What is Clinical Depression
Depression, also called major depressive disorder or clinical depression, is a serious and sometimes fatal mood disorder caused by persistent feelings of sadness. It affects cognitive functioning, mood and behaviors, and is often characterized by a loss of interest in day-to-day activities. Clinical depression usually requires clinical, long-term treatment, and without it, the condition can worsen until the sufferer sometimes starts to feel that their life isn’t worth living.
The genesis of clinical depression is often preceded by a life event, however, for many people there is no clear trigger. Similarly, there are different types of depression that are distinguished by the circumstances under which they’ve developed. For instance:
Seasonal affective disorder – depression that occurs during the winter months when there’s less natural sunlight.
Persistent depressive disorder – major depression that lasts for two or more years.
Postpartum depression – major depression during pregnancy or after delivery (postpartum) lasting two weeks or longer, making it difficult for new mothers to complete daily care activities for themselves and/or their babies.
Psychotic depression – severe depression that includes a form of psychosis, such as delusions or hallucinations.
Disruptive mood dysregulation disorder – a kind of depression diagnosed in children and adolescents who experience chronic and severe behavioral outbursts, uncharacteristic for their age.
Premenstrual dysphoric disorder (PMDD) – a more severe form of premenstrual syndrome (PMS) causing extreme irritability, depression, and anxiety in premenstrual women.
Symptoms of Depression
In addition to low mood, several of the following persistent symptoms are required for a diagnosis of depression, occurring most of the day, nearly every day, for longer than two weeks:
- A persistent sad, anxious, or “empty” mood
- Negative feelings such as hopelessness, pessimism, feelings of guilt, worthlessness, tearfulness, or helplessness
- Angry outbursts, irritability or frustration over small matters
- Decreased interest in activities that used to bring pleasure (like hobbies, sports, sex, etc.)
- Fatigue or decreased energy (in spite of sleep)
- Moving or talking in a slower manner than usual
- Restlessness or having trouble sitting still
- Being forgetful or having difficulty concentrating or making decisions
- Sleep problems including insomnia, sleeping too little or too much, or oversleeping
- Appetite and/or weight changes
- Aches, pains, and physical symptoms with no clear cause
- Thoughts of death, suicide, or suicidal attempts
Depression most often presents in one’s teens, 20s, or 30s, but can be diagnosed at any age, including young children and older adults. The symptoms of depression at these life stages could look a little different though, or be less obvious. For instance:
Depression In Children
- Sadness and irritability
- Aches and pains
- Refusing to go to school
- Being underweight
Depression In Teens
- Sadness and irritability
- Feeling negative and worthless
- Poor performance or poor attendance at school
- Feeling misunderstood or extremely sensitive
- Using recreational drugs or alcohol
- Eating too much or too little or sleeping too much
- Loss of interest in activities and social situations
Depression In Seniors
- Memory difficulties, or personality changes
- Physical aches or pain
- Fatigue, loss of appetite, sleep problems or loss of interest in sex (not caused by medical reasons)
- Withdrawing from social activities or doing new things, staying at home
- Suicidal thoughts or feelings, particularly in older men
Depression Medications & Treatment
Treatment of clinical depression usually involves a combination of lifestyle changes, self-help, psychological interventions and sometimes medications. The type of recommended treatment is also often based on the type of depression.
Medications are usually only prescribed in cases where moderate, to severe chronic depression has been diagnosed. The most prescribed antidepressant medications are selective serotonin uptake inhibitors (SSRIs) such as paroxetine, fluoxetine and citalopram. They work by increasing the serotonin levels, which are thought to enhance mood. However, SSRIs also come with a set of side-effects ranging from the relatively innocuous like headaches, nausea and dry-mouth, to the severe such as increasing the risk of shelf-harm and even suicide.
In cases where SSRIs are ineffective, tricyclic antidepressants (TCAs) such as imipramine and amitriptyline are prescribed. They have been around longer than SSRIs and work by raising serotonin as well as noradrenaline levels in the brain. Alternatively, newer serotonin-noradrenaline re-uptake inhibitors (SNRIs) such as venlafaxine, duloxetine and mirtazapine can also help. Like TCAs, they change the levels of serotonin and noradrenaline in your brain. Side effects usually include things like blurred vision, dry mouth, constipation and excessive drowsiness.
For those suffering from milder forms of depression, non-pharmaceutical interventions are often enough to help restore emotional wellbeing and balance. However, sufferers who are using pharmaceutical interventions can also benefit from using these types of treatments as an adjunct, complementary therapy.
Non-pharmaceutical interventions for depression generally involve a combination of psychological interventions such as cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), psychodynamic psychotherapy, counseling and mindfulness. In severe cases, psychiatrists might also apply brain stimulation techniques such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT).
CBD for Depression
Research & Scientific Evidence
Cannabidiol (CBD) as a treatment for depression is shows promise, however, data from clinical trials on humans is limited. Most of what is known comes from animal studies and the exact mechanisms on how CBD may help reduce the symptoms of depression in humans requires more research.
In a study from 2014 published in the journal CNS & Neurological Disorders – Drug Targets the researchers reviewed literature relating to animal models using CBD as an antidepressant and anxiolytic compound. Their aim was to assess CBD’s potential and efficacy as an intervention in the treatment of depression.
After identifying studies that met all the criteria, the researchers reviewed 14 papers that included animal studies regarding depression and anxiety models that used CBD as an isolated substance. They excluded studies that used CBD in conjunction with other cannabinoids or that involved the smoking of the whole plant in order to define dose composition for CBD specifically.
They found that CBD proved to be a useful, versatile and safe substance in the treatment of depression. According to their data, CBD also had no adverse effects on cognitive functioning or mobility, and effective doses were much lower than what would be considered harmful. From the literature, they concluded that the most likely mechanism with which CBD affects positive changes in mood is by modulating serotonergic neurotransmission via the 5-HT1A neuroreceptor in addition to affecting expression of serotonin subtypes 1A and 2A/2C receptors via the endocannabinoid system (ECS).
In a more recent 2019 study in Physiology & Behavior, the effect of CBD explored the therapeutic potential of CBD of two “depressive-like” genetic models in rats to expand on the evidence, and further examine CBD as a potential antidepressant by alleviating two key symptoms of depression namely anhedonia (inability to feel pleasure) and hopelessness/helplessness.
In this double-blind study, male and female Wistar Kyoto (WKY) and Flinders Sensitive Line (FSL) rats were either given 30mg of CBD per kilogram of body weight with food, or a placebo containing no CBD. The antidepressant effects of CBD were then measured using the Saccharin Preference Test (SPT) to assess anhedonia and the forced swim test (FST) for despair-like behavior.
The researchers found that CBD should be considered as an effective psychopharmacological option to relieve depressive-like behavior for symptoms of anhedonia as well as hopelessness/helplessness. They speculate that CBD’s polypharmacological profile resulting in multiple mechanisms of action that are responsible for its high therapeutic potential.
In a 2020 case study published in Case Reports, clinicians presented the case of a 16,9-year-old patient with multiple substance use disorder, severe depression, social phobia, and narcissistic personality disorder that was treated with CBD.
After the unsuccessful treatment with an antidepressant, titrated dosages of CBD was given to the patient. The starting dosage was 50 mg twice a day, which was gradually increased to 600 mg/day over a period of 8 weeks. Symptoms of depression, anxiety, and early psychosis were evaluated before treatment and again after treatment using various psychometric testing measures.
The CBD was well tolerated, and they found a significant improvement in symptoms of both depression and anxiety including, as well as the cessation of antidepressant medications and illegal drugs without withdrawal symptoms.
Any rudimentary search of the internet, you’ll find many testimonials, social media comments, and product reviews that shine a positive light on people’s personal experiences with using CBD for their depression.
Testimonials of users taking CBD for depression
However, in a more formal cross-sectional study of CBD users from 2018, researchers investigated, amongst other things, the reasons why people are using CBD and how effective they believe it is. Their data showed that anxiety and depression are the third and fourth most cited reasons for using CBD with the vast majority feeling that they are treating their condition “very well by itself”.
CBD as a complementary treatment for depression
In addition to its antidepressant effects, CBD can also complement other forms of treatment. For instance, CBD has been shown to effectively reduce feelings of anxiety, something that people suffering from depression often have to deal with as well. Similarly, CBD can further support people suffering from depression by helping to promote REM sleep that is thought to help improve mood overall.
In addition, the CBD’s antidepressant action can also be beneficial when used to complement psychotherapeutic interventions like CBT, IPT, and mindfulness practices as well as other types of lifestyle changes. However, CBD should not be taken in conjunction with antidepressant medications without consulting the treating physician first, as CBD may negatively interact with these.
The latest scientific evidence indicates that CBD shows potential as an effective natural and well-tolerated intervention for treating various forms of depression. Researchers believe that CBD’s antidepressant effects make it a viable psychopharmacological agent and that its polypharmacological profile allows for multiple mechanisms of action, including the mediation of endocannabinoid and 5-HT1A receptors. However, it is important to note that most of the data is from animal studies, and as the saying goes, mice are not men. More research is needed before definitive conclusions can be drawn. It is also important to remember that depression can be a serious, life-threatening condition so if you or a loved one are feeling depressed or experiencing suicidal thoughts, talk to a trusted friend, loved one, medical practitioner, or call your local emergency or suicide hotline for help.