HealthyGamerGG - Why Marijuana Helps Your Brain But Harms Your Mind

Episode Date: November 20, 2024

The effects of marijuana have long been debated, clearly having both positive and negative effects on its users. Today, Dr K. analyses the research behind the effects of longer term marijuana use on the mind. Check out more mental health resources here! https://bit.ly/3xsk6fE Learn more about your ad choices. Visit megaphone.fm/adchoices

So if you all have these positive experiences with marijuana, if you're thinking to yourself, but it really does help me with my anxiety. It really does help me with my insomnia. Dr. K, you don't understand. I've had patients who have bipolar disorder who have actually used marijuana quite successfully. So I've seen this in a clinical perspective, but we have to understand some of the nuance here and what makes it helpful and what makes it harmful. So for those of y'all that are enjoyers of the Mary Jane, the marijuana, the THC, y'all are probably celebrating right. now, thank God Dr. Kay is going to give me a license to get high and enjoy my life. And we are going to talk about medical studies and sort of things that weed can be helpful for, but I wouldn't

get super, super excited quite yet. Because here's kind of my take on this. Marijuana or THC can be very good for your brain or neurons, but chances are is bad for your mind. Now that may sound kind of weird, right, because we're sort of thinking about the brain and the mind is very related. how can something be good for the brain and bad for the mind? Like, what's up with that? So if we look at the studies, and there are a lot of them, and we'll go through them in a second, on the benefits of marijuana,

because there is an explosion of research recently, what we tend to find is that the studies that show a strong benefit tend to be for neurologic conditions, not psychiatric conditions. So there are studies that show benefits for things like multiple sclerosis, which is incredibly fascinating, things like pediatric epilepsy, things like degenerative neurologic diseases, potentially studies in things like Parkinson's.

So basically what we tend to see is that the more pathologic your situation is, the more weed benefits. So this is actually true of a lot of like medications, right? So if we look at the process of a doctor prescribing a medication, medications always have side effects. And the decision about whether to give a medication or not, let's take something like chemotherapy. So chemotherapy causes you to lose your hair, makes it makes you nauseous, makes you vomit a lot, causes you to lose weight, even increases your risk to develop cancer later in life. Why on earth would we give this? Well, because the situation in your life is so bad that the benefit of chemotherapy is worth the risk. And that's basically what we see in marijuana as well. We see that if you are

dealing with a more severe or chronic neurologic condition, then marijuana can be helpful for you. But unfortunately, for a lot of these psychiatric conditions, like people like, oh, like weed helps me sleep and weed helps me with my anxiety and this kind of stuff, there's not a whole lot of data. So let's kind of dive in. And then we'll also end with, even if you do really love weed, what are sort of the safe and best ways to use it based on our understanding of the evidence available? Okay. So when should use it? When should you not use it?

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even work through the setbacks that you will inevitably face. So check out the link in the description below to see if coaching is right for you. Neurological benefits, clinical challenges, and neuropathologic promise of medical marijuana, a systematic review of cannabinoid effects and multiple sclerosis and experimental models of demyelination. Okay, so this is like, we're just going to look at one paper in detail. So the first thing that I want you all to notice is that it says promise. So the first thing to understand about a lot of these studies showing the benefits of marijuana are that they're like basically small studies.

The majority of studies have fewer than 40 participants. I think 74% of studies have fewer than 40 participants. And so people are like, we're really in the early stages of finding benefits. Let's take a look in more detail. So pre-clinical studies, right? So this is another thing to keep in mind. The research is in its early stages. So we're not talking about randomized controlled trials with like 10,000 people.

people, right? So these are even pre-clinical studies demonstrated decreases in disease severity, hind limb stiffness, motor function, neuroinflammation, and demyelination. So this is super cool. So what this sort of suggests is that marijuana has a direct effect on the health of a neuron or a nerve cell. So this study looks at pre-clinical studies. So these are studies that aren't necessarily looking at patients and demonstrate decreases in disease severity, hind limb stiffness, motor function, neuroinflammation, and demyelination. So if we look at multiple sclerosis, which is a degenerative neurological disease where your immune cells attack the insulation surrounding your nerves. So remember for a second that a nerve conducts an electrical impulse. And any time we have

conduction of an electrical impulse, if we insulate the wire, it makes that conduction way better. So what we see in multiple sclerosis is a destruction of the myelin sheath around the neurons. that prevents us from transmitting signals properly. This can result in problems like pain. It can result in whichever nerves get affected. That's the symptoms that we'll see. So sometimes we'll see pain. We'll sometimes see things like incontinence.

We'll see dizziness. Like it depends on which nerves get attacked. And there are some promising early stage studies that suggests that multiple sclerosis can be benefited by using marijuana. So this is a study that's looking at balancing the risks and benefits of cannabis use, an umbrella review of meta-analyses. This is a higher level of evidence. A meta-analysis is when I take a bunch of trials and then I pool the data together of randomized controlled trials. So these are high-quality studies and observational studies, which are a little bit lower. So I like this paper because it's going to run us through a lot of the conditions. And instead of looking at, you know, a thousand papers that

are each looking at one condition each, we're going to look at all these conditions in one paper. So the first thing to understand, I'm going to orient, orient you all to this graph is if we see a dot that is on the left side of the table, that means that it's beneficial. If we see a dot that's on the right side of the table, that means that it's harmful. If the lines cross the middle, that means we don't know. So this, for example, is not a statistically significant effect. So the, you know, the effect of this could be anywhere in the middle here. So we're basically looking for helpful things on the left side of the equation with lines that don't cross the midpoint. Okay?

And that's a little bit complicated, but this good, this bad. Okay? So the first thing that I want to show you all is we can look at things like psychological distress. And we see that from a standpoint of psychological distress, marijuana, according to this particular paper, appears to be harmful. And we can look at things like spasticity is good, pain reduction is good, pain reduction less than 30% is good. So we're starting to see a trend here. Right. We're not going to focus on this stuff because it's kind of all around the midline. But as we go down, we start to see, you know, these are studies on epilepsy. So we see that like if we're talking about seizure reductions, a reduction is greater than 50%. We're starting to see when it comes to seizures and epilepsy. We're seeing a positive correlation with marijuana use. So this is brain stuff, not mine stuff. And then we start to see some of the challenge. So we're looking at things like birth weight and children neonatal kind of conditions here. So marijuana use in pregnancy is associated with bad things for the fetus.

We're seeing small for gestational age, low birth weight and increasing the risk of ICU admission. This is kind of scary, by the way. This is like 1.41. That means that if a mother uses marijuana, there's a 40% increase in risk of the child needing neonated. ICU admission. So that's like kind of scary. More likely to be born preterm. These are kind of scary. We also see that now we're getting into the psychiatric conditions. So if we're looking at adherence to antipsychotic treatment, what we tend to find is that if someone is on antipsychotic medication and they use marijuana, they are six times as likely to stop their medication because

of the marijuana. Now, there's some nuances there because maybe they're finding a benefit from the the marijuana so they don't need their medication. There's other considerations here that we need to, you know, think about. But we're also starting to see an increase in psychosis relapse. We'll get to why that is. Problems with working memory, right? So now this is kind of getting a little bit scary. Also, there are studies on things like driving and how marijuana increases the risk of car crash

increases the risk that you were at fault in car crash. Car death after car crash is increased by 70%. Like, that's kind of scary, man. And now we're going to get to actually the psychiatric condition. So here we're looking at psychosis, suicidicite attempt, psychotic symptoms, mania. And what we're starting to see here is that this is basically harmful when it comes to mental health conditions. And then we're also looking at studies on healthy people where we see cannabis use and things like perspective memory, verbal learning, verbal recognition, working memory. And we see problems all across the board here.

Right. So when we look at marijuana or when we talk about marijuana, there are a lot of, lot of people that say, okay, marijuana helps me in a lot of situations. And we see that there is data that shows that marijuana can be helpful for conditions, but basically those conditions involve things that are pretty severe and things that are pretty neurologic. So conditions like chronic pain, conditions like epilepsy, conditions like spasticity of the muscles. So when we have nerve-related problems that cause problems in our muscles, marijuana can be pretty helpful. So basically neurologic conditions. So if you're someone out there who's using marijuana and you're thinking it

helps me with my anxiety, it helps me with my insomnia, we'll get to that in more detail in a second. The studies really don't support that. The studies support that if you have a severe condition that is neurologic in nature, that's where marijuana could really be helpful. So now we have to get to kind of like a couple of really concerning things, right? Because here you all are. I know this is the HG community. I know we love video games. I know we love sometimes getting high. And like I'm behind that, right? I get that that's where we are. I work with a lot of people who are in the meditation community, and they really love using marijuana with meditation.

And so is Dr. K basically saying, like, we shouldn't use marijuana? Well, let's take a step back and understand really what's going on here, okay? So if you all have these positive experiences with marijuana, if you're thinking to yourself, but it really does help me with my anxiety, it really does help me with my insomnia. Dr. K, you don't understand. I've had patients who have bipolar disorder who have actually used marijuana quite successfully, I've had some patients that have some degree of anxiety that can use it somewhat successfully.

So I've seen this in a clinical perspective, but we have to understand some of the nuance here and what makes it helpful and what makes it harmful. So let's look more specifically at cannabinoid products in adult psychiatric disorders. This, once again, is a systematic review and meta-analysis of randomized controlled trials. So this is an umbrella review that looks at all kinds of conditions. But what if we look at specifically, you know, the Journal of Psychiatric Research, psychiatric conditions, because the majority of things that I hear are it helps me with anxiety, it helps me with my insomnia. And this is basically what this paper finds.

So of the 2,397 papers identified 31 RCT. So this is looking at 31 trials. 10 trials focused on treating cannabis use disorder, right? So sometimes we use things like buprenorphine to treat opioid use disorder. We'll use methadone to treat opioid use. use disorder. These are opiates used to treat opioid use disorder. Six on schizophrenia, five on opioid and tobacco use, three on anxiety disorders, two on Tourette's, two on anorexia, and one trial for ADHD and obsessive compulsive disorder. So this review finds limited evidence for the effectiveness of

CBPs to acut, acutely treat a narrow range of psychiatric symptoms. We report no evidence supporting the mid to long range effectiveness of any currently available CBP. So the basic issue here is that when we look at trials on psychiatric conditions, the majority of the trials show very little to no evidence. Basically, the best evidence for any kind of psychiatric condition is cannabinoid use disorder. So if you are addicted to marijuana, there's a medication called drabinol, which basically if we take people who are addicted to pot and we give them, them a pharmaceutical substitute for marijuana, it reduces their marijuana use over time. That's the only convincing data we have. We have studies on insomnia, anxiety, all this kind of stuff,

and there's really no data to support that marijuana is helpful for those long term. Now, this is the other thing to consider, is that most of these trials also look at short-term effects, right? So we're looking at studies that are like, okay, if you use marijuana for an eight-week period, what is the reduction that you experience in anxiety? The answer is not much. The real challenge with using marijuana is when I work with patients who are using marijuana to treat their conditions like anxiety and insomnia, they're using it over the course of months. And the studies don't even look at that. And that's really where I start to see a lot of problems with marijuana. I see good, decent, you know, indications for using marijuana. I know I just said that there's really not good evidence. But as a

clinician sometimes, you do things that are a little bit against the evidence because of a clinical scenario. So, for example, I had a patient once that had a bipolar disorder. And what she found is that, like, if she's starting to get manic, using marijuana for, like, one to three days to help her sleep get back on a regular sleep cycle and then stopping for a period of like two to three months was actually really useful at stopping this manic episode from becoming full-blown. And I've seen that clinically, it worked really well for this person.

But there are a couple of things to keep in mind here, right? So this is an isolated case where you're using marijuana in a very limited fashion to abort something like a manic episode, and then you're not touching it for a couple of months. What I tend to hear a lot on the internet is that regular users of marijuana are starting to use this stuff to treat chronic symptoms. And it's not just that this is ineffective for marijuana. This is actually an ineffective approach for certain pharmacologic medications as well. So let's talk about benzodiazepines for a second. So a couple of years ago, a couple of decades ago, pharmaceutical companies are like, bra, we got you, fam. We invented this great medication called

Xanax. And Xanax, or El Prazalam, is going to be amazing. It's going to cure your anxiety. And what happened is people were like, okay, so doctors were like, all right, cool, we finally have a cure for anxiety. We weren't able to treat this crap earlier. So now we've got a pill for it, fantastic. And then they started prescribing Xanax or El Prasolam. And their patients who had anxiety were like, oh, my God, I popped the pill and within minutes, my anxiety melts away. And everyone was like, this is amazing. It's a wonder drug. And then what started to happen is as people started to take Xanax or El Prazalam, every single day, what they started to notice is that it stopped working, that people became very addicted to it, that they became very dependent on it, that they needed to take more than they

originally took, that they needed to take it multiple times a day. And my guess is that the drug companies were aware of this. They were aware of how quickly it worked. They were aware of some of its addictive potential, and they realized, like, okay, we can get a lot of people addicted to this stuff. I really think that, like, if you were, you know, a competent clinician developing this, there's no way that you weren't aware of that. Maybe they weren't, who knows. So Xanax and marijuana in this way, I don't think, are very different because these are things that are very habit-forming. So you don't get physiological withdrawal with marijuana in the same way that you do with benzodiazepines or alcohol, different receptors. You don't get

withdrawal at the cannabinoid receptor. You do get withdrawal at the GABA receptor. We don't need to get too much into detail there. But I think one of the key things that we've learned as psychiatrists is that like giving someone, you know, this short acting medication that you then become dependent on that you build up a tolerance to is not a good way to treat a problem like anxiety or insomnia. I know a lot of people who have become very dependent on marijuana to help them sleep. And basically what happens is they build up a tolerance. They need higher and higher doses. And if you're someone who, you know, you think marijuana helps you sleep, I totally get it.

So now the question becomes, if the studies don't show that marijuana is effective at treating stuff like anxiety or insomnia, Why the hell do so many people swear by it? So this is a really funny study. I just wanted to share this a deal. So effective medical marijuana card ownership on pain, insomnia, and affective disorder in adults, right? So at some point, doctors were like, all right, cool. Let's use medical marijuana. If you've got the right conditions, we can prescribe you marijuana.

You can get a medical marijuana card and you can start using marijuana. So what happens when you take a patient who's got depression, pain, or insomnia and you give them a medical marijuana card. Let's see. The immediate card acquisition group had more cannabis use disorder symptoms. So this means that they qualified for a higher level of addiction. Fewer self-rated insomnia symptoms and reported no significant changes in pain severity or anxiety or depressive symptoms.

Participants in the immediate card acquisition group also had a higher incidence of cannabis use disorder during the intervention. And particularly those with a chief. concern of anxiety or depressive symptoms. So we got to really understand what this means, because this is kind of scary, y'all. This means that when we sat out and we were like, we're going to do a trial. Marijuana can be effective for depression, anxiety, insomnia, pain. This is great, dude.

It's good stuff, man. So we did a trial where we gave a bunch of people medical marijuana cards, and what did they find? They found that the most common, the most real statistical, significant thing is that when you give someone a medical marijuana card, the most likely thing to happen is, the most likely thing to happen is they will become addicted to marijuana. Like, that's the outcome of the trial. But what about things like insomnia?

So this is really important. The trial also found that there are self-reported symptoms of insomnia that improve, but that measures of depression or anxiety don't get better. And the more depression and anxiety you have, the more likely you are to get addicted to marijuana. And this is basically what I've seen as a clinician, which is that marijuana, just like benzodiazepines, just like Xanax, give people the subjective experience of relief, right? They make me feel like my anxiety goes away.

The moment that I get high, I feel like my anxiety goes away, my depression goes away. It makes it easier for me to sleep. So the subjective experience of this stuff gets better. But over time, if you track these people's symptoms, so if you ask this person three months from now, after they started using their marijuana for anxiety, are how? How much does your anxiety still impact your life? And the answer is it doesn't change at all. Right?

So people who use marijuana are not able to go on dates more easily. They're not able to talk to their boss more easily. They're not more able to speak up in class. And people may have a subjective experience for this. But if you objectively track improvement, because that's what we're looking for, right? When I'm a psychiatrist and I have a patient who's got anxiety, what I want to know when they come in and they say, hey, I have an anxiety disorder. I'm like, cool.

How is the anxiety disorder impacting your life? Well, I have difficulty asking for a promotion. I have difficulty setting boundaries. I'm very conflict avoidant. I let people walk all over me. And so those are the things that we want to measure three months out. That's the goal of treatment, right? Is to improve your life in significant ways. And unfortunately, when it comes to the trials on marijuana, we just don't see those kinds of impacts. So let's take a look at why this could be, right? So why is it that marijuana appears to help with certain neurologic conditions but doesn't help with psychiatric conditions, but doesn't help with psychiatric? psychiatric conditions. So this is from a paper called risks and benefits of cannabis and cannabinoids in psychiatry. So it actually comes down to a lot of really interesting receptor-based, like, neuroscience. So the first thing is that when we have marijuana, we tend to have CBD and THC. And what we tend to find is that these things, depending on the receptor that they activate, will have different effects. So CBD actually activates the serotonin 1A receptor, which can be used to help. And with things like anxiety and depression, activates the pain receptor. And then this is what's really interesting is that CBD also will affect the seizures and

psychosis receptors. And this is what's also really important is that when we take formulations that have a balance of CBD and THC, the CBD will actually block the action of THC. So this is really important for some issues like psychosis. So I'll give you all an example of this. There's something called synthetic marijuana or K2. And part of the reason that marijuana may not be as healthy as we think it is is because marijuana is actually changing quite drastically.

So as it's becoming decriminalized, what people are realizing is that a lot of the euphoria comes from a high concentration of THC. Okay. So what's happening is people are making marijuana that is not the, the same that it was 100 years ago. They are concentrating the THC. And if you concentrate the THC, you get more activation of the CB1 receptor, which gives us more euphoria. So we had this problem really bad in Boston where people were using synthetic marijuana or THC. And like, it's called K2 in Boston. And these people were getting like super psychotic and super violent because there's

THC without any CBD. So this is, it's important to understand that, you know, the balance of CBD and THC is responsible for a lot of these kinds of effects. That some receptors that we activate with marijuana can help us in some ways, but that other receptors, if we activate THC, if we get THC in here in the CB1 receptor, we'll see psychosis. Like, sometimes there's an interesting balance between psychosis and anxiety. So THC is kind of like a pro-anxiety molecule. and CBD is kind of an anti-anxiety molecule. So when we're looking at marijuana use over the whole,

if we've got THC and CBD in there, chances are that the net effect will be neutral. And over time, as you develop tolerance, your anxiety could actually get worse. So now the question becomes, okay, Dr. Kay, you said that this is a video about the benefits of marijuana. And look, y'all, I swear to God, I tried, right?

So I sat down and I know that we made a couple of videos that are like not great about how, marijuana is potentially bad for you. And I really sat down, I went through a ton of papers. I looked at a bunch of meta-analyses to try to figure out like, okay, how can we make a case for marijuana? And the TLDRs, you can make a case if you have a bad neurologic condition like seizures, then marijuana can be helpful.

If you've got something like MS, then marijuana can be helpful. Chronic pain, it can be helpful. But for psychiatric conditions, it really doesn't work well, especially if it's used over the long term. And this is the exact same thing that we learn for benzodia. So when I prescribe benzos, I rarely prescribe them on a standing basis that you take it every day. Sometimes I'll prescribe things like clinazepine for people and it can work pretty well. But that's the exception rather than the rule.

One of the biggest lessons we've learned in psychiatry is that things that make people feel really good, things that make them feel euphoric, have a high chance of abuse, and generally speaking, don't lead to good outcomes over the long term. Now, there are a couple of big caveats to everything that I just said. because the studies don't look at things long term, right? So the studies aren't for like six months. They tend to be shorter in nature, but generally speaking, I don't think that six-month studies will reveal that, oh, yeah, marijuana really cures anxiety.

I don't think that we're going to find that. But fair enough, it works for some people, sort of. But I think what it works at is making you feel like it's working without actually changing objective measures of your life. So here's what I've learned about how to use marijuana in the healthiest way possible as a psychiatrist who's worked in addictions, worked with people who really like marijuana, find it helpful for their anxiety, their sleep, et cetera. And, you know, even being a meditation teacher where people swear that marijuana

helps them calm their mind and stuff like that. So what's kind of the TLDR? The first thing is that I do not think you should use marijuana if your brain is developing. Now, I realize that that's probably half of y'all, and that's when we love to use it. So we know that marijuana usage alters the dopaminergic architecture of our brain and makes us more vulnerable to addictions over time. Generally speaking, I want to say that 75 to 90% of, like, college students that I've worked with who use marijuana on a regular basis, once they get sober, their mental health vastly improves.

So we don't want to use it under the age of 25. The second thing is that marijuana should be used very, very rarely if you are using it to treat a problem. So if you're using it to treat anxiety or treat insomnia, then it should not be used on a daily basis, maybe even not a weekly basis. So there's probably some stuff about tolerance and things like that, but I would say at a minimum, like, sorry, at a maximum, at a minimum once a week. At a maximum, like once a week. So if you're using benzodiazepines or things like that, we'll let people use that a little bit more,

maybe like two to three times a week. But daily use of marijuana doesn't seem to be very good at helping with anxiety or insomnia. Now, it may help you feel like it's helping a lot, but over time, it won't improve outcomes. At least that's what the data suggests, right? So use it carefully. And the last thing that may sound kind of weird is that I honestly think that sometimes when it comes to things like alcohol and marijuana, they shouldn't necessarily be used as a treatment purpose at all. So when I think about, okay, what's a healthy relationship with alcohol? It's not like drinking to manage your anxiety.

Like that sounds like the birth of an addict right there. It's drinking to celebrate. So if you're like getting married or you're going to a bachelor party and you want to have a couple glasses of champagne, like go for it. And that's where when I think about marijuana and we're seeing a lot of decriminalization of marijuana, which I don't necessarily think is a bad thing, by the way. What I think it could be used for, I don't know, I don't know should is a strong word. But what it could be used for is on occasion enhancing the pleasure that you get from certain activities. To use it in a recreational manner, because at least from a psychiatric perspective, it seems like it really doesn't help. So I know we have a lot of people in our community who feel very strongly about marijuana.

And there's a lot of promising research that marijuana can be helpful for things like medical conditions. And there's a lot of people who are like, oh, man, we addict people to benzos and like, why is marijuana any worse? I don't think it is, right? I think actually the two of them fall into the same category. And what we've learned, we made this mistake of addicting a generation of people to Al-Prasalam. And now we're getting wise to some of these things. We addicted a generation of people to opioid medications by claiming that, oh, it's going to help so much with your chronic pain when what we really found is that over time you just increase the dose and make things worse. And I think when it comes to euphoric substances that are used for medical reasons, all three of these fall under the same general umbrella, which is that if you want to use it for a medical reason, first of all, you have to have something really bad going on, which means something like multiple sclerosis, something like seizures, something.

like cancer. So the more pathology you have within you, the better the risk benefit ratio becomes for a harmful substance. So the worst things are, the more beneficial potentially marijuana can be. The last thing is that basically for psychiatric conditions, I cannot in good conscience recommend using marijuana like for the general public. The data just isn't there. And I tried, y'all. I really did, but that's just not what it shows. So if you're someone who's really thinking like, oh, marijuana is really good for me, I love it, I love it, I love it, I love it. I don't dispute that you have a subjective experience of symptom relief for your problem. The real problem that I see with marijuana, though, is that when people start using marijuana

and they feel that subjective relief, they stop doing the things to actually fix the problem in a more permanent way in the rest of their life. And number one on the list is I'll see people who are like, yeah, I really find that marijuana helps with my anxiety. So I'm not going to do cognitive behavioral therapy. I'm not going to see a therapist. I mean, studies on CBT show that if you do a six-month course of CBT and you have ADHD, the benefits of a six-month course of CBT lasts for two years, right? So people who are using marijuana to help them focus, stop engaging in more healthy treatments

that will probably be way better for you and last beyond how long you're specifically high. So if you all love marijuana, like, look, I get it. I think the data just doesn't support it, though, and I'm sorry to say that, you know. I guess this will be like, well, our most downvoted video on the channel, but like, that's what we got to do. We really looked at the data. And I'm sorry, but that's kind of where things are now. Maybe, you know, by all means, comment and tell me I'm a dumbass. Tell me I don't understand. Tell me this is medical establishment. Let all the rage flow, right? Downvote this shit. Like, do whatever you all think. But look, what our goal here on the channel is is to try to provide y'all with like very, very

solid evidence-based approaches to things. We try to look at things as objectively as possible. And we have to be honest if the data really doesn't support something. Really reconsider if you all really love marijuana. Like do the things that are really important as opposed to just getting high because we all know in the back of our mind that like there's a reason why you're gunning for that answer.