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Evidence Review

Kratom use and depression

A structured review of the human evidence

Reviewed by Dr. Van Krasnov, M.D.
Last reviewed 2026-10-19

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Kratom and depression: what young adults and families should know

A structured narrative review of selected human evidence. Source checks updated October 19, 2026.

Some people describe relief from low mood when they use kratom. Those experiences deserve attention, but the studies examined here do not establish that kratom effectively treats a depressive disorder. Other reports describe dependence, difficult withdrawal, and worsening symptoms. They do not establish that kratom causes persistent depression, either. The useful clinical question is what each kind of evidence can tell us—and where it leaves uncertainty. [1–8]

For families, the age distinction matters. Most of the detailed mood research discussed below concerns adults. One national survey includes adolescents, but it does not report the relationship between kratom use and depression separately for that age group. None of the verified findings establishes kratom as a depression treatment for children or adolescents. [2–5]

Feeling better and treating depression are different questions

Kratom is a plant whose compounds interact with opioid receptors and can produce stimulant-like or sedating effects. A person may feel calmer, more energetic, or less distressed after taking it. Whether such relief becomes a sustained improvement in a depressive disorder requires a different kind of study: a defined patient population, an appropriate comparison, repeated validated depression assessments, and attention to harms and functioning. [11]

In Grundmann and colleagues’ survey, about 80% of respondents who met its self-report depression criteria endorsed less depressed mood with kratom. This was a report of perceived benefit, not a depression remission rate. The comparison involved groups who both used kratom; it did not compare kratom with placebo or with no kratom. Recruitment through kratom-related networks and retrospective self-report could favor participation by people with positive experiences. Another survey analysis by Bath and colleagues also recorded perceived mental-health improvement, without a controlled treatment comparison. [1,14]

Such surveys help explain why people choose kratom. They cannot determine what those same people would have experienced without it, how much of the perceived benefit lasted, or how it compares with established depression care.

What repeated measurements add

Timmons and colleagues analyzed repeated reports from 357 adult kratom consumers who completed 15 days of observation. After adjustment, a single use event in the preceding three hours was associated with a sadness rating about 1.6 points lower on a 0–100 scale than an interval with no reported use event. This comparison tracked differences within the same people. Multiple use events were not significantly associated with lower sadness compared with no reported event. [2]

Repeated observations give a closer view of mood around use than a single retrospective survey. The difference was numerically small, and its clinical importance is uncertain. The study measured momentary sadness in existing users; it did not test sustained recovery in patients recruited for depression. An interval without recent use was not necessarily drug-free, and the findings do not establish an effective treatment schedule. [2]

Selection also matters: people who did not complete the study had higher baseline depressive-symptom scores. One item was inadvertently omitted from that baseline depression questionnaire. Medication and other substance-use adjustments relied on baseline reports rather than the timing of each dose. These limitations constrain what the associations can establish. [2]

Comparisons between users and nonusers give a mixed picture

Yang and colleagues compared 403 adult men with a history of methamphetamine use in Malaysian rehabilitation centers: 244 had a kratom-use history and 159 did not. Several individual depression symptoms were lower in the kratom-history group in the initial comparisons. However, none of those symptom differences remained statistically significant after the authors corrected for the many comparisons performed. That correction reduces the chance of interpreting a chance finding as a real difference. [3]

This does not prove that the groups were identical. It does make the initial favorable findings less persuasive. The study measured symptoms at one time, excluded people with a history of significant mental-health problems, and did not test depression treatment. Its exploratory network analyses also found associations in both directions, rather than a consistent antidepressant effect. [3]

Other comparisons point in a different direction. In Smith and colleagues’ survey of U.S. adults with recent alcohol, opioid, or stimulant use, people who had ever used kratom reported higher depressive-symptom scores than those who had never used it. Depression score was not a statistically significant predictor of lifetime kratom use in the adjusted analysis. That analysis asked which characteristics were associated with having tried kratom; it did not estimate kratom’s effect on later depression. [4]

McCabe and colleagues examined U.S. national survey data from 2021–2024, including respondents aged 12 and older. Both use in the past year and use only before that year were associated with higher odds of survey-defined past-year major depression than never use, after adjustment for demographic characteristics. The analysis could not establish whether depression preceded kratom use, followed it, or reflected other differences between the groups. Its main depression comparisons were not reported separately for adolescents. [5]

These results do not cancel one another out or form a tally of studies “for” and “against” kratom. They involve different populations, exposure histories, symptom measures, and statistical questions. People with depression may seek kratom for relief; other substance use, pain, and social circumstances may affect both kratom use and mental health. Observational comparisons cannot reliably separate these possibilities from an effect of kratom itself. [3–5]

Saref and colleagues’ interview survey provides a different favorable perspective. In a selected opioid-using population, participants recalled a lower prevalence of depression among opioid-related problems after starting kratom. The reported prevalence comparison does not establish improvement on a validated depression measure. Retrospective recall and possible concurrent changes in opioid use complicate attribution of the reported benefit. Only the abstract was assessed here. [15]

Case histories show why the course over time matters

Müller and colleagues described a 63-year-old man with depression and generalized anxiety who recalled useful symptom relief during approximately seven years of kratom self-management. Later, increased stress coincided with loss of perceived benefit and a psychiatric crisis. The authors described functional reliance on kratom, but did not observe physical dependence or withdrawal in this individual. Several treatments were tried in hospital, and he reported resuming kratom before discharge. This history documents perceived benefit and a later crisis; it cannot identify kratom as the cause of either. [6]

A different case, reported by Bowe and Kerr, described kratom dependence alongside worsening depression, anxiety, and chronic pain in a person with opioid use disorder. The abstract reported improvement after treatment with buprenorphine-naloxone. This is a relevant adverse experience, but changing substance use and treatment prevent it from isolating a lasting depressive effect of kratom. [7]

These case histories illuminate self-management and substance substitution. They cannot tell families how often a problem occurs, and recalled improvement cannot establish treatment efficacy.

Low mood during withdrawal is not the same as persistent depression

In Singh and colleagues’ retrospective study of 150 selected regular kratom users in Malaysia, the original abstract described predominantly mild depressive and anxiety symptoms during cessation, with heavier consumption associated with moderate depressive symptoms. This gives relevant evidence about recalled symptoms around stopping use. The assessed abstract does not establish how long those symptoms lasted, prove that all users experience withdrawal, or demonstrate a lasting depressive disorder caused by kratom. [8]

When someone reports that kratom improves mood, or that mood deteriorates without it, several explanations may need consideration: relief of an existing condition, relief of withdrawal, a substance-related adverse effect, or a change in an underlying illness. The studies reviewed here do not reliably distinguish these explanations for a particular person. Symptoms should be assessed in relation to the timing of use, missed doses, other substances, and the person’s mental-health history. [6–8,11]

Safety involves more than mood

Online surveys by Coe and Garcia-Romeu and their colleagues recorded adverse reactions that respondents generally described as mild. Some respondents in Garcia-Romeu’s survey also reported withdrawal or sought medical treatment. These self-selected survey responses do not provide a population-wide probability of harm. Gandhi and colleagues reported a case of severe liver injury following use of a kratom-containing supplement; a single case identifies a safety concern without establishing its incidence. [9,10,13]

NCCIH describes reported side effects, dependence and withdrawal concerns, and uncertainty about interactions with other drugs. The absence of a measured interaction in a small or observational study should not be treated as evidence that a combination is safe. [11]

Products also differ. Findings from people using leaf preparations or tea should not be assumed to apply to products deliberately enriched in 7-hydroxymitragynine, often labelled “7-OH.” The FDA distinguishes enhanced or concentrated products from those with a chemical composition closer to the plant’s leaves. The studies discussed here do not establish comparable effects or safety across those products. [12]

What this means for a clinical conversation

This evidence does not support recommending kratom as a treatment for depression in young people. It also does not justify dismissing reported relief as imaginary or telling every person who uses kratom that it has caused permanent depression.

A useful discussion with a clinician includes:

• The symptoms that led to use, and whether they began before kratom.
• The actual product, frequency of use, and any change in the amount taken.
• What happens to mood, sleep, and functioning between doses or when use stops.
• Prescription medicines, alcohol, and other substances used alongside it.

Someone using kratom regularly should discuss changes in use with a clinician because withdrawal may complicate the picture. Persistent or worsening depressive symptoms deserve assessment and a treatment plan, rather than an assumption that either continuing or stopping kratom will explain and resolve everything. [6–8,11]

How this review was prepared and what it cannot answer

This is a structured narrative review of selected human reports, not a systematic review. It asks a broader question than treatment efficacy alone: what human reports show about perceived mood benefit, depressive symptoms, withdrawal, and relevant harms. Reports came from a supplied review package, with targeted retrieval of original sources to check newer findings, conflicting results, and adverse observations. Source checking on October 19, 2026, included complete copies of the Yang and Timmons papers. It was not a new comprehensive database search.

Available full reports were checked for their populations, comparisons, measured outcomes, and relevant results. Abstract-only assessments are identified above and in the references. Studies with favorable, unfavorable, and statistically nonsignificant findings were retained according to their relevance to these questions. No pooled effect, formal certainty rating, or count of independent “positive studies” was calculated.

Several sources were available only as abstracts or extracts, and supplementary analyses were not comprehensively checked. A thesis in the source package was available only in an extract containing its abstract and early chapters. Some primary reports contain inconsistencies in ancillary counts, questionnaire details, or contrast labels; the accompanying verification record identifies them, and affected claims were qualified or omitted. Other limitations include selected samples, self-reported exposure, uncertain product composition, possible cohort overlap, and limited follow-up. This review cannot establish all published findings, comprehensive harm rates, a safe dose, or sustained treatment effects in adolescents.

The evidence supports taking both perceived benefit and reported harms seriously. It leaves kratom’s effectiveness as a depression treatment unestablished in the studies examined here, and does not establish that it causes persistent depression.

References

1. Grundmann O, et al. Correlations of kratom use behavior and psychiatric conditions from a cross-sectional survey. Experimental and Clinical Psychopharmacology. 2023. Full report.
2. Timmons P, et al. Associations between kratom use and real-time anxiety and sadness: A 15-day ecological momentary assessment study. Drug and Alcohol Dependence. 2026;288:113383. Original report. Full article assessed.
3. Yang Y, Müller CP, Singh D. A network analysis of depression, anxiety, and their associations with kratom use among people who previously used methamphetamine. Journal of Psychoactive Drugs. Online 2025. Original report. Full article assessed; separate supplement not assessed.
4. Smith KE, et al. Social, psychological, and substance use characteristics of U.S. adults who use kratom: Initial findings from an online, crowdsourced study. Experimental and Clinical Psychopharmacology. 2022;30(6):983–996. Full report.
5. McCabe SE, et al. Kratom use and associations with mental health in the United States. Journal of Addiction Medicine. Online 2026. Full report. Main report assessed; supplementary file unavailable.
6. Müller E, Hillemacher T, Müller CP. Kratom use for depression/anxiety self-management: challenges during the COVID-19 pandemic—A case report. Heliyon. 2021;7:e07039. Full report.
7. Bowe A, Kerr PL. A complex case of kratom dependence, depression, and chronic pain in opioid use disorder: Effects of buprenorphine in clinical management. Journal of Psychoactive Drugs. 2020;52(5):447–452. Original indexed abstract. Abstract assessed.
8. Singh D, et al. Severity of kratom psychological withdrawal symptoms. Journal of Psychoactive Drugs. 2018;50(5):445–450. Original indexed abstract. Abstract assessed.
9. Coe MA, et al. Kratom as a substitute for opioids: Results from an online survey. Drug and Alcohol Dependence. 2019;202:24–32. Original indexed abstract. Abstract assessed.
10. Gandhi D, et al. Kratom induced severe cholestatic liver injury histologically mimicking primary biliary cholangitis: A case report. World Journal of Hepatology. 2020;12(10):863–869. Full report.
11. National Center for Complementary and Integrative Health. Kratom. Agency background and safety information; not a primary depression study.
12. U.S. Food and Drug Administration. Hiding in plain sight: 7-OH products. Product distinction checked October 19, 2026; not depression efficacy evidence.
13. Garcia-Romeu A, et al. Kratom: User demographics, use patterns, and implications for the opioid epidemic. Drug and Alcohol Dependence. 2020;208:107849. Full report.
14. Bath R, et al. Self-reported health diagnoses and demographic correlates with kratom use: Results from an online survey. Journal of Addiction Medicine. 2020;14(3):244–252. Full report.
15. Saref A, et al. Self-reported prevalence and severity of opioid and kratom side effects. Journal of Ethnopharmacology. 2019;238:111876. Original indexed abstract. Abstract assessed.

Suggested citation

Krasnov V. Evidence Review: Kratom Use and Depression. vankrasnovmd.com. Last reviewed 2026-10-19. Available at: https://vankrasnovmd.com/evidence-review/kratom-depression.html

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