What We’ve Said

What we’ve said about Cannabis

11 points from 7 episodes, newest first

Also searched as marijuana, cannabis use disorder

In short

Cannabis helps people fall asleep but drastically worsens sleep quality, and it may not deepen depression directly but it blocks recovery. It rarely causes true mania, though it can cause psychosis, so ask patients to try going off it and warn them about the REM rebound when they do.

Sleep

  1. Cannabis and alcohol let people fall asleep right away, so they seem to help, but they affect sleep quality drastically. The felt benefit is mostly suppression of the symptoms that interfere with sleep, not better sleep itself.

    “I do think the subjective experience of cannabis and alcohol being effective is generally more about treating symptoms, not treating, suppressing symptoms that are interfering with sleep rather than helping the sleep itself”
    33:02Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026
    Also said in 1 more episode
    “you take that and take them and you're able to fall asleep right away so sometimes subjectively people think that it's helping their sleep but the it affects your sleep quality drastically”
    30:38Beyond Medications: The Best Lifestyle Treatments for Mental HealthFeb 2025

  2. We put alcohol, Z-drugs, benzodiazepines and cannabis in the same category: things that make people feel as if they are sleeping or getting better when they are not necessarily.

    “Alcohol, you know, Z-drugs, benzos, cannabis, I would all put in the same category as things that make people feel as if they're getting better or sleeping when they're not really necessarily getting better or sleeping”
    30:57Beyond Medications: The Best Lifestyle Treatments for Mental HealthFeb 2025

  3. Alcohol and marijuana massively harm sleep architecture. It is worth asking patients to try going off for a little while.

    “Other things, alcohol and marijuana massively negatively impact sleep architecture. It's worth telling patients, why don't you try going off of it for a little bit”
    1:03:55Insomnia and Sleep Medications in PsychiatryDec 2024

  4. Start with 300; if it is not enough, go to 600 and call. If it is way too much, call and you will send 100s. Titrate to effect.

    “I'll start with 300 and I'll say, if it's not enough, go to 600 and call me. And if it's way too much, call me and I'll send you 100s. So basically starting on 300 and then titrating to effect”
    1:05:32Insomnia and Sleep Medications in PsychiatryDec 2024

Mood

  1. Cannabis may not directly worsen depression, but it does directly prevent recovery.

    “while I don't necessarily believe it has a direct impact on worsening the depression, I definitely believe, as you say, that has a direct impact in preventing recovery”
    27:31What Patients Should Know When Diagnosed With DepressionSep 2026

  2. At high doses it puts you into an intoxicated, delirium-like state where you cannot consolidate memories or put your thoughts together the way you normally do.

    “using it at high doses essentially puts you into an intoxicated state of delirium where you're not going to be able to consolidate your memories or put your thoughts together in the way that you normally do”
    29:52Beyond Medications: The Best Lifestyle Treatments for Mental HealthFeb 2025

  3. True mania or hypomania from cannabis is ridiculously rare. Psychosis, and agitation from psychosis, yes; plain mania and hypomania, quite unlikely.

    “ridiculously rare to see true mania or hypomania happening as the result of cannabis use. Psychosis, yes, and agitation from psychosis, yes, but just plain mania and hypomania, quite unlikely”
    16:12How to Diagnose Bipolar Disorder: The Interview Framework That Beats Screening QuestionsFeb 2026

  4. Cannabis and nicotine use often goes up during mood episodes, but it is not what triggers them.

    “with the substances, often I will see an increase in the use of cannabis and nicotine during mood episodes, but I think just to emphasize what you're saying is it's not triggering those mood episodes”
    17:48How to Diagnose Bipolar Disorder: The Interview Framework That Beats Screening QuestionsFeb 2026

Psychosis

  1. At very high doses most people can get a little psychotic on cannabis; at lower doses most do not, but some do. In our opinion, people more prone to these experiences may be more likely to develop a long-term primary psychotic disorder.

    “if you have a substance-induced psychosis from a drug that does not cause psychosis in most people most people like cannabis yes at a very very high dose Most people can get a little psychotic on cannabis, but most people do not on a lower dose, but some people do”
    54:31What is Psychosis? Look at the DSM, Common Mimics, and a Framework for the DifferentialJan 2026
    Also said in 1 more episode
    “People who are more prone to these experiences, in my opinion, actually would be more likely to develop a long-term primary psychotic disorder, even with drugs that you might not necessarily expect to cause that”
    43:18Psychosis: History, Delusions, Diagnosis, Theories, and Modern CareNov 2024

Talking to patients

  1. When patients say cannabis helps them sleep, do not tell them they are wrong and lose the alliance. Agree that it helps them fall asleep, then explain what it does to their sleep.

    “Important for me not to lose therapeutic alliance by being like, you're wrong. They're terrible for sleep. I explained to them, it's like, you're right. So it does help you fall asleep”
    31:01Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026

  2. When they stop, warn them about REM rebound: almost every time, they have crazy dreams that wake them up. Explain that dream sleep has been suppressed for a long time and the brain is now exploding with dreams.

    “I see almost every single time you see this crazy REM rebound that they're having these crazy dreams that are causing them to wake up. I tell them that their brain has had dream sleep suppressed for a really long time and their brain is now exploding with dreams”
    32:28Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026

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From these episodes

Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.

Educational content only. Everything here is what was said on the Psychofarm podcast, for clinicians. It is not medical advice and not a substitute for clinical judgment, current labeling or guidelines. An episode reflects what we thought when we recorded it, so check anything before you rely on it.