Things not going so well? Bummed? Living life in an endless D minor?
There's therapy, of course, and a whole pharmacopoeia of mood changers ready to pump your serotonin levels.
Or there's marijuana. Maybe.
Two months ago, the International Cannabinoid Research Society (ICRS) held its annual huddle in Budapest, Hungary, where participants reviewed, among other items, the latest studies on pot's effect on mood.
A quick perusal of the conference agenda, however, gives an idea of the yawning gap that now exists between what scientists are able to prove and what tokers are experiencing.
For some years, many smokers have claimed reefer as a tonic for funk, posing the possibility that even more are self-treating for depression without even knowing it. And now some therapists are prescribing pot as as an alternative to pharma products, with their scary side effects.
But recent studies are contradictory. Some conclude that the green worsens the blues, while others are more hopeful. Last year, for example, a team headed by Dr. Xia Zhang at the U. of Saskatchewan discovered that a synthetic version of the cannabinoid compound found in pot reduced depression in lab rats.
With the profit motive in full force, increasing pharma bucks are now being spent on the pot-mood equation, and we may at last have an answer. Does pot trump Prozac? It depends.
One enthusiastic observer is Umar Syed, vice-president of scientific and strategic affairs at Cannasat, a firm hoping to bring cannabis-based pharmaceuticals to market and an attendee at July's ICRS meet. "There's decent scientific evidence that marijuana works for depression," he says.
He points out that back in the 80s, scientists located two cannabinoid receptors in the brain: CB1 and CB2. CB1, in particular, works with THC to alleviate depression, "though the exact mechanism is unknown."
It's no wonder there are so many reports of successful self-medication, he says, because although there are up to 60 active ingredients in cannabis, most North American plants have been bred for the high and contain 4 to 8 per cent THC, a substance known to raise depression-easing serotonin levels in the brain.
But not everyone is convinced it's THC that makes the difference. Researcher Richard Musty, executive director of the ICRS and a University of Vermont professor emeritus, believes it's cannabidiol (CBD), a non-psychoactive component of the marijuana plant, and not THC, that shows the most promise.
"This is kind of a confusing area right now. It's going to take more time," he cautions. Musty, with others, conducted studies of rats and concluded that CBD has therapeutic potential. He also monitored patients using CBD, and found that two out of five showed improvement.
But he doesn't recommend trying to get your CBD fix from a reefer, because "there's just nothing out there," says Musty, referring to the low CBD content in Canadian pot. And the kicker: when he ran a depression study on animals using THC, "it actually made the animals worse," he says.
Dr. Richard Deyo, a professor of psychiatry at Winona State U. in Minnesota, agrees that while there are positive results from components in marijuana, it's not time to roll a J.
"Cannabis itself causes depression in some people and seems to alleviate it in others," says Deyo, who presented a paper at the ICRS conference. "There are too many cannabinoids in it, and it's not stable. It can produce one effect today and one effect tomorrow. That's the danger."
Deyo, whose research is funded by drug companies, claims many factors can affect marijuana's effects, including a smoker's age, gender and mental state. He emphasizes that the chemistry of marijuana differs greatly according to the climate in which the plant is grown, making consistent research results tricky.
This, in fact, seems to be the major hurdle of pot studies today. With prohibition the law of the land in North America, researchers have trouble experimenting with the many plant varieties. "Until we have a [conducive] legal environment, you're not going to see any good tests," says Cannabis Culture magazine publisher Marc Emery, who points out that more than 500 different kinds of seeds are available.
"The modern medical world is all about dosage ranges that are quantified. Cannabis doesn't work that way; you take it until it works," he says.
While clinical reports are smoky, things certainly look a lot different on the front lines. Here, an empiricism of a different kind is at work: what patients report works for them.
At the Toronto Compassion Centre, Jim Brydges has been dispensing pot for nine years, and while he has no fancy science to describe how it works, he says he's had repeated success treating depressed clients with the leafy green. His technique is mix-and-match; he uses different plants on different people, combining various strains of pot and keeping at it until the client reports feeling better.
"A cannabis-indica-based product we know as M-39, for example, is traditionally known to take away anxiety and relax the person using it," says Brydges.
In California, the only U.S. state that allows doctors to prescribe marijuana for mental illness, there are similar reports. "There's a lot of anecdotal research recorded," says Allen St. Pierre, exec director of the Washington-based National Organization for the Reform of Marijuana Laws. "About 35 per cent of people who go to the dispensaries indicate they're taking cannabis in conjunction with, but more often as a substitute for, everything from attention deficit disorder drugs to very powerful anti-depression and anti-psychotic meds."
This positive experience mirrors that of more scholarly med pot specialist Dr. Lester Grinspoon , associate professor emeritus of psychiatry at Harvard Medical School and author of several landmark books.
Grinspoon points out that no double blind studies had been done on lithium way back when he became the first to prescribe it for bipolar disorder. So he can't see why it shouldn't be acceptable for his patients, many of whom have been helped by pot, to have legal access to it. Why, he seems to ask, don't patient reports count?
His website documenting hundreds of users' positive experiences opens with a quote by native American poet Simon Ortiz: "There are no truths, only stories."
"Government propaganda notwithstanding, marijuana is much less toxic than anything we as psychiatrists have to offer," says Grinspoon. "Some patients find it more useful than Prozac for low-grade depression."
Grinspoon's not the only psychiatrist reporting such findings. California's Tod Mikuriya, who was in charge of marijuana research for the U.S. National Institute of Mental Health Center for Narcotics and Drug Abuse Studies some decades back, says it's shocking that modern medicine has ignored the history of cannabis in the 100 years before the 1940s, when it was taken off the market.
"It's usually patients who have had poor results with standard antidepressants" who do best with marijuana, he says. "One of the things I've been learning is the complicated relationship between emotional and physical conditions. Depression is closely connected with pain, and most of the medications prescribed [such as opiates] have a bad effect. Cannabis operates on a totally different system in the body."
Scientists, he says, are desperately looking for something patentable, "but they're going to have a hard time. They're calling things 'cannabinoids' instead of admitting that they are molecules from good old cannabis that are unpatentable. The reason I feel so strongly is because I am so aware of the chemical studies done prior to the contemporary ones."
Studies or no, the Canadian Psychiatric Association, seems to have positioned itself carefully outside the fray. "We don't have any official guidelines," says CPA spokesperson Hélène Càté.
At Health Canada, too, officials remain noncommittal. Spokesperson Carol Saindon points out that while the Marijuana Medical Access Regulations don't specifically mention psychiatric conditions, physicians may prescribe pot for whatever purpose they think is appropriate, if they attest that they have consulted a specialist.
But while inhaling for depression has a trail of backers, things look different when it comes to other mental ills. Toking may not be what the doctor ordered for bipolar illness, for example. Says Cannasat's Syed, "THC is only safe in the depressive states of bipolar. If a patient is in a manic state, they would probably benefit from CBD. But they could be on the precipice of a manic attack, take THC and make it worse. I would be very hesitant to recommend any cannabinoid for bipolar disease."
The same caution applies to schizophrenia. "A fair number of studies point to a significant increase in risk of either causation or relapse of schizophrenia in smokers of pot," says Dr. Harold Kalant, professor emeritus of psychiatry at U of T.
Syed, however, says growing evidence suggests that CBD is effective for this disorder. "The strongest data out there is that CBD, in strong enough doses, controls schizophrenia. This is the hottest area of research fresh out of Hungary, and no one really knows it yet," he says.
As momentum builds for cannabis-based meds, there's a chance the bid for legalization of just plain weed may get left in the dust. NORML's St. Pierre sees that as the great irony of pharma's new interest in the plant.
"Many pot reformers are investors in these companies. They think their investment can free up the politics [and end prohibition], but it's more likely the government will soon say, 'There's a product and it's safe and you have to go through the drug system. '"