The month of May is coming to a close, and with the end of Mental Health Awareness month comes one of the most difficult topics of discussion among the cannabis industry: Does cannabis improve mental health, or make it worse? Many dedicated consumers and patients would be quick to tell you that the plant has had a profoundly positive influence on their lives. And yet, emerging science on the topic has revealed that cannabis and mental health have a much more complicated relationship than ever predicted.

What is Mental Health?

Before diving into the ways in which cannabis affects mental health, it’s useful to paint a picture of what mental health actually means. For most, mental health means being free from depression, free from psychiatric illness, and perhaps even blissfully happy. Unfortunately, while more people are aware of mental and emotional health than ever before, the concept is still far too often boiled down to either a means of coping with severe mental disorders or as a reinforcement of the idea that you should strive to be happy all of the time.

Both of these popular beliefs are a myth — most people must learn how to develop mental health skills at some point in their lives, and, although it is difficult to admit, being happy all of the time is a scientific anomaly. Contented and peaceful, sure, but moments of blissfulness and pure happiness wax and wane for just about everyone. Of course, this is not to discount the lives or experiences of the many who struggle with severe mental health concerns, such as post-traumatic stress, severe depression, and other psychiatric ailments.

For Marsha Linehan, the founder of Dialectical Behavioral Therapy and a world-renowned psychologist, mental health can be broken down into four primary components: mindfulness skills, interpersonal effectiveness, emotional regulation, and distress tolerance. While the names may seem like a mouthful, Linehan believes that each building block is essential for being able to both tolerate and relate to the world in a healthy way.

First, mindfulness is the ability to observe what is happening in the present moment without judgment. Secondly, interpersonal effectiveness relates to your ability to ask respectfully for what you want while setting clear boundaries and saying no what you don’t want. Emotional regulation refers to the ability to feel your emotions without clinging to them or letting them get the better of you. Finally, distress tolerance is the ability to tolerate daily stresses and bounce back from stressful situations.

For Linehan, mental health means practising and maintaining fitness in all four of these skills. Even those with a diagnosed psychiatric disease can still practice these skills to improve their mental health. The therapy was initially designed for those with Borderline Personality Disorder, but the concepts have taken root in the world of psychology and are often readily applied to individuals experiencing all sorts of mental health concerns — from addiction to depression to schizophrenia to struggling with an unexpected life transition.

The Complex Relationship Between Cannabis and Mental Health

So, why bring up Linehan? The definitions of mental health are perhaps as vast as the types of therapies available. As such, there are numerous ways to approach the broad topic of mental health. Most psychiatrists offer a mixture of skill-building and medications in order to treat their patients. Is cannabis a worthwhile therapy for mental health? Well, if early research is any indication, it appears that it would depend on how you use it.

Cannabis for Mental Health: The Pros

For many, cannabis is a go-to remedy for mental health concerns. Whether that means popping a CBD capsule to get through a stressful day or if that means developing a treatment plan to keep symptoms of traumatic stress at bay, cannabis is oft touted as an effective way to improve your state of mind. Cannabis has a long-held reputation as a mood-lifter, inspiring laughing fits, improving sleep, and promoting all-around feelings of well-being.

In patients with serious diseases like cancer, the plant has been proven to reduce pain and improve quality of life, factors which have a profound influence on mental health. There is some early evidence that specific cannabis compounds may be helpful for reducing psychosis related to advanced diseases like Parkinson’s Disease.

Similarly, early experiments suggest that isolated cannabis extracts may reduce agitation associated with dementia. In early clinical trials, CBD treatment has even improved the lives of patients living with treatment-resistant schizophrenia. In the area of post-traumatic stress, cannabis compounds are being studied as uniquely viable treatments for the condition. Amazingly, research suggests that chemicals in the cannabis plant may be able to address possible neurotransmitter deficiencies in PTSD patients.

Further research still explores the ability of low to moderate doses of cannabis medicines to reduce symptoms of depression and anxiety, perhaps offering patients an alternative to medicines like benzodiazepines, which come with a greater addiction potential and a host of severe side effects. Cannabis, in contrast, has been dubbed as well-tolerated with limited side effects in most of the mental health trials conducted so far.

The Risks of Cannabis For Mental Health

But, is cannabis a cure or a crutch? While a body of positive research on cannabis as a mental health aid exists, the plant cannot simply be lumped into a category as either good or bad. Instead, research seems to indicate that cannabis may be beneficial in some circumstances, but it may also worsen overall mental health in others. In high doses, for example, the primary psychoactive component in cannabis, tetrahydrocannabinol (THC), may increase anxiety and cause panic attacks.

Further, professionals also have concerns about the chronic consumption of high-potency cannabis. Several epidemiological studies have suggested that long-term cannabis consumption, especially of the high potency variety, is correlated with increased rates of depression, anxiety, and poor mental health. While correlation does not always indicate causation, researchers have found that the younger you are when you pick up a regular cannabis habit, the more likely you are to experience negative mental health outcomes.

And then, of course, is the argument that cannabis can cause psychosis in some people. This is not exactly the same Reefer Madness argument that has dominated since the late 1930s. Instead, modern genetic research suggests that cannabis consumption may contribute to psychiatric illness in those with a genetic predisposition, especially in those that heavily consume the plant. In teens and adolescents, regular cannabis consumption was correlated to an earlier onset of psychotic symptoms in those with a predisposition to this type of mental health trouble.

Finally, both cannabidiol (CBD) and medical cannabis consumption show potential in treating some forms of addiction, including alcohol, nicotine, and opioid addiction. Regular cannabis consumers, however, can also develop a dependency on the herb. For some, this dependency can cause symptoms of withdrawal after stopping the herb. For this reason, many health professionals are reluctant to offer cannabis as a mental health treatment.

Everything in Moderation

What Linehan describes in her Dialectical Model of Behavioral Therapy are a series of skills that an individual must learn in order to developmental and emotional resilience. While progressive mental health and medical professionals see cannabis medicines as tools that better enable patients to focus on these skills, the plant itself is not a cure-all for mental health problems. In fact, in some cases, overreliance on the herb may lead to greater problems, such as dependence on the plant in order to cope with stressful situations.

And yet, it is almost impossible to evaluate the subjective benefits of the herb. When consumed in moderation, the cannabis plant has a knack for providing sudden shifts in perspective and for opening mental doors that once seemed impossible. After a stressful day, a little cannabis may feel like a nudge in the right direction — a glimpse into another way of thinking that was suffocated by a sour mood. A time-out from a stagnate way of thinking can be an invaluable source of healing and self-compassion.

Scientists and medical professionals have yet to decide whether or not chronic and continuous cannabis consumption is an effective treatment for mental health issues. When consumed in moderation, with mindfulness, and with proper support, however, it’s difficult to deny that the plant holds real value and has the ability to affect lives in a positive way.

Ultimately, it’s up to the patient and their trusted medical professional to decide when the plant is helpful and when it has become an unhealthy diversion.

If you or someone you know needs help with mental health issues, please reach out to Mental Health America or your local helpline.

Of the 20,000 aromatic molecules called terpenes found throughout nature, roughly 200 have been discovered in the cannabis herb. As an aggregate, the most common health efficacies offered by cannabis-derived terpenes are reduced systemic inflammation, anti-cancer properties, and analgesic (pain-killing) benefits. The terpene Borneol emits an odor involving scents of camphor, earth, and menthol; its scent is sometimes described as “herbal minty.” It is found in many plants other than cannabis, including camphor, mint, and rosemary. It is a natural insect repellent and is utilized industrially in the manufacture of perfumes and colognes.

Borneol is not extremely common in cannabis. Strains of cannabis offering more significant amounts of this terpene include Hazes and K-13.

The Details of Borneol

This terpene offers many health benefits, including improved digestion (via the stimulation of gastric juices) and better blood circulation. It also effectively treats bronchial symptoms to improve lung function and ease breathing (helpful for sufferers of bronchitis and asthma). Like many of its sibling terpenes, it has been found to reduce anxiety.

Borneol also assists in the healing of wounds. Historically, it has been incorporated into topical treatments for such applications, including the treatment of hemorrhoids. Combined with other terpenes that convey sedative qualities — such as myrcene and linalool — the terpene can effectively combat insomnia. It is also antibacterial and antiseptic.

Borneol exemplifies the dynamics of the entourage effect, a theory that cannabinoids and terpenes work together, synergistically, to offer particular therapeutic and medicinal benefits to humans via supplementation of the mammalian endocannabinoid system (ECS). Borneol amplifies the permeability of the blood/brain barrier, allowing other molecules and compounds to more efficiently bind with specialized receptors in the brain and central nervous system.

When isolated, it can act as an irritant to eyes, skin, and the respiratory system. As a good demonstration of the impact of accurate and strategic titration (dosing), at large doses, it is extremely toxic and harmful if swallowed. A “probable lethal dose” is 50-500 mg/kg of body weight, which equates to between only a teaspoon and an ounce for a 150-pound human.

The Research

Multiple studies have demonstrated the wide-ranging medicinal efficacy of the terpene, including its pronounced role as an anti-inflammatory, bronchodilator, and cancer killer.

A 2017 study entitled “Terpenes from Forests and Human Health” and published in the journal Toxicological Research investigated how borneol reduced inflammation of the lungs. Concluded the researchers, “Borneol alleviated acute lung inflammation by reducing inflammatory infiltration, histopathological changes, and cytokine production.”

A 2013 study published in the journal PLOS ONE and entitled “Natural Borneol, a Monoterpenoid Compound, Potentiates Selenocystine-induced Apoptosis in Human Hepatocellular Carcinoma Cells” revealed the anti-cancer properties of this terpene.

The study’s researchers concluded, “Borneol effectively synergized with SeC to reduce cancer cell growth through the triggering apoptotic cell death. These results reveal that borneol strongly potentiates SeC-induced apoptosis in cancer cells by enhancement of cellular uptake. Borneol could be further developed as a chemosensitizer of SeC in treatment of human cancers.”

Most people forget their dreams shortly after waking. As soon as the eyelids flutter open, an entire evening of vivid adventures and abstract situations shuffle to an end, often leaving only lingering traces of their presence — a fragment of a dress here, the flashing face of a stranger there. While some individuals may be adept at remembering these mysterious nocturnal encounters, for the most part, the dreaming mind remains an enigma.

For those who consume cannabis, the dreaming self may remain even more elusive. The plant, you see, may prevent the sleeping mind from dreaming. Although cannabis has long been used as a meditation aid and sleep-inducer, preliminary research suggests the trance-inducing herb may suppress some forms of sleep consciousness. Of course, however, research on how cannabis affects dreams is far too premature to make any serious assessments.

The Purpose of Dreaming

Dream science over the past several decades provides more and more hints into the true nature of the dreaming mind. While the exact purpose of dreaming is unclear and dreams are particularly difficult to study, it is generally understood that the dreaming mind is also an emotional mind. While logic and rationality dominate during the day, the unique function of the dreaming mind is to help soothe and come to terms with emotional memories.

Most dreaming occurs during rapid eye movement sleep (REM sleep). The REM cycle is the closest sleep state to wakefulness when electrical activity in the brain increases, along with heart rate and breathing. During this time, levels of bodily stress hormones drop to their lowest levels. During the day, the hormone norepinephrine increased in the bloodstream in response to everyday stressors and anxieties. At night, however, norepinephrine levels slowly decrease as the dreaming mind takes over.

Brain scans suggest that the dreaming mind is very similar to the waking mind; visual areas of the brain are highly engaged, as well as areas related to memory and conscious thinking. A primary difference, however, is that the waking mind also responds to stress signals by releasing hormones like norepinephrine for fight-or-flight response. When dreaming, even strong emotions are distanced from this fight-or-flight impulse of the nervous system.

While the content of dreams may be very different than your visual memories from everyday life, it appears that emotional memory processing is a core function of REM sleep. The situations that your dreaming self is exposed to may be abstract or downright weird, but the emotional context of the dream may be what holds real value.

How Cannabis Affects Dreams

If dreams are the brain’s way of de-escalating and filing away emotional memories, then the effects of cannabis on dreams are well worth knowing. Thus far, a multitude of preclinical and small human trials show that cannabis consumption causes a reduction in REM sleep. This reduction is most strongly correlated with THC, although animal research thus far hasn’t determined whether or not the same effect occurs with CBD.

For individuals with recurring nightmares, this could be a positive benefit. Those with post-traumatic stress disorder (PTSD), for example, often demonstrate disturbed REM sleep patterns and may consistently remember their dreams. Healthy sleep is sleep that promotes feelings of restfulness upon waking. If a person plagued by chronic nightmares, it can have a distressing impact on the next wakeful day

In PTSD, patients are unable to delete fear-based experiences from their memories. Already, preclinical research suggests that cannabis medicines may be beneficial for those with the condition, potentially helping patients extinguish fear-based memories during the waking day.

And yet, for the everyday individual, the overall effect of cannabis on dreams remains unknown. Research suggests that the plant does, in fact, reduce dreams and limits the amount of time spent in REM sleep. Given that REM sleep is when the body records and desensitizes emotional memories, it’s possible that reducing time spent in REM may have a negative effect on emotional processing.

The catch? Very little research has been conducted on the aftermath of cannabis consumption on dreaming. Although cannabis is one of the most popular illicit sleep aids in the world, no high-quality or conclusive evidence exists on the impact of cannabis on sleep. Further, the bulk of research on the topic was conducted in the 1970s and 1980s, with isolated cannabis compounds and small participant numbers. As a result, the way in which cannabis affects dreaming and the implications this may have on waking life are simply unknown.

REM Rebound

The human brain does not like to go without enough REM sleep. While quality research on cannabis and dreaming is appallingly absent from the scientific literature, what is known, however, is that dreams come back with a vengeance after a brief period of abstinence from the plant. When regular cannabis consumers abstain from the herb, one of the most common side effects of withdrawal is the resurgence of very vivid and memorable dreams. This phenomenon has a proper name: REM rebound.

During REM rebound, a person is able to reach a state of REM sleep more quickly. They’re also more likely to remain in REM sleep for an extended amount of time. This dreaming rebound most often occurs after a person experiences sleep deprivation. The brain, it would seem, opens the floodgates of emotion once you’ve finally safe to hit the hay.

In terms of REM sleep, does cannabis produce similar effects to sleep deprivation? Without more research on how cannabis affects dreams, it’s hard to say.