Degenhardt Louisa, Hall Wayne, Lynskey Michael
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
Addiction. 2003 Nov;98(11):1493-504. doi: 10.1046/j.1360-0443.2003.00437.x.
To examine the evidence on the association between cannabis and depression and evaluate competing explanations of the association.
A search of Medline, Psychinfo and EMBASE databases was conducted. All references in which the terms 'cannabis', 'marijuana' or 'cannabinoid', and in which the words 'depression/depressive disorder/depressed', 'mood', 'mood disorder' or 'dysthymia' were collected. Only research studies were reviewed. Case reports are not discussed.
There was a modest association between heavy or problematic cannabis use and depression in cohort studies and well-designed cross-sectional studies in the general population. Little evidence was found for an association between depression and infrequent cannabis use. A number of studies found a modest association between early-onset, regular cannabis use and later depression, which persisted after controlling for potential confounding variables. There was little evidence of an increased risk of later cannabis use among people with depression and hence little support for the self-medication hypothesis. There have been a limited number of studies that have controlled for potential confounding variables in the association between heavy cannabis use and depression. These have found that the risk is much reduced by statistical control but a modest relationship remains.
Heavy cannabis use and depression are associated and evidence from longitudinal studies suggests that heavy cannabis use may increase depressive symptoms among some users. It is still too early, however, to rule out the hypothesis that the association is due to common social, family and contextual factors that increase risks of both heavy cannabis use and depression. Longitudinal studies and studies of twins discordant for heavy cannabis use and depression are needed to rule out common causes. If the relationship is causal, then on current patterns of cannabis use in the most developed societies cannabis use makes, at most, a modest contribution to the population prevalence of depression.
研究大麻与抑郁症之间关联的证据，并评估该关联的各种相互竞争的解释。
对医学文献数据库（Medline）、心理学文摘数据库（Psychinfo）和荷兰医学文摘数据库（EMBASE）进行检索。收集所有包含“大麻”“大麻制品”或“大麻素”，以及“抑郁症/抑郁障碍/抑郁”“情绪”“情绪障碍”或“心境恶劣”等词汇的参考文献。仅对研究性论文进行综述，不讨论病例报告。
在队列研究以及针对普通人群精心设计的横断面研究中，大量或存在问题的大麻使用与抑郁症之间存在适度关联。未发现抑郁症与偶尔使用大麻之间存在关联的证据。多项研究发现，早期开始规律使用大麻与后期患抑郁症之间存在适度关联，在控制潜在混杂变量后这种关联依然存在。几乎没有证据表明抑郁症患者后期使用大麻的风险增加，因此对自我药疗假说的支持甚少。在大量使用大麻与抑郁症之间的关联研究中，控制潜在混杂变量的研究数量有限。这些研究发现，通过统计控制，风险大幅降低，但仍存在适度关联。
大量使用大麻与抑郁症有关联，纵向研究的证据表明，大量使用大麻可能会使部分使用者出现抑郁症状。然而，要排除该关联是由增加大量使用大麻和抑郁症风险的共同社会、家庭及环境因素导致的这一假说，目前还为时过早。需要进行纵向研究以及对在大量使用大麻和患抑郁症方面存在差异的双胞胎进行研究，以排除共同病因。如果这种关系是因果关系，那么按照最发达社会目前的大麻使用模式，大麻使用对抑郁症在人群中的患病率最多只起到适度作用。
