Clinical depression is a serious mood disorder characterized by persistent sadness and loss of interest, sometimes leading to decreased appetite and energy and suicidal thoughts in people. Social anxiety and depression sometimes go hand in hand, while with post traumatic stress disorder can be implicated in the onset of depressive side effects. Current medications typically used in the treatment of depression involve the use of pharmaceutical drugs that target serotonin, a chemical messenger that is thought to act as a mood stabilizer. The neural network of the endocannabinoid system works in a similar way to the dopamine and serotonin systems, according to some research, cannabinoids such as cannabidiol (CBD) can affect serotonin levels. In the case of tetrahydrocannabinol, low doses can increase serotonin, whereas high doses can decrease and even worsen conditions like depression or anxiety.  In a 2009 study, scientists revealed there was positive significant evidence pointing to endocannabinoid signaling as a target for the pharmacotherapy of depression.  In a 2016 study, authors wrote that, “CBD could represent a novel fast antidepressant drug, via enhancing both serotonergic and glutamate cortical signaling through a 5-HT1A receptor-dependent mechanism.” 
CBD may be uniquely effective for depression related to chronic stress, which has been shown to cause a decrease in endocannabinoid levels.   
It is suggested to work with a healthcare professional that is experienced in recommending medicinal cannabis or CBD to treat depression so the delivery and dosage may be worked out appropriately. Along the same lines, educated and aware people may become their own highly informed health consultants. The information contained in this article is for informational purposes only, and does not constitute medical advice. Prior to making changes to your lifestyle or treatment plan, consult with your doctor.
Cannabidiol products with a ratio of 20:1 or higher are most suitable and best taken as capsules, drops or edibles. More specifically, strains made with Electra 4 or Valentine X are more energizing, helping bring relief to depression. When lethargy and low energy is a core challenge, stimulating strains like sativa can be advantageous for increasing energy and focus when THC can be tolerated. Strains that are higher in the terpene limonene are best for mood elevation. As always, start with a micro dose to test for sensitivity and work your way up as needed using the titrate method until symptoms subside. The micro to standard dose is typically recommended for depression.
For immediate relief of symptoms, smoking or vaporizing cannabis provides the fastest relief for immediate symptoms, or a boost in dosage, such as in sleep issues. Tinctures or sublingual sprays can take effect quickly and last longer than inhaled products.
The Cannabis Health Index is a scoring system based on the best available evidence in the medical literature, with cannabis rating in the possible-to-probable range for efficacy to treat depression.
In 2005, researchers called for clinical trials to look into the potency of cannabinoids for bipolar disorder (manic depression).  In a 2010 study, CBD was not associated as useful for manic episodes in bipolar disorder.  However, for depressive episodes, the literature points to greater potential for effectiveness. 
In a 2013 review of the studies on animal models, authors wrote that CBD showed anti-anxiety and antidepressant effects and suggested that the compound worked through interacting with the 5-HT1A neuroreceptor. 
“It is important to remember that CBD improves the activity in the endocannabinoid system by increasing the time anandamide works on the CB1 and CB2 receptors,” writes Dr. Michael Moskowitz. “Anandamide works on the serotonin, norepinephrine, and dopamine systems. It also works on the GABA-glutamate system and the hypothalamic-pituitary-adrenal axis. Its main role is restoring balance through inhibition when levels are too high and enhancement when they are too low. This is the most likely reason phytocannabinoids in general and CBD specifically are able to regulate depression and anxiety.”  For more information on increasing serotonin levels using hemp and maca, see this article.
In a 2019 study, published in the Journal of Chemical Neuroanatomy, researchers called cannabidiol, “a promising compound” in that “recent evidence suggests that CBD promotes both a rapid and a sustained antidepressant effect.” 
Another 2019 study had researchers conclude that, “results from these (human) studies are promising and suggest that CBD may have a role in the development of new therapeutic strategies in mental diseases, and they justify an in-depth commitment in this field.”
In a 2020 study, CBD allowed for the successful cessation of antidepressant medication with the patient showing improvements in both depression and anxiety symptoms. 
In patients with depression, there is disorder regarding endocrine and inflammatory processes, in which the endocannabinoid system has proven involvement in bringing back into balance, while exerting potent antidepressant effects.  [15
The endocannabinoid system (ECS) manages the healthy functioning of all the other bodily systems and works by bringing order and balance back to the body. The ECS can become overwhelmed when the stresses placed upon it are too great, leading to dysfunction and disorder in other bodily systems. The ECS produces its own cannabinoids, but can also work with cannabinoids from plants, such as cannabis. Plant-based cannabinoids can help to support your ECS when it is struggling to keep up with demand, helping to restore full healthy functioning across the body. Cannabis contains over 120+ naturally occurring cannabinoids, not to mention, hundreds of different terpenes that act synergistically to enhance the potency and effectiveness inside the body. This is why consuming full spectrum products is superior in many cases, to an isolated product, such as in CBD products. For more information on this synergy, see our article on The Entourage Effect, The Endocannabinoid System Explained, and Full Spectrum Extracts.
Learn more news on how cannabinoids act on other mental health or mood related psychiatric disorders see our articles on anxiety disorders, bipolar, PTSD, BPD, ADHD, insomnia, autism, stress-relief, brain injuries, alzheimers, addiction and withdrawal, focus and concentration.
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10. Michael Moskowitz MD, personal communication with the authors, February 2, 2017.