THE DOUBLE STANDARD ON DEPRESSION

The San Diego District Attorney doesn't know -or just can't stand it-
that California law authorizes doctors to approve the use of
marijuana as a treatment for "any condition for which marijuana
provides relief." After raids that closed five local dispensaries
July 6, DA Bonnie Dumanis said "Our office has no intention of
stopping those who are chronically ill with AIDS, glaucoma and cancer
from obtaining any legally prescribed drug, including medical
marijuana, to help them ease their pain." Deputy DA Dana Greisen
complained to Channel 10 News that profiteering doctors were
approving marijuana use too readily: "The doctors, because they're
giving it to so many people, are basically legalizing marijuana one
doctor and patient at a time... It's being recommended for insomnia,
depression, anxiety... The law is being abused on a massive scale."

Actually, the law is being implemented on a limited scale, given how
many Californians are using pharmaceutical antidepressants and how
afraid/uneducated most doctors are when it comes to cannabis. The
way to deprive cannabis specialists of revenue, if that were really
law enforcement's goal, would be to remove the fear that constrains
other doctors from approving their patients' use of the herb -mainly,
fear of being investigated by the state medical board.

So why has SDDA sent a letter to the medical board requesting
investigations of four doctors who allegedly issue approvals too freely?

The investigations will undoubtedly have a chilling effect on every
doctor south of Capistrano Beach who might be considering a more
liberal approach.

Patients, instead of asking their regular doctors to approve their
cannabis use, will continue to seek out the docs who advertise their
cannabis consultation services in the San Diego Reader. The cost of
lawyers will justify the cannabis consultant's fee, and the system
will grind grimly on.

Are Bonnie Dumanis and her deputies totally ignorant of the relevant
history? In 1994 and again in 1995 the California legislature passed
and Governor Pete Wilson vetoed bills that would have legalized
marijuana for the treatment of AIDS, cancer, glaucoma, and multiple
sclerosis -a finite list. After Wilson's second veto, Dennis Peron
gave up on the politicians and decided to change the law by ballot
initiative. The measure he crafted, with input from Tod Mikuriya, MD
(and over the opposition of most activists), left it entirely up to
the doctors which conditions cannabis could be used to treat. Thus
Prop 215 was and is much more liberal than the bills Wilson had vetoed.

There was nothing misleading about what appeared on the ballot: the
very first sentence of Prop 215 establishes "the right to obtain and
use marijuana for medical purposes where that medical use is deemed
appropriate and has been recommended by a physician who has
determined that the person's health would benefit from the use of
marijuana in the treatment of cancer, anorexia, AIDS, chronic pain,
spasticity, glaucoma, arthritis, migraine, or any other illness for
which marijuana provides relief."

The Voters Handbook "Argument Against Prop 215" clearly stated the
opposition of the California State Sheriffs Association, the District
Attorneys Association, the Police Chiefs Association, the Narcotics
Officers Association and the California Peace Officers Association.
"Prop 215 DOES NOT restrict the use of marijuana to AIDS, cancer,
glaucoma and other serious illnesses," they reminded us. "Read the
fine print: Proposition 215 legalizes marijuana use for 'any other
illness for which marijuana provides relief.' This could include
stress, headaches, upset stomach, insomnia, a stiff neck, or just
about anything."

It wasn't fine print, it was the first sentence of the measure that
we, the people, read and passed by a 56-44 margin.

The district attorney of San Diego ought to read it because it's the
law she's supposed to uphold.

When Depression is Serious

"It's open drug dealing with legitimacy," says DDA Greisen of the
medical marijuana industry.

The same could be said of the pharmaceutical industry's marketing of
antidepressants. Why hasn't the San Diego DA's office gone after Eli
Lilly or Pfizer or Glaxo for making inordinate profits by selling
Prozac, Zoloft and Paxil? The pills cost pennies to manufacture. The
high retail prices are justified in the name of "research," but an
investigation would establish that the corporate owners have been
pocketing millions. Evidently, depression is a serious illness when
treated with corporate drugs, and pharmacists who sell corporate
drugs and doctors who prescribe corporate drugs are too legit to indict.

A doctor's diagnosis of "clinical depression" is based on criteria
set forth in the Diagnostic and Statistical Manual, the so-called
"bible" of the American Psychiatric Association. The drug companies
influenced the drafting of the DSM so that the definition of
depression would apply to as many people as possible -i.e., would
maximize the number of potential customers. (See "The Selling of
DSM-III," a great book by Kirk and Kutchens.) Doctors are taught to
detect depression based on patients' responses to a simplistic questionnaire:

"The presence of depressed mood (5) or loss of interest (6) and at
least four other symptoms over a two-week period is required for the
diagnosis of a major depressive episode.

1) Changes in appetite and weight

2) Disturbed sleep

3) Motor retardation or agitation

4) Fatigue and loss of energy

5) Depressed or irritable mood

6) Loss of interest or pleasure in usual activities.

7) Feelings of worthlessness, self-reproach, excessive guilt

8) Suicidal thinking or attempts

9) Difficulty thinking or concentrating.

Is there a single adult in America who could not qualify for a
diagnosis of depression? The criteria are vague and all-embracing.
Losing weight?

You're depressed. Gaining weight?

You're depressed.

Sleeping too little?

You're depressed. Sleeping too much? You're depressed.

Going too slow? You're depressed. Going too fast? You're depressed...
The all-important fifth criterion -"Depressed or irritable mood"-
used to define depression is a syllogism. And even when the external
causes of a patient's "depressed or irritable mood" may be obvious
- -loss of a job, a relationship on the rocks, kid trouble, etc.- the
resultant diagnosis, "Clinical Depression," will imply that his or
her internal psychological condition was causal!

Is there such a thing as a double syllogism?

"Loss of interest or pleasure in usual activities" can be associated
with physical aging and/or deteriorating quality of life. For
example, you may no longer take pleasure in swimming at a beach after
you've noticed human shit bobbing in the waves.

You may not find driving as pleasurable now that there's
bumper-to-bumper traffic and the ride that once took less than 20
minutes takes more than an hour.

The definition of "clinical depression" can never be rigorous and the
whole concept -the medicalization of unhappiness-is a misdirection
play, pointing away from the real causes, insecurity and loneliness.
Insecurity is a function of the rich/poor system, compounded by
looming ecodisaster and personal health problems.

Loneliness is almost everybody's lot in a socioeconomic system that
breaks up families geographically. Prevention -which nobody ever
talks about-would involve changing the system to encourage social stability.

But in the meantime....

In this mean time, marijuana is the anti-depressant and anti-anxiety
medication of choice for millions of Americans. That's the
statistical fact at the heart of Dennis Peron's famous line, "In a
society where they give Prozac to shy teenagers, all marijuana use is
medical!" Prop 215 explicitly established the right to obtain and use
marijuana in the treatment of any condition for which it provides relief.

The medical profession and the government recognize depression as a
serious, disabling illness for which Prozac, Wellbutrin, et al can be
prescribed to provide relief -and were prescribed to some 2.5 million
Californians last year. "What's sauce for the goose is sauce for the
gander," as the old saying goes. Californians have every right to use
marijuana in the treatment of depression.

This may be a winnable fight. U.S. employers were losing $3,000 per
year per depressed worker, according to the 1994 MIT study.

The biggest impact of depression, more costly to employers than
absenteeism, was "the effects of poor concentration, indecisiveness,
lack of self-confidence," i.e., dawdling. Most employers probably
assume that widespread marijuana use would lead to even more dawdling.

Just wait till they find out it's a performance enhancer!

Accomplia Update

Acomplia, Sanofi's weight-loss drug that works by blocking
cannabinoid receptors in the brain, was approved by British
regulatory authorities in late June and promptly offered for sale by
on-line pharmacies such as SpeedyHealth.com -28 tablets (20 mg) for
$389, which comes to about $336 per pound lost in the first year. A paper published in General Archives in Psychiatry in
April 2001 examined whether Sanofi's drug blocks the psychoactive
effects of marijuana.

A team of researchers from the National Institute on Drug Abuse led
by Marilyn Huestis gave various doses of the drug or a placebo to 63
cannabis smokers who then smoked NIDA-wanna (2.64% THC) or placebo
joints. The authors' abstract states that only at the 90 mg dose did
Acomplia produce "a significant dose-dependent blockade of
marijuana-induced intoxication." But medical-graduate student Sunil
Aggarwal has analyzed the paper and discerns a similar blocking
effect at 10 mg. "It is not statistically significant per se, but the
dose-response blocking curve is," says Aggarwal. (20 mg/ day is
Sanofi's recommended starting dose of Acomplia. In clinical studies,
higher doses led to an unacceptable incidence of gastrointestinal
problems.) Huestis has reportedly done an unpublished study in which
subjects taking 60 mg/day of Acomplia for two weeks did not lose the
ability to get "high" when they smoked marijuana.