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Cannabis and Depression


“No amount of sleep in the world could cure the tiredness I feel.” - Anonymous

Depression has long been a major public health issue. According to the National Institute of Mental Health, 15.7 million adults (6.7% of all U.S. adults) aged 18 or older in the United States experienced a major depressive episode in 2014. For those who suffer, depression can be a hell that has been described as “living in a body that fights to survive while your mind tries to die.”

To treat depression, doctors generally prescribe a pharmaceutical like Prozac or Zoloft. Often, they’ll also prescribe an antianxiety medication like Valium or Xanax. However, antidepressants don’t work for everyone. Worse, benzodiazepines such as Valium or Xanax can be highly addictive. Of course, we’ve all seen the commercials for these drugs. The part of the commercial devoted to listing the potential adverse side effects is usually longer than the part of the commercial describing the benefits. And, what are one of the potential side effects? Thoughts of suicide!

Clearly, the limited number of effective options to treat depression are, in fact, depressing! No wonder many people choose to self-medicate with cannabis to treat depression. However, how does cannabis play into the equation? There has long been an association between depression and cannabis consumption. But, it’s been a chicken and the egg thing. Does cannabis consumption cause depression, or do people with depression use cannabis to to alleviate their depression?

While all important considerations, first, let’s start by defining “depression.”

What is Clinical Depression?

While everyone experiences periods where they “feel depressed,” at what point is it depression? Feeling sad or blue after experiencing a common life event — such as a job loss or the break up of a relationship — is a normal human response. But, what actually constitutes clinically diagnosable depression?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) — the “bible” used by mental health professionals in the U.S. to diagnose mental health conditions — major depressive disorder is defined as experiencing either depressed mood or loss of interest or pleasure over a period of two weeks or longer, and at least five out of nine identified symptoms that reflect a change in functioning, such as problems with sleep, diet, energy, feelings of self-worth, and concentration.

What Causes Depression?

It’s important differentiate between “risk factors,” “triggers,” and “causes.” They’re all closely related and often used interchangeably, but there are subtle, notable, distinctions.

Risk factors - Natural or environmental factors that increase one’s likelihood of developing depression. For example, heredity can be a natural risk factor, as mental illness is known to run in the family. Substance abuse, on the other hand, is an example of an environmental risk factor. For example, it’s well established that alcoholism is a major risk factor in developing depression.

Trigger - A causal event that triggers the onset of a depressive episode. For example, a death in the family, job loss, emotional abuse, disease, or even taking a medication, as some medications are known to trigger depression.

Causes - In this context, what is the physiological explanation for depression? For example, a chemical imbalance (i.e. a serotonin deficiency).

Contrary to popular belief, we can’t point to a single factor — like serotonin deficiency — that causes depression. It’s likely the interaction of several factors, such as stressful life events, medical issues, genetic vulnerability and physiological functions that work together to elicit the onset of a depressive episode.

Further, evidence suggests there are multiple pathways that could be factors in causing major depression, including faulty mood regulation by the brain, chronic inflammatory response and alterations of the endocannabinoid system. Of course, ingestion of cannabinoids affect endocannabinoid system (ECS), and the ECS plays an important role in modulating the body’s inflammatory response. Which, of course, makes the study of cannabis and depression even more interesting. Could cannabis provide the key to unlocking a class of new therapeutic options to treat depression? Quite possibly.

Australian psychiatry researchers from the University of Newcastle upon Tyne write: “Anandamide, tetrahydrocannabinol (THC) and cannabidiol (CBD) variously combine antidepressant, antipsychotic, anxiolytic, analgesic, anticonvulsant actions, suggesting a therapeutic potential [for cannabinoids] in mood and related disorders.”

The Endocannabinoid System: Its Role In Mood & Well-Being

Our body’s own cannabinoid system — the endocannabinoid system (ECS) — is one of the most important physiological systems in our bodies, as it plays an indispensible role in helping us maintain physical and emotional health. The ECS does far more than just modulate the psychoactive effects of cannabis — it plays a major role in appetite, pain sensitivity, memory, and of course, mood and well-being.  

There are numerous paths to manipulate the endocannabinoid system. When you ingest cannabis, you’re also ingesting THC and CBD (along with dozens of other plant cannabinoids). These cannabinoids then bind to receptors in the ECS to elicit pharmacological effects beyond just getting you “high,” or creating euphoria. (This is why cannabis can be medicine or an inebriant.)

Interestingly, exercise can stimulate production of the body’s naturally occurring version of THC, the “bliss molecule,” anandamide. You’ve no doubt heard about the “runner’s high.” Well, it’s likely anandamide molecules (not endorphins) cause this high. Chocolate lovers take note — dark chocolate also stimulates anandamide production.

As researchers have noted, the endocannabinoid system is involved in mood and related disorders. Clearly, modifying the ECS through activities like exercise is beneficial in regulating mood. Likewise, consuming synthetic and plant-based cannabinoids modify the ECS. Obviously, many people use cannabis because it makes them “feel good.” What’s less clear is to what degree the short-term benefits translate into potential long-term benefits or adverse effects.

Here’s what we know so far...

How Does Cannabis Affect Depression?

Dr. Ethan Russo, one of the most important figures in cannabis medicine, notes that in India, cannabis was credited for helping alleviate anxiety and depression as far back as 1500 B.C.E. In recent history, the Ohio State Medical Committee on Cannabis stated in 1860: "As a calmative and hypnotic, in all forms of nervous inquietude and cerebral excitement, it will be found an invaluable agent, as it produces none of those functional derangement or sequences that render many of the more customary remedies objectionable.”

It’s a truism, to proclaim that a great many people use cannabis because it makes them “feel good.” Because it makes them “happy,” and it elevates their mood. There’s nothing particularly controversial about those statements. However, what has been a source of controversy during recent years is what the relationship is between cannabis and depression. It’s only been quite recently that among mainstream scientific community has there been an interest in studying cannabis and cannabinoids for its potential therapeutic value in treating psychiatric conditions such as depression.

As part of the perpetual, seemingly unending, “War on Drugs,” research funding has been allocated disproportionately to prove cannabis is a dangerous drug that warrants residency in perpetuity on the DEA’s infamous Schedule I — reserved for the world’s most dangerous and addictive drugs. Consequently, despite the fact throughout recorded history cannabis has been credited for its antidepressive powers, there are very few high-quality, scientifically rigorous studies that exist demonstrating cannabis’s potential as an antidepressant. As the public’s perception of cannabis continues to rapidly evolve over recent years, and the scientific community follows, more research is now being done. But, we’re still in our infancy.

Irrespective, of federal policy that has impeded serious scientific study of whole-plant cannabis for decades, we’ve managed to accumulate some notable research no less.

Here’s what the research tells us so far:

The Effects (Good and Bad) of THC Are Dose-Dependent

One thing that is well-established is that THC produces dose-dependent biphasic effects. What the heck does that mean? Low to moderate effects elicit desirable effects; too high of doses, produce the exact opposite effects. This should be pretty obvious to anyone who has ingested too much of an edible, or smoked too much. You can get paranoid or anxious. Quite simply: moderate doses of THC tend to produce pleasant effects like euphoria and relaxation, while too high of doses could exacerbate anxiety or depression — at least acutely. The science is still out on the long-term effects of chronic consumption.  

Again, we don’t have much “gold standard” research studies on humans, but preclinical research — on lab rats and mice — tend to support this hypothesis. Anecdotal reports from her patients inspired Dr. Gabriella Gobbi — and her team at McGill University — to embark on a study to evaluate the potential of cannabis to act as an antidepressant.

"As a psychiatrist, I noticed that several of my patients suffering from depression used to smoke cannabis. And in the scientific literature, we had some evidence that people treated with cannabis for multiple sclerosis or AIDS showed a big improvement in mood disorders. But there were no laboratory studies demonstrating the antidepressant mechanism of action of cannabis."

Gobbi and her team conducted their research on experimental animal models by injecting the mice with a synthetic version of THC. What they found is that in low doses, the synthetic version of THC had a potent antidepressant effect, significantly increasing serotonin in the rats' brains. However, at higher doses the exact opposite occurred: serotonin levels dropped significantly. She noted, also, that “excessive cannabis use in people with depression poses high risk of psychosis.” However, since this study, research has emerged to suggest THC only increases the risk of psychosis in individuals who are predisposed to it.

Notably, Gobbi’s research only tested synthetic isolated THC. We now know that CBD —  the (largely) non-psychoactive sibling of THC — is a potent force of temperance against THC. CBD — proportional to its concentration — offsets most potential adverse effects of THC.

CBD Produces Antidepressant (And Antianxiety) Effects

Remarkably, our appreciation for CBD’s huge therapeutic potential is a recent phenomenon — it’s only really taken off over the last five years. Within psychiatric research, preclinical studies in humans and animals have found that not only could CBD potentially treat depression and anxiety, it alleviates withdrawal effects from drugs like opioids. (In fact, it can even reduce cue-driven drug-seeking behaviors and cravings.)

CBD is the most popular (largely) non-psychoactive cannabinoid found in cannabis. Researchers (and others) frequently point to CBD as having tremendous potential to treat  psychiatric conditions, noting, also, that among its antidepressant and antianxiety potential, it can counteract potential adverse effects of THC. (In fact, it could quite possibly also be a powerful antipsychotic agent.)

Other studies, too, suggest CBD has powerful antidepressant and antianxiety properties.

Spanish researchers, conducting (another) experimental study using animal models (e.g. mice), found that by enhancing serotonin and glutamate levels, CBD could be a fast-acting antidepressant drug.  

Another study conducted by researchers in Israel and Brazil noted that in human trials, CBD doses producing the most impressive results were nominally high (well, not that high!), however, they identified three other CBD derivatives that could be incredibly potent antianxiety and antidepressant agents at very low doses.

Cannabis Use (Probably) Doesn’t Cause Depression

Clearly, our scientific understanding of cannabis and ongoing research are pointing to expanding therapeutic roles of cannabis (particularly CBD) to elevate mood and alleviate depression, but what about all the talk over the years that cannabis use can actually cause depression? Well, that research has been largely debunked.

Swedish researchers conducted a study of 8598 Swedish men and women between the ages of 20 and 64 over a three year period. After factoring in other risk factors such as alcohol and illicit drug use, adverse life events, family tension, they found no statistically significant data to suggest that cannabis use triggers depression.

In January 2015, researchers published a longitudinal study in Journal of Affective Disorders releasing findings from data they analyzed that was collected by the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and concluded that cannabis use was not significantly associated with an increase in major depressive episodes.

Depression May Lead People to Use More Cannabis

But, of course, all the news can’t be good. While cannabis may not cause depression —  users generally perceive cannabis as helping them alleviate depressive symptoms — there is strong evidence that already depressed individuals are at an elevated risk to increase their cannabis consumption to potentially problematic levels. Moreover, there’s a risk that depression could increase anxiety levels and accelerate transition in vulnerable individuals from casual to problematic use.

Keep in mind, however, that in studies there were generally overlapping factors beyond depression that lead to problematic use — such as a parent who had a history of mental illness or drug use disorder.

A 2014 study showed that depression or “pre-existing anxiety was associated with higher average levels of cannabis intoxication, which in turn was linked to acute anxiety responses due to cannabis use." Further, researchers have found depressive episodes were “associated with increased speed of transition to dependence, which is consistent with emerging findings of an association between depression and cannabis use disorders.”

Interestingly, the perception of getting better or higher quality sleep may be one of the reasons people increase cannabis use. A study published in The American Journal of Drug and Alcohol Abuse suggests that “individuals with heightened depression may have higher rates of problematic cannabis use, in part, because of the beneficial effects of cannabis in terms of perceived sleep quality.” According to one of the study’s researchers, Marcel O. Bonn-Miller, “Sleep issues are often a problem in people who are depressed, and many individuals will use cannabis to help them sleep. Paradoxically, while the individual may solve one problem — in this case, sleep — they may creating a bigger long-term problem. Dependency.”  

Cannabis (Laws) Reduce Suicide Rates

On another positive note, cannabis — or at least the enactment of medical marijuana laws — is saving lives! In the seminal paper, High on Life? Medical Marijuana Laws and Suicide, researchers reported that after states enact medical marijuana laws they experience a nearly 5 percent reduction in total suicide rate. And, it gets better! Among 20 to 29 year old males, the suicide rate declines by 11%, while 9% fewer 30 to 39 year old males commit suicide.

While this data provides compelling evidence for liberalizing cannabis laws, it doesn’t necessarily speak to the antidepressant powers of cannabis. There could be other factors contributing to the reduction in suicides:

First off, adverse life events which cause a shock in individuals who were otherwise happy can cause someone to commit suicide. Medical marijuana laws remove criminal penalties for qualified patients using, possessing or cultivating cannabis. While these penalties apply to medical marijuana patients, and few states allow patients to obtain a recommendation for mental health issues, most states allow patients to use marijuana to treat subjectively measured conditions like chronic pain and nausea.

Individuals often obtain a cannabis recommendation to treat chronic pain, when in fact, they are obtaining it for other reasons. By not having to risk arrest, they are no longer subjected to potential criminal penalties that could cause a whole host of issues that are known to cause significant stress. Beyond legal issues, following an arrest, individuals often face other stressors, such as the loss of employment, child custody, or a relationship.

Another interesting possible explanation is that because alcohol consumption goes down in medical marijuana states, so does suicide. There is a clear association between alcohol use and suicide. Alcoholism is associated with an increase in suicidal ideation and completed suicides.

While this research may not provide insights into the potential therapeutic benefits, it incontrovertibly demonstrates that liberalization of marijuana laws reduces suicides, and that is obviously a wonderful thing!

At the end of the day, depression is a complex condition, and cannabis is a highly complex plant with more than a hundred cannabinoids. We’re only just beginning to develop an understanding of how cannabis and cannabinoids could play a role in treating depression. Thus far, research is still in its infancy. Again, because most research has been confined to find negative associations between cannabis use and mood disorders, studies demonstrating how cannabis plays a role in psychiatric disorders are limited, but offer encouragement.

The data so far suggests cannabis research — from a sociopolitical and therapeutic perspective — should be a priority.  However, as long as the federal government continues to consider cannabis a Schedule I drug — meaning they believe it’s highly addictive and there are no accepted medical uses — scientists have to navigate numerous bureaucratic obstacles to conduct much needed research. Nonetheless, the research is clear that there is a direct link between the enactment of medical marijuana laws and a reduction in suicides. The fact that suicide claims three times as many lives as homicides in the U.S. every year and cannabis could reduce this rate, provides a compelling argument to continue dismantling cannabis prohibition and ending the failed “War on Drugs.” 

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Wikileaf fan
2:00, February 28, 2017
I choose to consume to treat my clinical depression and anxiety. I never knew how calm and beautiful the world could be until I learned how to relax for the first time. I was able to finally leave my house and go to college in public without losing my composure.
Wikileaf fan
7:55, February 18, 2017
I choose to be able to not have my social anxiety and depression not hinder my life or my health. I've always had major stomach problems from my anxiety to the point where I couldn't keep down water even. But the first time I smoked was the first time I ate an entire cheeseburger. ~<3
Wikileaf fan
7:23, February 15, 2017
It helps me focus and not to stress and to fight depression .
Wikileaf fan
5:16, February 13, 2017
It helps with my depression as well as my anxiety and also helps with the stress of my life it helps me become a better person and makes me want to be more than just who I am but what I can be
Wikileaf fan
2:02, February 10, 2017
I chose to consume, because it helps with a rear skin condition i have, called epidermolysis bullosa (EB for short). Which is a condition that causes the skin to blister, everywhere and from anything. Because of it, i am almost blister free. I can finally wear socks, i can finally wear headphones, with out them hurting my ears. I can walk for long periods of time, i can finally wear shoes! It is incurable, and hurts more than word can describe. With cannabis, i can do things that i couldn't before. To add on to my list of problems, that it helps with, anxiety, depression, insomnia, severe menstrual cramps, frequent migraines. The natural way, is the best way.
Wikileaf fan
10:51, February 06, 2017
I have suffered depression for as long as I can remember. So I basically smoke sativa for a head high and it keep me happy. It really makes me feel like myself again.
Wikileaf fan
2:48, February 06, 2017
It helps me study & it helps me with creativity and my depression.
Wikileaf fan
9:00, February 05, 2017
I choose weed not only for a creative mind, or even to relax but, I have a serious issues with depression, and when I get in that state of mind, I tend not to eat for certain amount of weeks. Also, I have scoliosis in my lower spine, which doesn't help me cause I can no longer sleep more than 4 hours. I consume it cause it helps me gain an appetite and it eases the pain for me to sleep.
Wikileaf fan
8:20, February 05, 2017
I choose to be able to eat throughout the day, to ease my anxiety and depression, and to break the cycle of my addiction naturally instead of pharmaceutically
Wikileaf fan
5:27, February 03, 2017
I choose to consume cannabis to help calm my anxiety and depression
Wikileaf fan
7:44, January 31, 2017
I choose to consume not only because I enjoy it but to also help me live my everyday life. My extreme anxiety, major depression, ADHD, schizophrenia, and bipolar tendencies have quite literally ruined my life. Without weed and a very close friend of mine, I wouldn't of survived after my suicide attempt last year. Nothing has helped me as much as they have.
Wikileaf fan
5:08, January 29, 2017
I chose to consume to alleviate the pain of fibromyalgia and sciatica. It also helps with depression and appetite.
Wikileaf fan
6:56, January 26, 2017
I choose to consume, because it helps with insomnia, my depression, gets me eating, and makes me a happier person, even while working.
Wikileaf fan
3:08, January 26, 2017
I choose to calm my anxiety and depression. I have OCD and bi-polar depression and the one thing that has helped me get through it all has been cannabis!
Wikileaf fan
2:23, January 26, 2017
Because I was born blind and with osteoporosis, assuring I would have nothing close to the kind of life everyone I knew would end up living, which often depressed me. Because I grew up in an unhealthy home environment and suffer from both depression and anxiety. Because the love of my life died days before her 24th birthday, and she loved Cannabis. Because I love how happy and carefree it makes me feel, like when I spent time with her. Because...I've always dreamed of flying!
Wikileaf fan
2:20, January 17, 2017
I choose to treat my insomnia, Depression, anxiety with cannabis. It's a beautiful plant. So many uses, helpfulness and love.
Wikileaf fan
12:55, January 15, 2017
I choose to consume because it helps my anxiety and depression! I've been on countless medications since I was 13 and cannabis is the only thing with minimal side affects and makes me feel so much better! Drug free for 7 years!
Wikileaf fan
8:52, January 06, 2017
I have anxiety and depression
Wikileaf fan
1:52, December 24, 2016
I use cannabis to treat bouts of depression and anxiety after the loss of my 16 year old daughter to cancer. Sometimes crippling, cannabis takes it away instantly. Thankful that I live in California!
Wikileaf fan
11:46, December 21, 2016
I consume because it makes my anxiety and depression much easier to deal with; when I smoke, the part of my brain that keeps telling me to worry calms down. I am able to be much more outgoing and \"normal\" with the help of marijuana.
Wikileaf fan
8:13, December 21, 2016
I suffered with type 1 diabetes for 33 years diagnosed in 1981 at age 2. Diabetes eventually lead to end-stage kidney disease blind this and dialysis. On August 16, 2014 I received a simultaneous kidney and pancreas transplant at California Pacific medical center in San Francisco. I am truly blessed. Through all of these illnesses cannabis get me going 100% it helped with severe depression, anxiety, infection, and most definitely appetite issues. I could not be more thankful for my life today and the comfort that cannabis provided during my struggle .
Wikileaf fan
10:04, December 17, 2016
As a kid I was very sickly that's how I got my exposure to high fructose , my step_dad was a politician in back home ( that's my button politically correct thinking ) twenty years later added with some stupid mistakes ; moved to L.A some how was convinced to move in with my mom and sam and anxiety disorder set in . It's been 9 phkng years ( muscle spams , cramps , depression , mood swings ) what has helped the most is actually meditating , working-out & eating right ( most often than not faded ) . It's whering me out to be living with the one responsible for 50 % of my former toxic behavior , right now finishing studies to be a personal trainer/massage therapist to help others fight big pharma . #OneBowlAtATime , Blessings
Wikileaf fan
5:34, December 08, 2016
I suffer from constant nausea, anxiety, depression and anger and marijuana has always helped me to cope and deal with all 4, it brings me calm peace of mind and helps my body literally feel better, I solely count on this plant for my well being, as I know many others do. That's why I choose to consume
Wikileaf fan
5:22, December 08, 2016
I choose to relieve injuries & lift depression.
Wikileaf fan
5:05, December 01, 2016
I choose to treat my anxiety and depression naturally and effectively with cannabis.
Wikileaf fan
2:22, November 29, 2016
I choose to consume to relieve anxiety and depression.
Wikileaf fan
1:47, November 29, 2016
I choose to live my life everyday despite the hardships that are brought on by anxieties both generalized and social, by depression, by ADHD. They're not mental illnesses to me anymore, they're life upgrades that help me become the best version of me that I can be one day. I also choose to let my worries drift away when they seem larger than the world when in reality those worries are never really large at all when the storms dissipate. I choose creativity for my passions in art & writing music. I LOVE consuming & I will probably consume until the day of my death when I'm way down the road in my years. #ichoosetoconsume
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9:05, November 28, 2016
I was diagnosed five years ago with PTSD, depression and severe anxiety. I am also a recovering alcoholic. If it was not for medical cannabis I don't know where my life would be right now. at this very moment I am now on nothing but medical cannabis to combat all of these illnesses and I swear by it. It has saved my life and I would probably still be drinking and not even know that I had PTSD, depression and severe anxiety if I had not known that cannabis would be able to save my life like it has for the last five years, I am a living testament and proof that medical cannabis is a lifesaver .
Wikileaf fan
6:42, November 27, 2016
I choose pain relief and happiness over depression. I'm a dispensary agent in Phoenix, AZ and I would love to visit a weed B&B in Colorado!!
Wikileaf fan
4:19, November 27, 2016
I choose to not give in to depression.
Wikileaf fan
1:09, November 27, 2016
Hello... my name is Danny. I'm 23 and live in New Bedford, ma. Ever since I was a kid, I suffered from depression. Marijuana helps me control and clear my mind whenever I need it. And I know its healthy and has a boat load of benefits and healing properties. It helps me with my anxiety, joint/muscle pains, headaches, insomnia, and my eating disorder. I love this plant!!!
Wikileaf fan
6:23, November 22, 2016
I choose to treat my health without chemicals. I choose the possibility of happiness over unrelenting anxiety and depression. I choose positivity and creativity.
Wikileaf fan
4:22, November 22, 2016
I started smoking when I was 17. I have always struggled with eating disorders but could manage hiding it. Until I became so sick I couldn't eat even if I wanted to. I had stress induced IBS. I became so thin at one point I was under 100 lbs, at the height of 5'4. Everything I ate literally went right through me. I was a teenage girl too embaressed to even tell my mother what was going on. Smoking pot saved my life. I could eat enough to maintain my weight even if it was very low. I could stop the fever sweats and the anxiety. I had something to take for my depression. I still smoke to this day. Marijuana cures all ails. Well most of them anyways.
Wikileaf fan
7:16, November 20, 2016
I have depression and anxiety. Smoking helps so much 
Wikileaf fan
2:45, November 20, 2016
i choose to consume to manage bipolar disorder, anxiety, seasonal depression, and pain from endometriosis.
Wikileaf fan
6:46, November 16, 2016
I consume because it has changed my life when it comes to my anxiety & depression. Thank goodness for marijuana becoming legal
Wikileaf fan
4:08, November 16, 2016
Because it helps my anxiety, depression, degenerative disc disease, fibromyalgia, relaxing, sleep.
Wikileaf fan
4:03, November 16, 2016
I love smoking because it helps with my depression and bipolar
Wikileaf fan
12:55, November 15, 2016
I consume to be calm and relax. I suffer from PTSD, depression and anxiety. It's helps me with my appetite and my insomnia.
Wikileaf fan
12:54, November 15, 2016
I choose to relax, I love it, and i choose to maintain my sanity over anxiety & depression.
Wikileaf fan
10:07, November 15, 2016
I choose to smoke because of my back pain I've had for over 10 years and it has helped rid me of depression and lower my anxiety!
Wikileaf fan
3:34, November 12, 2016
I choose to consume because it helps me with depression and anxiety. I used to take a \"cocktail\"of 3 different medications and have been med free for almost a year now thanks to the legalization of marijuana in the state of Oregon.
Wikileaf fan
11:22, November 11, 2016
I'm a senior studying public relations at San Jose State. I use cannabis for medical purposes. Cannabis helps with my anxiety, depression and insomnia.
Wikileaf fan
7:20, November 11, 2016
I choose to distress, decompress, beat Depression and anxiety, and just be CHILL.
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