Most cancer patients often suffer from anxiety and depression, which can have a considerable negative impact on their quality of life. Patients with comorbidities are found to have worse outcomes where often it has been found that both depression and anxiety among patients are strongly associated with high suicide rates. Despite such alarming situations and the availability of multiple treatment options, very few patients are found to seek advice and treatment for depression and anxiety.

Several medicines are reported to have good efficacy in the treatment of depression and anxiety. However, many patients are uncertain about the use of medication, and antidepressants, due to the presence of side effects associated with such drugs. Adverse events are fairly common across all classes of antidepressant drugs, which can lead to non-initiation or discontinuation of such drugs by the patients. Although research studies have demonstrated the effectiveness of antidepressant drugs in reducing depression and anxiety among patients, there is a lack of awareness among the patients due to which they refrain from taking those drugs. In many incidences, patients are also found to suffer from withdrawal symptoms if they discontinue the use of such drugs, which can last for several months^?1?.

Traditional treatment for depression

Treatment of depression and anxiety is unique for patients and depends on the individual patient's profile and the severity of the treatment.

Patients suffering from mild depression are often referred for psychosocial treatments, such as psychotherapy. For mild cases of depression, drugs are generally not prescribed for the patients.

Psychological treatments, which include behavioural or interpersonal psychotherapy, are referred to as an initial treatment regime for patients suffering from moderate to severe depression.

Doctors generally refer antidepressants to patients suffering from severe depression. Commonly used antidepressants include tricyclic antidepressants and selective serotonin reuptake inhibitors. Antidepressant drugs may be associated with various side effects and should only be used under the doctor's supervision. Antidepressants must be used with caution among teenagers and children with depression^?2?.

Medical cannabis as an antidepressant

Due to the associated side effects of antidepressant drugs, an increasing number of patients suffering from depression and anxiety are opting for medical cannabis medicine for symptom management. Medical cannabis products generally contain extracts that are based on three predominant chemical constituents:

1. Products with a dominant quantity of ?9-tetrahydrocannabinol (THC)
2. Products with a dominant quantity of cannabidiol (CBD)
3. Products equal ratio of both THC and CBD

Research studies on the impact of medical cannabis for the treatment of depression and anxiety have shown mixed results, which are often found to vary depending on the type and ratio of medical cannabis compound used and the duration of the dosing regimen.

Many patients have reported that medical cannabis helps in reducing depression. Medical cannabis is also found to promote good sleep, improve quality of life, and reduce pain. Initiation of medicinal cannabis among patients during the follow-up period was found to be associated with a considerable decrease in depressive symptoms and anxiety^?1?.

How did medical cannabis work as an antidepressant?

Medical cannabis is reported to modulate the stress and reward networks, which consist of the ECS (endocannabinoid system), hypothalamic-pituitary-adrenocortical (HPA) axis, and dopamine system. These networks help in maintaining the balance between stress and well-being. Medical cannabis is found to produce a state of calmness among patients similar to that observed during social interaction and exercise, which is mediated by the interactive effect of oxytocin receptor activation, anxiolytic effects of cannabinoids and effects of elevated dopamine. Research studies have demonstrated that changes in the endocannabinoid signalling lead to increased anxiety and depression^?3?.

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