Elsevier

Journal of Affective Disorders

Volume 213, 15 April 2017, Pages 168-171
Journal of Affective Disorders

Patterns of marijuana use among psychiatry patients with depression and its impact on recovery

https://doi.org/10.1016/j.jad.2017.02.016Get rights and content

Highlights

  • Marijuana use decreased among depression patients but patterns varied by characteristics.

  • Older psychiatry patients were at high risk for increasing marijuana use over time.

  • Marijuana was associated with worse symptoms and mental health functioning.

  • Marijuana use should be assessed and addressed in the context of depression treatment.

Abstract

Background

Depression is associated with substance-related problems that worsen depression-related disability. Marijuana is frequently used by those with depression, yet whether its use contributes to significant barriers to recovery in this population has been understudied.

Method

Participants were 307 psychiatry outpatients with depression; assessed at baseline, 3-, and 6-months on symptom (PHQ-9 and GAD-7), functioning (SF-12) and past-month marijuana use for a substance use intervention trial. Longitudinal growth models examined patterns and predictors of marijuana use and its impact on symptom and functional outcomes.

Results

A considerable number of (40.7%; n=125) patients used marijuana within 30-days of baseline. Over 6-months, marijuana use decreased (B=−1.20, p<.001), but patterns varied by demographic and clinical characteristics. Depression (B=0.03, p<.001) symptoms contributed to increased marijuana use over the follow-up, and those aged 50+(B=0.44, p<.001) increased their marijuana use compared to the youngest age group. Marijuana use worsened depression (B=1.24, p<.001) and anxiety (B=0.80, p=.025) symptoms; marijuana use led to poorer mental health (B=−2.03, p=.010) functioning. Medical marijuana (26.8%; n=33) was associated with poorer physical health (B=−3.35, p=.044) functioning.

Limitations

Participants were psychiatry outpatients, limiting generalizability.

Conclusions

Marijuana use is common and associated with poor recovery among psychiatry outpatients with depression. Assessing for marijuana use and considering its use in light of its impact on depression recovery may help improve outcomes.

Introduction

Depression affects approximately 6% (16 million adults) of the U.S. general population and is a leading cause of disability (Substance Abuse and Mental Health Services Administration, 2015). Studies report that depression is associated with substance use, which can worsen depression-related disability (Davis et al., 2008, Grant et al., 2004). These studies have found depression is associated with a two-fold increase in the rate of alcohol-related problems and a six-fold increase in marijuana-related problems (Grant et al., 2004). Yet clinical outcomes of depression patients who use marijuana are understudied in contrast to alcohol, perhaps due to the larger public health burden associated with depression and alcohol use (Hall and Degenhardt, 2009). However, there is also considerable potential for marijuana to impede the recovery of vulnerable subgroups, including clinical populations. Clinical studies reportd that marijuana use among depression patients can lead to worse symptoms, more depressive episodes, and impede treatment (Davis et al., 2008, Bricker et al., 2007). These findings suggest that marijuana may be a critical issue for further understanding recovery outcomes in adults with depression.

Differences in demographic, clinical, and marijuana use characteristics are important considerations for the treatment and recovery of persons with depression. Depressed persons who use drugs, including marijuana are often younger, male, divorced or never married and not of Hispanic origin (Davis et al., 2008, Melartin et al., 2002; McDemut et al., 2001). Marijuana and other drug use among depressed persons can lead to worse anxiety, drug use relapse post-treatment, and poor functioning (Hasin et al., 2002, Davis et al., 2008). Whether such findings are present and persist over time in a clinical sample of depressed patients is largely unknown.

This study addresses this important question by examining 6-month patterns of marijuana use and its impact on symptom and functional recovery outcomes for 307 depressed outpatients using and not using marijuana and participating in an alcohol/illicit-drug use intervention. We identified: (1) longitudinal patterns of marijuana use; (2) demographic and clinical predictors of marijuana use; (3) associations between marijuana use, depression and anxiety symptoms, and functioning over the 6-month follow-up.

Section snippets

Participants

Data were collected for a randomized controlled trial of motivational interviewing (MI) in alcohol/drug use treatment for depressed patients, for which the results have been reported (Satre et al., 2016). A total of 307 patients were recruited from Kaiser Permanente Southern Alameda Center Department of Psychiatry in Union City and Fremont, CA. Inclusion criteria were: aged 18 or older; Patient Health Questionnaire score ≥5 (PHQ-9: Kroenke et al., 2001); met drug use (illicit/non-prescribed

Prevalence and characteristics of depression patients using marijuana

A considerable number of depressed patients were using marijuana at baseline, with 125 (40.7%) of the 307 patients reporting use in the prior 30 days (Table 1). Overall, few differences existed between those using and not using marijuana. Marijuana using patients were younger, less likely to be married, and more likely to use tobacco than those not using the drug (Table 1).

Longitudinal patterns and predictors of marijuana use and the impact of marijuana on symptom and functional outcome

After finding few baseline differences between the marijuana using and non-marijuana using groups, the patterns and

Discussion

This study examined 307 depression outpatients using and not using marijuana on their recovery and marijuana outcomes over 6 months. Baseline findings revealed those who used marijuana were younger and less likely to be married. Reported rates of marijuana use were the highest within 30 days of baseline and then declined overall; however, patterns varied by patient characteristics. Higher depressive symptoms placed patients at risk for continued marijuana use, and patients aged 50+ were at high

Conclusions

This study found that marijuana use was common and associated with poor recovery among psychiatry outpatients with depression. Our findings signal the need for conducting marijuana use assessments in the context of outpatient psychiatry treatment and considering its use for at risk subgroups (i.e., young people and older adults, high depression severity patients) in light of its impact on recovery.

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