The purpose of this paper is to explore the qualitative relationship between cannabis and the most commonly used antidepressant drugs known as selective serotonin reuptake inhibitor (SSRIs) through the narratives of depressed individuals who have used both drugs at one point during their lifetime. Despite their prevalence, depression, cannabis use, and SSRI use have not been previously studied together through the perspective of those who have experienced them. Using a exploratory approach, this paper investigates and compares the user experiences of these drugs.
Semi-structured interviews were conducted involving participants who were between the ages of 16–59 in the UK and have used both SSRIs and cannabis either simultaneously or at any point in their lives. Five interviews were conducted either via telephone or in person, and the method of analysis was an inductive approach which was inspired by grounded-theory.
While the two drugs were used by participants in order to relieve symptoms of depression, they were used for very different reasons and typically at different stages of their lives. Though participants did not state that the drugs were interchangeable for improving mood, their responses indicated that these drugs were viewed as two alternatives to alleviate symptoms of depression. Participants’ relationships with their doctors also played a crucial role and affected interviewees’ decisions to use either SSRIs or cannabis, as well as perceptions of the medical industry.
This research shows the importance of doctor and patient interactions as they were crucial influences on patients’ decisions related to drugs. Participants’ experiences with SSRI and cannabis were subjective and varied, therefore, the value of personalised treatment (which may or may not include psychotropic drugs) is highlighted. These findings can help health practitioners gain a better understanding of the rationale of depressed patients in choosing treatments and thereby improve healthcare outcomes.
Given that depression is stigmatised, and cannabis use is both illegal and stigmatised, this paper examines the opinions of a difficult to reach population. Previous work involving cannabis, antidepressants and mood-elevating effects is primarily written with a biochemical or medical perspective which paid more focus on the efficacy of these drugs and had less emphasis on the beliefs of the users. This paper highlights the opinions of cannabis and SSRI users regarding these two drugs specifically, which had not been previously explored.
CitationDownload as .RIS
Emerald Publishing Limited
Copyright © 2020, Emerald Publishing Limited
Two of the most highly used legal and illegal psychoactive drugs are cannabis and a subcategory of antidepressant drugs known as selective serotonin reuptake inhibitors (SSRIs). Cannabis is the most commonly consumed illegal drug in England and Wales (Home Office, 2018a), while SSRIs are currently the most dispensed drug in the therapeutic category (NHS Digital, 2017). Recreational cannabis currently remains illegal, though there have been some significant amendments to UK cannabis law, including its modification from a Class B to a Class C drug in 2004 (Braakmann and Jones, 2014) and its reclassification into a Class C drug in 2008 (Lloyd, 2008). However, these changes had a minimal effect on the overall consumption of cannabis, perhaps due to much of the population being unclear as to the meaning of the changes in cannabis policy (Lloyd, 2008; Hamilton et al., 2014). The current study was conducted prior to the legalisation of medical cannabis in 2018 (Home Office, 2018b).
Despite the fact that nearly 20 per cent of those in the UK exhibit signs of depression or anxiety (Office for National Statistics, 2019), there is limited research on the narratives of those who have experience with depression, SSRIs and cannabis use. While they may appear unrelated, SSRIs and cannabis both have a connection to depression: SSRIs are a type of medication used to alleviate depression, and cannabis has also been shown to be effective in treating symptoms of depression (Coomber, Oliver and Morris, 2003; Hill and Gorzalka, 2005; Bambico et al., 2007; El-alfy et al., 2010) due to its relaxing effect (Chatwin and Porteous, 2013; Hamilton et al., 2014; Home Office, 2017). Moreover, cannabis use has been previously linked to those suffering depressed states (Degenhardt et al., 2003; Arendt et al., 2007; Chatwin and Porteous, 2013; Feingold et al., 2015), and self-medication is frequently mentioned as the rationale for cannabis consumption by its users (Khantzian, 1985; Markou et al., 1998; Chatwin and Porteous, 2013).
Previous literature which specifically compares cannabis and antidepressants has been limited. Controlled trial studies found that cannabis compounds have been shown to mimic antidepressant effects depending on the amount ingested, but these studies were conducted on rodents (Hill and Gorzalka, 2005; Bambico et al., 2007; El-alfy et al., 2010), therefore the findings may not necessarily be transferrable to humans. One study involving human experiences of cannabis use and depression has found that differing dosages still resulted in better mood outcomes, specifically, cannabis use once per week vs seven times per week (Denson and Earleywine, 2006). Studies which include human participants’ usage of antidepressants and cannabis prioritised studying substance efficacy over user experience, therefore, their study did not elaborate on the details of participants’ opinions or their reasons for choosing these drugs as remedies for low mood (Gruber et al., 1996; Cornelius et al., 1999). Exploring user narratives is crucial to gaining a better understanding of the reasons for cannabis and SSRI consumption through the perspective of depressed patients. This research aims to address this gap in the literature and considers the point of view of users in greater depth.
The goal of this study was to include participants who had used both SSRIs and cannabis at one point in their lives, in order for participants to compare the experience of the two drugs. The requirement was that they had used SSRIs or cannabis at least once and it was not necessary that the consumption occurred simultaneously. There were no limits or minimums set on how many times they had used either drug, and given that this project aimed to have an exploratory approach, their reasons for resuming or discontinuing the use of the drugs would be an important part of the findings.
As part of the procedure for the ethics application, a participant information sheet, consent form and research proposal were included as part of the application package. Contact information for mental health support services, such as the UK National Drugs helpline and Samaritans, was included in both the participant information sheet as well as the consent form. This was to ensure that respondents would receive adequate help in case of distress over the material in the study, and participants were made aware that withdrawing from the study at any time was an option. After receiving ethics approval, online advertisements were made through websites such as Gumtree and social media in order to reach individuals nationally. Posters and leaflets were also distributed across London, England, and the Kent county area.
One of the biggest challenges in obtaining a sample for this project was that depression is stigmatised and cannabis use is both illegal and stigmatised, thereby limiting the number of participants willing to volunteer. This was evident given that, during the recruitment period, two participants failed to respond after being shown a consent form and one withdrew, ultimately leaving five participants who remained in this study. The recruitment period occurred in 2016 and the sample consisted of two participants in their 20s or younger, two in their 30s, and one in his 50s. While they did not mention their specific diagnostic status in terms of mild or severe depression, they each had symptoms which lead them to have been prescribed with SSRIs by their respective doctors. Three of these individuals were male and two were female, and other details of the participants will remain undisclosed for the purposes of participant confidentiality. Participants were encouraged to choose their own pseudonyms and their true identities were not revealed to the researcher.
This study was inspired by grounded theory (Glaser and Strauss, 1967) whereby inductive reasoning guides the research process. As such, the goal was to create an interview environment in which the participants could express the issues which were most important them. For participants who lived nearby, the interviews were conducted in person, and those who lived further away interviewed via telephone. While some questions were prepared beforehand, the discussion was mainly led by their responses and interviewees were asked to elaborate on their opinions. The method of analysis was based on the notion that the data should guide the theory; accordingly, the data were coded without a predefined structure to allow themes to emerge naturally. That is, codes were based on the similarity, frequency, or significance of the interviewees’ responses, and they were then organised into multiple categories. These categories were subsequently grouped into several main themes which formed the final results.
What are the consumption patterns of psychotropic drug users?
SSRI consumption pattern
In terms of SSRI dosages, interviewees stated that they received between 25 to 150 mg of SSRI depending on the severity of their depression during a given period. The antidepressants were meant to be taken orally once every 24 h, and participants typically followed their dosages as instructed. Mathew was the only interviewee who was unable to follow the recommended dosage due to homelessness; hence, he was unable to purchase any medication. No participant had used SSRIs for a period longer than two years at the time of writing.
When respondents explained their experience with SSRIs, the two main characters in their stories were their doctors and themselves, signifying that the doctor and patient roles are the most important in consumption habits. However, both roles were not equally influential in determining prescribing patterns. For instance, Sally’s description of her experience in working with her doctor to find the right dosage was as follows:
I was on 25 milligrams a day. And then, basically, my doctor told me all about the [sertraline], she knew that I had done biomed, so she was happy for me to self-prescribe on not-so-good days where I went up to a 100[mg].
The choice to cease SSRI use was solely Sally’s decision that was supported by her doctor, indicating that Sally held the major role in antidepressant consumption. Kelly also had a similar experience:
[…] so [my doctor is] quite happy for me to stay [on SSRIs] as long as I want it. It works for me at this time […] when I feel that I’m a lot stronger or healthy emotionally and everything that’s happened, then yeah I’d know time when I’d like to try without [SSRIs] again.
Both Kelly and Sally’s interviews showed that the short-term dosage and the long-term continuation of antidepressant drug use were influenced by the patient. In contrast, Mathew and Stan did not want to use antidepressants but took them based on advice from their doctors:
I felt a little bit gutted when I was told needed antidepressants, but I wanted to try it. It’s still my choice to take them, it takes a while to take effect, but no other options were offered […].
I went to my doctor and I said that I wasn’t feeling great, I would like to speak to someone, a counsellor or something, and she just said oh no no no, you can just take these tablets and decided to prescribe me tablets which I wasn’t happy about […].
Their doctors directly impacted their choice to use SSRIs and their doctors held more of an authoritative role in prescribing antidepressants. Stan expressed that he never wanted to use antidepressants and, after two years of consistent SSRI consumption, he has recently thought about contravening his doctor’s instructions. Mathew also said that he never desired to be on antidepressants. Eventually, due to financial challenges, Mathew abruptly stopped taking all prescription medication.
Participants generally did not want to take antidepressants for an extended period of time and some held the concern that they would be required to consume SSRIs indefinitely. The participants who had successfully weaned off the drug have permanently stopped taking it, while other participants who had not weaned off the drug expressed the desire to eventually discontinue antidepressant use. These findings reflect a low interest in long-term use of SSRIs among interviewees which somewhat contrasts with their overall opinion on cannabis use.
Cannabis consumption pattern
Interviewees typically first experienced cannabis in their adolescence and continued to use it at varying frequencies through to adulthood. All participants mentioned that their first experience with cannabis was socially influenced, as the following examples will show:
[…] my friend came up to me and was like, “I’ve got some stuff [cannabis], would you like to try it?” I said “yeah, sure, why not.” I was in a good mood, I was at a party, everyone had been drinking. And yeah, that was the first time. It wasn’t that I was depressed at all, at that point, I wasn’t really I’d had low points, but at this point, it wasn’t a daily occurrence, it was just I was at a party and I decided to try it for the first time.
It was because of a friend had [cannabis] and said so try it, so I did try it, and I guess the reason why it was after that experience of why I continued to try it was because of the benefits that it gave me and I could see that I had a controlled mind I didn’t have so much, sort of, side effects from [cannabis].
At this stage, they may have treated some low mood symptoms with cannabis but they were not specifically seeking it for this purpose. After adolescence, participants typically continued to use cannabis into adulthood but less frequently. Each participant had different reasons for reducing their cannabis use. For instance, Rob explained that he mostly used cannabis in moderate amounts several times a week with friends during his first year in university. Kelly stated that cannabis quality was a major concern and it influenced her decision to stop taking illegal drugs, including cannabis, given that black market drugs are not regulated. However, if cannabis became legalised and regulated, she would be open to trying it as a medicine.
Cannabis use was generally inconsistent among participants in terms of days and weeks, but intermittent cannabis consumption typically stretched out for a period of longer than two years. In other words, based on participants in this project, SSRI usage was consistent on a short-term basis with a lifetime usage of no more than two years, while cannabis use tended to be more sporadic but have a longer lifetime prevalence within individual users.
What is the relationship between SSRI and cannabis use?
One of the purposes of this qualitative research project was to find if there was a connection between SSRI use and cannabis use. The intention was not to determine causality as that would have employed the statistical meaning of “relationship”, and that would have been better suited for a quantitative research method. Rather, the goal was to discover if participants felt, based on their experiences, that cannabis and SSRIs are related in the context of low mood. For instance, did consumption of these drugs occur in the same chronological order, do participants use one drug to substitute another, or are the effects of these drugs comparable? Interviewees were asked to describe their usage of cannabis and SSRIs in-depth and to provide their rationale in order to determine if any pattern existed.
Participant responses revealed that they primarily only used antidepressants or cannabis in a given period of time, and that they typically did not use both drugs simultaneously. For example, Kelly consumed cannabis regularly in her adolescence and began her SSRI use years after the cessation of her cannabis use. For other participants, if cannabis and SSRI consumption did overlap, it was coincidental and not intentionally done so for the purposes of gaining further mood elevation. In Stan’s case, he had already been using cannabis regularly when he was instructed by his doctor to use antidepressants. Mathew had been using cannabis for at least two decades prior to when his doctor prescribed him antidepressants. Though Mathew found the antidepressants somewhat helpful, he ultimately stopped using SSRIs and has continued using cannabis.
The evidence did not indicate that participants used SSRIs and cannabis interchangeably; however, interviewees did express their preferred drug to treat their depression. Kelly, Stan, Rob and Mathew each acknowledged that cannabis had been helpful to relieve symptoms of low mood. Kelly stated that, during her adolescence, she unknowingly used cannabis to treat her symptoms because she was unaware of her depression. Although Kelly no longer uses cannabis, she mentioned that:
I would really appreciate if there was cannabis that was brought into a tablet form and I would be really happy to try that if that was available through a GP. Knowing the [cannabis] experience I had when I was in my teens [when she was depressed and used cannabis].
Furthermore, Stan, Rob and Mathew have used cannabis specifically to treat depressive symptoms, and they indicate that it has worked successfully:
Without a doubt, 100%, I believe that cannabis was put on this earth as a wonder drug. I think it’s got so many health properties […] I would say cannabis would definitely be the best thing. The right type and the right quantity, though […] You know, they’ve saved my life, made me feel great, you just feel so invigorated and positive, and everything, so it’d have to be the right sort of type.
[I’ve] never had a bad experience with [cannabis], not one time. Apart from when it’s bad cannabis, when it’s poor grown and a crappy plant […] I choose cannabis purely on the history of it, the culture of it, and how it makes me feel […] I promise you I’ve been as low as I could possibly be, you can get up, woe is me, or you can get up and say you know, what it’s a blessed day being happy or sad is a choice, but cannabis helps me cannabis keeps me completely sane […].
One of the reasons for the interviewees’ preference towards cannabis may be that, though SSRIs can be helpful, they can cause unpleasant side effects. Sally, Kelly and Mathew acknowledged that antidepressants have helped their depression but their side effects are part of the reason for their desire to live without SSRIs. Sally recalled how the SSRIs prevented her from sleeping due to her mind constantly having active or intrusive thoughts. Kelly felt the tablets could have the opposite effect and cause her to feel fatigued and drowsy, or they could make her nauseated. Mathew explained that SSRIs caused some stomach trouble which his doctor only addressed by prescribing more tablets to counteract the digestive issues. This led to the necessity of up to four different tablets per day, a burden that was not worth the benefits of SSRIs.
When asked about whether or not cannabis had side effects, Rob, Stan and Mathew noted that cannabis can cause side effects as well but that they could be attributed to the type of cannabis being used:
Cannabis, it depends really on what type of cannabis, you know. There’s obviously unlimited different varieties and sort of strains and all have a different psychoactive effect. Sometimes you can have some and it just doesn’t agree with you at all.
I know many many many people that use cannabis without any detrimental effect […] if you can’t sleep, choose a strain that helps put you to sleep. If you have lethargy, choose a type of cannabis that will get you up cleaning and do stuff. People don’t understand […] you can get weed from different countries around the world that has a different effect.
Their responses showed a bit more leniency towards side effects pertaining to cannabis use than with SSRI consumption. When Sally discussed the same topic, and whether or not one drug was better than another, she was hesitant to choose one and instead discussed the subjective nature of drug use:
[Psychotropic drugs] affect people differently, obviously you know because you’ve got all the chemicals and stuff in each person is different and it depends. I know for some people, depression is a chemical imbalance and for others it’s triggered and stuff, but I do think they all elevate your mood.
Her answer showed that, given that cannabis and SSRIs are experiences are diverse among individuals, an essential component of drug choice could be that SSRIs work best for some people while cannabis works better for others. This was true in the context of the other interviewees whose responses showed that the experience of using one drug varied greatly between interviewees, sometimes within the same interviewee, and was influenced by other factors such as their mood or circumstances. In consideration of these findings, it was difficult to determine any distinct patterns or connections in their SSRI and cannabis consumption.
Personalisation of treatment and alterative remedies
When interviewees were asked if they would advise depressed patients to take cannabis or SSRIs, their responses were complex. They suggested cannabis, however, their full response would reveal that cannabis was simply one alternative included in a number of options to improve mood:
I would say that exercise and a strain of cannabis and a dosage that would not cause you to be too psychoactively affected […] I would say cannabis would definitely be the best thing. The right type and the right quantity, though.
I would initially suggest trying CBT [cognitive behavioural therapy] or other things I don’t believe pharmaceuticals can completely you have to deal with the problem. But if I did find out if the guy smoked [cannabis] anyway then I would introduce him to a light [cannabis] strain that would lighten his mood and distract him from negative thoughts.
get as much knowledge as [you] can, and to try for [yourself] and also have other tools there whether it be CBT, meditation, or something, but get to know how [you] can work with [your] mind.
Sally also mentioned that she relied on therapy and meditation, in addition to her medication, for mood elevation. The fact that participants suggested solutions outside of psychoactive drugs, such as meditation and exercise, indicates that interviewees felt that one psychoactive drug alone may be inadequate for alleviating depressive symptoms. This finding was particularly interesting because it speaks to the complexity of treating depression and the need for treatment to be personalised for each individual. It may be that cannabis and SSRIs are simply two options, that both happen to be drugs, among a variety of options to assist in remedying depression. Personalisation was more important to the interviewees than the type of drug they chose.
“Natural” remedies and distrust of the medical industry
While the interviews were semi-structured with open-ended questions, none of the questions directly or indirectly inquired about interviewees’ opinions on medicine or the medical industry. Yet, participants took the initiative to introduce the topic of substances as “natural” or “chemical”. All interviewees indicated that they believed that cannabis was the more natural product, whereas antidepressants were implied to be “chemicals” and therefore less natural. Some of the participants chose to elaborate further and expressed their concern regarding medicalisation and the pharmaceutical industry:
I think that antidepressant use has gone up because the big pharmaceutical companies promote it. It’s like, when I went in to get counselling, she just said “no, no, just take these” […] almost feels like doctors are sort of legal drug pushers […] There’s probably been an increase in people taking SSRIs […] pharmaceutical companies want to make money. That’s what I believe really, it’s all about profit, it’s all about money, at the end of the day, keeping the population down.
Stan felt that SSRIs are pushed onto patients, leading to more people using the drug than is perhaps necessary, and that doctors and pharmaceutical corporations held a heavy influence as drivers of medicalisation. He believed that the medical and pharmaceutical industries were self-interested which was demonstrative of his lack of trust towards them. Mathew’s response also shared related concerns when explaining why he felt cannabis was a safer and more natural product:
I know many, many, many people that use cannabis without any detrimental effect. I’m not quite so many people that don’t have problems with general pharmaceuticals […] I choose not to take pharmaceuticals because I don’t trust any of them, they’re not having a cure, there’s no money in a cure, keep people on meds. Keep pharmaceuticals rich, that’s how I feel.
Similarly, Rob explained that he tried antidepressants as his doctor suggested, but they were ineffective, and consequently it increased his distrust in doctors. Subsequently, Rob turned to cannabis in order to alleviate his symptoms of low mood since cannabis consumption does not require a doctor’s involvement which therefore made it more trustworthy.
Although Kelly and Sally also felt that cannabis was more natural, they spoke in more neutral terms about their doctors and the medical industry. They also preferred more natural substances, but it was not due to a distrust in doctors or the pharmaceutical industry. When Kelly and Sally discussed their doctors’ roles in their depression, they indicated that they had more of an active role in working with their doctors to decide on prescription dosages. This is in direct contrast to Mathew, Stan, and Rob who did not have as much of an open dialogue with their doctors to decide on dosages; their narratives indicated that their doctors were more authoritarian and gave direct instructions on not only the decision to take SSRIs but also the dosages at which to take them. This finding shows that those who felt more pressure from their physicians to use SSRIs spoke more negatively about SSRI use and the medical industry. It is also important to note that Mathew, Stan and Rob described their initial appointments with their doctors, when they were first prescribed SSRIs, with much more detail and emotions than Kelly and Sally did, thereby showing the significance of that event in their lives in the context of their depression.
Discussion and conclusion
Through an exploratory approach, this research was meant to gain a deeper understanding of the SSRI and cannabis consumption through its users. It was not the intention of this study to advocate for either cannabis or SSRI use as treatment. One of the key findings was that there are varied influences on drug choice which are unique to this population of drug users. Their decisions pertaining to drug use were complex and included factors such as feelings towards the medical practitioners and personal history.
Participants who worked together with their doctors to agree on a dosage of SSRIs were more willing to take SSRIs and have a more positive perspective towards the medical field. In contrast, interviewees who felt that they had less control over their SSRI intake based on their doctors’ instructions described less optimistic feelings associated with using SSRIs, and they seemed to have a greater desire to discontinue their use. They also tended to be more distrustful towards their doctors as well as the medical industry. This finding is in line with existing literature which has argued that trust between healthcare providers and patients is crucial (Williams and Calnan, 1996), and that changes in the field of medicine in the past several decades have moved the balance of control more towards patients than doctors (Williams and Calnan, 1996; Conrad, 2007; Metzl and Herzig, 2007). Similar to the literature, the results of this study support the idea that it is crucial for doctors to work jointly with patients rather than to direct patients as an authority figure in order to achieve better health outcomes for depressed patients. Further, these findings provide a more in-depth understanding of the perspective of patients, and can be used to improve communication between doctors and patients.
Though the data revealed that SSRIs and cannabis were not viewed as directly comparable in terms of mood elevation or experience, this was because participants viewed these drugs as two alternatives within a variety of treatment options. The idea that one drug was better than the other was not as important to the interviewees as having a range of choices, including those outside of psychotropic remedies, rather than being limited to SSRIs or cannabis. This was evident when they expressed a cognisance of the fact that the effectiveness of remedies is subjective to each patient, and that they each had different treatment preferences.
It is important to note that in between the time that this study was conducted and its publication, the use of medicinal cannabis was legalised in the UK (Home Office, 2018b). This crucial change would have impacted some of the responses since multiple interviewees stated that they would try cannabis options if it were legal and therefore safe. Interviewees also viewed cannabis as a natural alternative to SSRIs, and this finding supports previous research which has found that patients preferred cannabis as a more natural option but that some people viewed illegality as a cause for concern (Coomber, Oliver and Morris, 2003). In light of the recent legislation change, it would be worthwhile for future research to explore how medical cannabis has affected the health outcomes for UK nationals who suffer from low mood.
There are some limitations which should be taken into consideration. The data of this study consists solely of interviewee responses, therefore, it relied on the participants to be accurate in their recollection of the events and their feelings. The stigmatisation of illicit drug use as well as mental illness, in addition to the illegality of recreational cannabis use, could have had an impact in the responses and it likely had an influence on the small sample size. With smaller sample sizes, the inferences that can be made regarding the population of SSRI and cannabis users are limited. Moreover, the sample may not necessarily represent the demographics of all SSRI and cannabis users given that these the interviewees varied in factors such as age, socioeconomic status, education, and residential location. As a result, these differences could have caused a bias in the results and the findings may be limited in their transferability.
Despite its limitations, this study provided evidence that it would be beneficial for medical practitioners to offer additional alternatives for treatment and provide personalised options for patients. More choices could help empower patients as they would be less limited in treatment options which could possibly diminish the stigma surrounding depression and drug use. Considering that many individuals experience depressive symptoms in their lives, that one’s reasons for choosing SSRIs or cannabis can be complex, and that SSRIs and cannabis use may not be entirely sufficient treatments on their own, it is worthwhile to dedicate more attention to this topic through further research.
Arendt, M., Rosenberg, R., Fjordback, L., Brandholdt, J., Foldager, L., Sher, L. and Munk-Jørgensen, P. (2007), “Testing the self-medication hypothesis of depression and aggression in cannabis-dependent subjects”, Psychological Medicine, Vol. 37 No. 7, pp. 935-45, doi: 10.1017/S0033291706009688.
Bambico, F., Katz, N., Debonnel, G. and Gobbi, G. (2007), “Cannabinoids elicit antidepressant-Like behavior and activate serotonergic neurons through the medial prefrontal cortex”, Journal of Neuroscience, Vol. 27 No. 43, pp. 11700-11, doi: 10.1523/JNEUROSCI.1636-07.2007.
Braakmann, N. and Jones, S. (2014), “Cannabis depenalisation, drug consumption and crime – evidence from the 2004 cannabis declassification in the UK”, Social Science and Medicine, Vol. 115, pp. 29-37, doi: 10.1016/j.socscimed.2014.06.003.
Chatwin, C. and Porteous, D. (2013), “Insiders? The experiences and perspectives of long-term, regular cannabis users”, Contemporary Drug Problems, Vol. 40, pp. 235-58.
Conrad, P. (2007), The Medicalization of Society: On the Trans- formation of Human Conditions into Treatable Disorders, The John Hopkins University Press, Baltimore.
Coomber, R., Oliver, M. and Morris, C. (2003), “Using cannabis therapeutically in the UK: a qualitative analysis”, Journal of Drug Issues, Vol. 33 No. 2, pp. 325-56, doi: 10.1177/002204260303300204.
Cornelius, J., Salloum, I., Haskett, R., Ehler, J., Jarrett, P., Thase, M. and Perel, J. (1999), “Fluoxetine versus placebo for the marijuana use of depressed alcoholics”, Addictive Behaviors, Vol. 24 No. 1, pp. 111-4, doi: 10.1016/S0306-4603(98)00050-1.
Degenhardt, L., Hall, W. and Lynskey, M. (2003), “Exploring the association between cannabis use and depression”, Addiction, Vol. 98 No. 11, pp. 1493-504.
Denson, T. and Earleywine, M. (2006), “Decreased depression in marijuana users”, Addictive Behaviors, Vol. 31 No. 4, pp. 738-42.
El-alfy, A., Ivey, K., Robinson, K., Ahmed, S., Radwan, M., Slade, D., Khan, I., Elsohly, M. and Ross, S. (2010), “Pharmacology, biochemistry and behavior antidepressant-like effect of Δ9-tetrahydrocannabinol and other cannabinoids isolated from Cannabis sativa L”, Pharmacology, Biochemistry and Behavior, Vol. 95 No. 4, pp. 434-42, doi: 10.1016/j.pbb.2010.03.004.
Feingold, D., Weiser, M., Rehm, J. and Lev-Ran, S. (2015), “The association between cannabis use and mood disorders: a longitudinal study”, Journal of Affective Disorders, Vol. 172, pp. 211-8, available at: http://dx.doi.org/10.1016/j.jad.2014.10.006
Glaser, B. and Strauss, A. (1967), The Discovery of Grounded Theory: Strategies for Qualitative Research, Aldine Transaction, New Brunswick.
Gruber, A., Pope, H. Jr and Brown, M. (1996), “Do patients use marijuana as an antidepressant?”, Depression, Vol. 4, pp. 77-80, doi: 10.1002/(SICI)1522-7162(1996)4:23.0.CO;2-C.
Hamilton, I., Lloyd, C., Hewitt, C. and Godfrey, C. (2014), “Effect of reclassification of cannabis on hospital admissions for cannabis psychosis: a time series analysis”, International Journal of Drug Policy, Vol. 25 No. 1, pp. 151-6, doi: 10.1016/j.drugpo.2013.05.016.
Hill, M. and Gorzalka, B. (2005), “Pharmacological enhancement of cannabinoid CB1 receptor activity elicits an antidepressant-like response in the rat forced swim test”, European Neuropsychopharmacology, Vol. 15, pp. 593-9, doi: 10.1016/j.euroneuro.2005.03.003.
Home Office (2017), “Drug misuse: findings from the 2016/17 crime survey for England and Wales – GOV.UK, National Statistics”, available at: www.gov.uk/government/publications/drug-misuse-findings-from-the-2013-to-2014-csew/drug-misuse-findings-from-the-201314-crime-survey-for-england-and-wales (accessed 27 November 2019).
Home Office (2018a), “Drug misuse: findings from the 2017/2018 crime survey for England and Wales”, available at: www.gov.uk/government/statistics/drug-misuse-findings-from-the-2016-to-2017-csew (accessed 27 November 2019).
Home Office (2018b), “Government announces that medicinal cannabis is legal”, available at: www.gov.uk/government/news/government-announces-that-medicinal-cannabis-is-legal (accessed 27 November 2019).
Khantzian, E. (1985), “The self-medication of addictive disorders: focus on heroin and cocaine dependence”, American Journal of Psychiatry, Vol. 142 No. 11, pp. 1259-63, doi: 10.1007/978-1-4613-1837-8_7.
Lloyd, C. (2008), “UK cannabis classification: a flawed debate”, The Lancet, Vol. 371 No. 9609, pp. 300-1.
Markou, A., Kosten, T. and Koob, G. (1998), “Neurobiological similarities on depression and drug dependence: a self-medication hypothesis”, Neuropsychopharmacologyq, Vol. 18 No. 3, pp. 135-74.
Metzl, J.M. and Herzig, R.M. (2007), “Medicalisation in the 21st century”, The Lancet, Vol. 369, pp. 697-8, doi: 10.1016/S0140-6736(07)60317-1.
NHS Digital (2017), “Prescriptions dispensed in the community, England 2006-16, National Statistics”, available at: https://files.digital.nhs.uk/publication/s/o/pres-disp-com-eng-2006-16-rep.pdf (accessed 27 November 2019).
Office for National Statistics (2019), “Measuring national well-being: domains and measures”, available at: www.ons.gov.uk/file?uri=%2Fpeoplepopulationandcommunity%2Fwellbeing%2Fdatasets%2Fmeasuringnationalwellbeingdomainsandmeasures%2Foctober2019/domainsandmeasuresautumn2019.xls (accessed 27 November 2019).
Williams, S.J. and Calnan, M. (1996), “The ‘limits’ of medicalization?: Modern medicine and the lay populace in ‘late’ modernity”, Social Science and Medicine, Vol. 42 No. 12, pp. 1609-20, doi: 10.1016/0277-9536(95)00313-4.
There are no conflicts of interest or external sources of funding to declare.
About the author
Judy Castañeda is based at the Social Policy, Sociology, and Social Research, University of Kent, Canterbury, UK and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.