, where herfamily lives, and hide out for the next threeand a half years. Crazy! But I really believedit. I maxed out all my credit cards, quit myjob, and packed up all my things, includingdisguises I thought we were going to need.
Eventually I had to return home with no joband major bills. I knew then and there that I would have togo back on marihuana. It's been sevenmonths now since I resumed smokingmarihuana, and I don't know what else to do.
I have to choose between obeying the lawand staying sick or breaking the law andbeing well. Jacci Papi is a forty-five-year-old health professional andthe mother of a twenty-year-old son: In late 1994 and early 1995 my son Michael,age eighteen, began to go out of control. Hewas unable to sleep, attend school, orfunction in a normal fashion. He was runningaround nonstop, acting on impulse withoutany sense of normal judgment. He was inserious danger of accidentally harminghimself or others. There was no way toreason with him, because he was unable tothink or listen long enough to understandwhat you were trying to say. He had becomea human time-bomb. Then, on February 14, 1995, he had a full-blown psychotic manic episode and refusedtreatment. I had to petition a court to commithim to a psychiatric hospital in Portland,Maine, where he was given a diagnosis ofmanic-depressive disorder. Both Michael'sfather and my grandmother suffered from thesame disorder, which is now called bipolardisorder. During his nine days in the hospital (the timeallotted by my insurance company) Michaelwas given lithium and Trilafon[perphenazine, an antipsychotic drug]. Wewere told that he would need lithium for therest of his life. They explained that it workedvery well in 60% of people with this disorder. file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon We returned home, and for the first month ortwo, the mania seemed to have ended. Atthe end of the second month the Trilafonwas discontinued, but Michael was stilltaking a high dose of lithium. At that point hedeveloped a rash on his neck and chest; healso had dark circles under his eyes, and hewas incoherent most of the time. The lithiumlevel in his blood was exactly where thedoctor wanted it, but now he was acting likean Alzheimer's patient. He couldn't read orcomprehend a paragraph, let alone finishschool. He was detached from hissurrounding and himself. There was noemotional content left in him. He wasbecoming unrecognizable. He had alwaysbeen very much like Robin Williams inpersonality and extremely athletic -- a skier,football player, and weight lifter. It washeartbreaking to watch him lose himself in amedicated stupor. I became convinced thatlithium did not eliminate the disease butinstead was drowning his brain so thesymptoms could not be activated. I could stillsee tiny mood swings and moments ofcomplete restlessness, but in a body thatwas unable to become hypomanic. Michael decided to cut his lithium in half. Iknew this would be dangerous but I agreedthat something had to be done. Soon he wasmore himself, laughing and talking andalmost back among the living. Then hestarted to become more hypomanic, and Iknew we were headed for trouble. He wasback to the energy level of someone on highdoses of speed, and this lasted for months.
He was running through life like a high-breed stallion, while I was gatheringeverything ever written on manic-depressivedisorder. Then one day he came home and wasperfectly normal in every respect. I thoughtthat maybe he was in remission because thedisease is known to do that, and I wasthrilled at the possibility. Later that night hewas back to full speed ahead, and all hopesank within me. This continued as the weekspassed. There would be times when he wasperfectly normal, but only for short intervals.
I could not figure it out. I started to chart hissleep pattern, his food intake, the kinds offoods, what chemicals he was subjectinghimself to, and so on. Finally one day Idiscovered that he was smoking pot. Ofcourse I freaked out. We talked about it atlength and he told me point blank, "I onlyfeel normal when I smoke a joint." By thistime I was ready to blame the disease on hispot smoking. I was totally irrational about file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon this. Michael and I fought constantly for amonth about it. Finally he asked me toresearch cannabis and let him know what Ifound. I figured I would be able to findenough damaging information to put thesubject to rest. The next week was my weekof discovery. Not only could I not find what Iwas looking for, but I became convinced thatthere was no permanent damage, and thatcannabis was actually helpful for people withmood disorders. I went on-line on the computer to talk toother people suffering from bipolar disorder,and I was overwhelmed by first-personstories of the benefits that others had found. The hardest part of this entire thing wasrearranging my value system. I was raised tobe a law-abiding citizen. Although I grew upin the '60s and had tried pot and inhaled, Iwas never a regular user because it wasillegal. I raised Mike right. He was taught torespect elders, do what you are supposed todo, and above all follow the law. It is hard enough to live with an eighteen-year-old during a naturally rebellious time,but to be forced to participate in an illegalactivity is the absolute worst scenario. Butthat is exactly what I'm doing. Mike has beensmoking pot for two months now. He doesnot smoke daily, but when the mania beginshe smokes and within five minutes he is fine.
He never appears to be "high," just happyand relaxed. We don't have to deal withmood swings anymore. He can work on hishome-schooling program, and I don't doubtthat he will finish by the end of summer. Hehas been repairing lobster traps with a friendand will be lobstering six days a week by theend of April. At this point I expect to be arrested someday, because if Mike gets arrested, they willhave to take me right along with him. I planto grow a plant this summer for his use. Iknow I could end up in jail, but I also knowthat without some kind of medication thatworks, my son could end up in jail,institutionalized, or dead. What choice do Ihave? Except for the eight who have Compassionate INDs, everyone of the many thousands of Americans who usemarihuana as a medicine runs a risk of being arrested.
They have to worry about financial ruin, the loss of theircareers, and forfeiture of their automobiles and homes.
Some have an additional burden, because mandatoryschool drug programs and Parents for a Drug-Free file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon America advertisements have given their children anexaggerated idea of the dangers of using marihuana.
Many of these children become concerned about thehealth and well-being of their marihuana-using parents. Afew of those parents have been arrested because theirworried children informed on them to the police officerswho serve as instructors in the popular school drugprogram known as Drug Abuse Resistance Education(DARE). The following accounts are by a forty-year-oldsoftware engineer and his thirty-seven-year-old wife, whosuffers from bipolar disorder. He speaks first: My wife and I and our two boys live inTyngsboro, Massachusetts. My wife wasgiven a diagnosis of bipolar disorder in 1982and has been taking lithium since 1992. Shealso uses marihuana for her symptoms. Shehas had six psychiatrists in the past fourteenyears and has been interviewed by manymore. I have always told them that she usesmarihuana regularly, and not one of themhas told her to stop. They do not even seemto care or pay attention. I posted a question about this to thealt.support.depression.manic newsgroup onthe Internet. I asked whether doctors knewsomething about marihuana but could notrecommend it because of its illegality. Theresponses were varied, but most people whowere manic-depressive said marihuanahelped them, and one said that some doctorsconsidered it effective in controlling mooddisorders. My wife functions much better when sheuses marihuana. When she is hypomanic, itrelaxes her, helps her sleep, and slows herspeech down. When she is depressed andwould otherwise lie in bed all day, themarihuana makes her more active. Whenshe runs out of marihuana and can't getmore, she becomes more irritable and hardto live with. Lithium is also effective, but itdoesn't always keep her in control duringseasonal mood changes. Our dilemma is that our thirteen-year-old hasbeen through the DARE program and haslearned about the evils of drugs and alcohol.
He opposes all substance use, legal orillegal --- and I want it that way. But heknows that my wife uses marihuana and it"eats" at him, although he also knows abouther illness and how marihuana helps.
Understandably, all this confuses him. I believe that marihuana could help somepeople if it were made available as aprescription medicine. Certainly there areother health and social issues involved, and I file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon can't decide what would be right for thecountry as a whole. All I know is that in thisfamily it has relieved us all of much suffering. I am thirty-seven, and I have been usingmarihuana for twenty years. I was diagnosedbipolar in 1982. I take lithium and Wellbutrin[bupropion], although I dislike these drugs.
I've gained about forty pounds since I startedtaking lithium, but otherwise there are noside effects. My thirteen-year-old son knows about myillness. He has also known about mymarihuana smoking for about five years. Herealized what I was doing after heparticipated in the DARE program in school.
It bothers me when he comes home andsays they talked about drugs and he wasthinking that his mother is "one of them". Hedoesn't want anyone to know his mother is a"druggie," and until now we've kept it as oursecret. I don't think he would tell anyone, butI'm still afraid something might get out.
Sometimes these programs use tricks to getkids to inform on their friends and relatives.
They say, "If you really care about thisperson, the only way you can help them is toreport them." My husband has talked to himabout it. He has explained that lithium andthe other medications I'm taking are drugs.
He also explained that many legal drugs arefar more dangerous than marihuana and thatno one has ever died from using marihuana.
But my son insists that if it is illegal, then it iswrong. This bothers me so much that I haveconsidered stopping. The trouble is that at times when I feel tiredand run-down, just a couple puffs ofmarihuana bring me back to life. SometimesI think it brings me to a level of normalcy thateveryone else achieves naturally. At othertimes, when everything seems to be goinglike a whirlwind around me and I can't keeptrack of what I'm thinking about or saying orfeeling, the marihuana just seems to slowthe world down a bit. When I have troublesleeping, it helps zonk me out, but if I havetrouble waking up it brings me to life. I don'tlike being thought of as a "drug-abusingmother," but I actually think I'm a better momwhen I'm feeling in control because ofmarihuana. Here is another account of cannabis use by a person withbipolar disorder, emphasizing the reduction of lithium sideeffects: file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon I am twenty-nine years old, born and raisedin North Carolina. My academic backgroundis in English literature, computer science,and law; I now work as a technologyconsultant and writer, although I amcontemplating returning to graduate school. Iam divorced. I am reasonably active in mycommunity, though work takes much of mytime these days. I was first diagnosed with bipolar disorderabout five years ago, when I was in lawschool (a psychiatrist also tentativelyventured this diagnosis during myundergraduate years), but I suspect that Ihave had a mood disorder for most of mylife. I was certainly clinically depressed asearly as age nine, and my first hypomanicepisode occurred at seventeen. There is alsoa family history of mood disorders, especiallyon my mother's side. All three of her brothershad "mercurial" personalities, and they allexperienced tremendous successes andnotable failures in business. Theirextravagance and outgoing personalitiesresemble my behavior while manic orhypomanic. Although none of them wereformally diagnosed with a mood disorder,both my parents have been treated forclinical depression. Before I was diagnosed and found the righttreatment, I had the typical symptoms ofbipolar disorder. During depressive phases Ibecame withdrawn, uncommunicative, andpreoccupied with suicide. I found it nearlyimpossible to function in school or at work.
During hypomanic or manic phases I spentfreely, traveled all over the country (andworld), made poor personal and businessdecisions, engaged in risky sexual behavior,and so forth. The illness has caused me agreat deal of personal pain as well asfinancial woes. I separated from my wife(who eventually divorced me) the summerbefore I was diagnosed. I've lost jobs, ruinedfriendships, and alienated members of myfamily. Fortunately, much of this damage hasbeen repaired with time and understanding. Ithank God that my ruined credit rating is theonly apparent lasting harm. Thanks to lithium and sensible therapy,including the judicious use of cannabis, Ihave been relatively stable and sane for thepast three years, although my sleep is oftendisturbed and I still have (very much milder)hypomania and depression in much thesame cyclic pattern as before. I first used cannabis in my freshman year of file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon college (1984). I preferred it to alcohol as anintoxicant, and used it a few times a week,almost always by smoking (I still prefer totake it that way.) In retrospect, it seems clearto me that I was medicating myself forbipolar disorder even then. When depressedand anxious, I found that cannabis wassoothing and enhanced my ability to enjoylife. When I was in a manic phase, it relaxedme and helped me get to sleep. I often feltas though I had so much energy inside methat I would jump out of my skin; thecannabis helped tremendously with that. Butthere was a downside. Manics have a bigproblem with impulse control, and cannabisseemed to exacerbate it. ("Drive to Canada?Great idea. Let's go!") It also ratcheted upmy already overactive libido a notch or two,which wasn't the healthiest thing in theworld. When I was diagnosed and began treatmentwith lithium, I got almost immediate relief,but I also suffered from nausea, poundingheadaches, hand tremors, and excessproduction of saliva. A friend suggested that Itry getting high, reasoning that if cannabishelped chemotherapy patients deal with theirnausea and discomfort, it might help me too.
My doctors thought the idea was absurd butadmitted that it would be safe to takecannabis together with lithium. So I tried it,and the results were remarkable. The handtremors subsided, the headaches vanished,and the saliva factory resumed normalproduction levels. All I needed was one ortwo puffs on a marihuana cigarette. Whenlithium side effects get bad, the availability ofcannabis has been an absolute godsend. Itis also nice to be able to use cannabis as anintoxicant, knowing that, unlike thecombination of lithium and alcohol, it cannotdamage my kidneys. Bipolar disorder is naturally cyclical; manic and depressiveepisodes come and go, so it is essential not to confusenatural remission with cannabis-induced improvement.
And of course, the proportion of patients with mooddisorders who would get the kinds of benefits describedhere is unknown. As usual, promising anecdotal evidencepoints to the need for more systematic clinicalinvestigation.
1 J.-J. Moreau de Tours, "Lypemanie avec stupeur;tendance à la démence. -- traîtement par l'extrait (principeresineux) de cannabis indica -- Guérison," LancetteGazette Hôpital 30 (1857):391.
2 G.T. Stockings, "A New Euphoriant for Depressive file:///Volumes/KAT/analyses/Grinspoon.html[6/21/12 1:28:33 PM] Depression and other mood disorders - Grinspoon Mental States," British Medical Journal 1 (1947):918-922.
3 D.A. Pond, "Psychological Effects in Depressive Patientsof the Marihuana Homologue Synhexyl," Journal ofNeurology, Neurosurgery and Psychiatry 11 (1948):279.
4 C.S. Parker and F.W. Wrigley, "Synthetic CannabisPreparations in Psychiatry: I. Synhexyl," Journal of MentalScience 96 (1950):276-279.
5 J. Kotin, R.M. Post, and F.K. Goodwin, "Delta-9-tetrahydrocannabinol in Depressed Patients," Archives ofGeneral Psychiatry 28 (1973):345-348.
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