1
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Bidwell LC, Martin-Willett R, Skrzynski C, Lisano J, Ortiz Torres M, Giordano G, Hutchison KE, Bryan AD. Acute and Extended Anxiolytic Effects of Cannabidiol in Cannabis Flower: A Quasi-Experimental ad libitum Use Study. Cannabis Cannabinoid Res 2024. [PMID: 38252547 DOI: 10.1089/can.2023.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
Objective: Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) have varying pharmacological actions with differential effects on acute and extended affective states, incuding anxiety. We aimed to study these effects on anxiety in legal market forms of cannabis. Method: This study makes use of a nonequivalent control group quasiexperimental design. Forty-two participants with anxiety symptions who were not using cannabis were compared to 258 participants with anxiety symptoms who used cannabis flower (∼3-4 times per week). Participants who used cannabis were randomly assigned to one of three legal market cannabis conditions; THC-dominant (24% THC, <1% CBD), THC+CBD (12% THC, 12% CBD), or CBD-dominant (<1% THC, 24% CBD). Changes in anxiety symptoms over 4-weeks were measured by the Patient Global Impression of Change (PGIC) scale and the Depression, Anxiety, and Stress Scale (DASS). Acute changes in subjective mood immediately after cannabis use were measured by the Profile of Mood States (POMS) Elation, Tension, and Paranoia subscales and the Addiction Research Center Inventory intoxication scale. Results: While all participants reported anxiety reductions over the 4-week study on the PGIC (F=30.65, p<0.001) and DASS anxiety measures (F=115.88, p<0.001), ad libitum CBD-dominant cannabis use was associated with lower scores on the DASS anxiety subscale compared to THC-dominant use when accounting for frequency of use (difference=-1.03, SE=0.45, p=0.02). Similarly, acute CBD-dominant cannabis use was associated with lower scores on the POMS tension and paranoia subscales (POMS tension: CBD-dominant vs. THC-dominant: difference=-0.41 SE=0.1, p<0.001; CBD-dominant vs. THC+CBD: difference=-0.28, SE=0.07, p=0.04; POMS paranoia: CBD-dominant vs. THC-dominant: difference=-0.49, SE=0.1, p<0.001; CBD-dominant vs. THC+CBD: difference=-0.33, SE=0.09, p=0.01). Participants in all cannabis conditions experienced acute changes in positive mood and subjective drug effects. Conclusions: This study provides novel information on the impacts of legal market cannabis with varying ratios of THC to CBD in indviduals with anxiety symptoms. Findings suggest that THC did not increase anxiety and that CBD-dominant forms of cannabis were associated with acute tension reduction that may translate to longer-term reductions in anxiety symptoms. Clinical Trial Registration: NCT03491384.
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Affiliation(s)
- L Cinnamon Bidwell
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, Colorado, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Renée Martin-Willett
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Carillon Skrzynski
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Jonathon Lisano
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, Colorado, USA
| | - Marco Ortiz Torres
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, Colorado, USA
| | - Gregory Giordano
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Kent E Hutchison
- Department of Psychiatry, College of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Angela D Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
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2
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Dave PA, Rohit RK, Tibrewal C, Modi NS, Bajoria PS, Gandhi SK, Patel P. Should Marijuana Be Legalized: A Scoping Review of Associations of Marijuana and Depression. Cureus 2023; 15:e42835. [PMID: 37664373 PMCID: PMC10474443 DOI: 10.7759/cureus.42835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
People with addiction to marijuana and those who have ever consumed marijuana at any time during their life suffer from depression at some point in their life. Depression has been associated with substance use as both a trigger and repercussion. A total of 3663 articles were analyzed, and 26 articles were collectively selected for this study. Consuming marijuana was linked to the development of depression in the majority of individuals. Marijuana consumption and its repercussions have both been connected to negative effects on the body, such as respiratory disorders and even psychological disorders, including stress and depressive disorders. Studies potentially point to a complicated causal relationship between marijuana consumption and depressive disorder, stating that early depressive symptoms enable marijuana usage, which then reduces depression. A research article clearly states that consuming marijuana can be helpful in elevating mood and anxiolytic initially, but it is subsequently followed by a rise in depressive symptoms, which manifest as mental distress and frustration. Discussions with patients about the extent of their marijuana consumption, techniques for reducing the use, and the impact of marijuana on depression may be beneficial in medical facilities where depressive disorder is treated. This research paper highlights the importance of understanding depression and the use of marijuana for temporary relief from depressive symptoms and its long-term consequences on mental health.
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Affiliation(s)
| | - Ralph Kingsford Rohit
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Charu Tibrewal
- Department of Internal Medicine, Civil Hospital Ahmedabad, Ahmedabad, IND
| | | | - Parth S Bajoria
- Department of Internal Medicine, Gujarat Medical Education and Research Society Gandhinagar, Gandhinagar, IND
| | | | - Priyansh Patel
- Department of Internal Medicine, Medical College Baroda, Vadodara, IND
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3
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Weidberg S, González-Roz A, Castaño Y, Secades-Villa R. Emotion dysregulation in relation to cannabis use and mental health among young adults. Addict Behav 2023; 144:107757. [PMID: 37224581 DOI: 10.1016/j.addbeh.2023.107757] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/08/2023] [Accepted: 05/18/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Emotion dysregulation (ED) is a transdiagnostic variable that accounts for the onset and maintenance of mental health disorders. The interplay between ED, cannabis use and mental health has not been appraised in the young adult population and whether there are sex-dependent effects has yet to be examined. This study looked at whether ED mediates the association between past-month cannabis use and mental health, while considering sex as a moderator. METHODS 2,762 (64.2% women) undergraduate Spanish students completed an online battery. Among others, they fulfilled the Depression Anxiety Stress Scale-21 (DASS-21) and the Difficulties in Emotion Regulation Scale (DERS-28). A two-way ANOVA assessed the effects of sex and past-month cannabis use on participants' DASS-21 scores. A set of moderated mediations tested whether the indirect effect of past-month cannabis use on DASS-21 through DERS differed by sex. RESULTS Past-month cannabis female users showed higher levels of depression, anxiety and stress (M = 51.10, SD = 26.72) than did men [(M = 33.76, SD = 20.31); F(1, 2758) = 5.119, p =.024, η2p =.002]. In female young adults only, the effect of past-month cannabis use on mental health was mediated by ED (total score), non-acceptance of emotional responses, lack of emotional control, difficulties in engaging in goal-directed behavior, and lack of emotional clarity (all p's < 0.005) CONCLUSIONS: Findings indicate the importance of considering ED in assessment and intervention practices. Interventions targeting ED may be particularly effective for female young adult cannabis users.
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Affiliation(s)
- Sara Weidberg
- Department of Psychology. Addictive Behaviors Research Group (GCA), University of Oviedo. Plaza Feijoo s/n, 33003, Oviedo, Spain
| | - Alba González-Roz
- Department of Psychology. Addictive Behaviors Research Group (GCA), University of Oviedo. Plaza Feijoo s/n, 33003, Oviedo, Spain.
| | - Yasmina Castaño
- Department of Psychology. University of the Balearic Islands. Ctra. Valldemossa, km 7.5, 07122, Palma, Spain
| | - Roberto Secades-Villa
- Department of Psychology. Addictive Behaviors Research Group (GCA), University of Oviedo. Plaza Feijoo s/n, 33003, Oviedo, Spain
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4
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Harley D, Rose T, Goings TC, Canfield J. Photovoice as a tool for exploring perceptions of marijuana use among Appalachian adolescents. J Ethn Subst Abuse 2023; 22:133-153. [PMID: 33829961 DOI: 10.1080/15332640.2021.1908922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study explored perceptions of marijuana use and abstinence among urban and rural Appalachian high school students using photovoice, enabling this subset of youth to co-construct their perceptions of marijuana use and abstinence. Twelve adolescents, ages 14-17, participated in the study. Participants identified managing stress and feeling peer pressure as two reasons teens might use marijuana. Participants identified four reasons for adolescent marijuana abstinence including having positive relationships, identifying with religion/spirituality, participating in extracurricular activities, and avoiding negative outcomes. Findings suggest that participants may smoke marijuana due to peer pressure and to cope with stress. Collective approaches including families, communities, and faith organizations may be important marijuana use prevention approaches for Appalachian adolescents.
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Affiliation(s)
| | - Theda Rose
- University of Maryland Baltimore, Baltimore, Maryland
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5
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Sachedina F, Chan C, Damji RS, de Sanctis OJ. Medical cannabis use in Canada and its impact on anxiety and depression: A retrospective study. Psychiatry Res 2022; 313:114573. [PMID: 35598566 DOI: 10.1016/j.psychres.2022.114573] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 12/24/2022]
Abstract
This was a retrospective study of patients utilizing medical cannabis who received their medical cannabis documentation and allotment from a Harvest Medicine clinic in Canada to determine the impact of medical cannabis on anxiety and depression outcomes. Patients included in the study were at least 18 years of age with completed validated questionnaires for anxiety (GAD-7) and depression (PHQ-9) at their initial evaluation and at least one follow-up visit. There were 7,362 patients included in the sample, of which the average age was 49.8 years, and 53.1% were female. There were statistically significant improvements between baseline and follow-up scores for both the GAD-7 and PHQ-9, with larger improvements seen for patients who were actively seeking medical cannabis to treat anxiety or depression. From 12 months on, those reporting anxiety had an average decrease in GAD-7 scores that was greater than the minimum clinically important difference of 4, and the same was seen for patients reporting depression from 18 months on, with the average decrease in PHQ-9 scores more than the MCID minimum clinically important difference of 5. This study provides some evidence to support the effectiveness of medical cannabis as a treatment for anxiety and depression.
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Affiliation(s)
- Faraz Sachedina
- Harvest Medicine, Two Executive Place1824 Crowchild Tr. NW, Unit 101Calgary, ABT2M 3Y7.
| | - Carole Chan
- Harvest Medicine, Two Executive Place1824 Crowchild Tr. NW, Unit 101Calgary, ABT2M 3Y7
| | - Rahim S Damji
- Harvest Medicine, Two Executive Place1824 Crowchild Tr. NW, Unit 101Calgary, ABT2M 3Y7
| | - Olga J de Sanctis
- Harvest Medicine, Two Executive Place1824 Crowchild Tr. NW, Unit 101Calgary, ABT2M 3Y7
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6
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McGuckin T, Ferro MA, Hammond D, Stewart S, Maloney-Hall B, Madi N, Porath A, Perlman CM. How High? Trends in Cannabis Use Prior to First Admission to Inpatient Psychiatry in Ontario, Canada, between 2007 and 2017. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:1059-1068. [PMID: 33380219 PMCID: PMC8689428 DOI: 10.1177/0706743720984679] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To examine the trends in cannabis use within 30 days of first admission to inpatient psychiatry in Ontario, Canada, between 2007 and 2017, and the characteristics of persons reporting cannabis use. METHODS A retrospective cross-sectional analysis was conducted for first-time admissions to nonforensic inpatient psychiatric beds in Ontario, Canada, between January 1, 2007, and December 31, 2017, using data from the Ontario Mental Health Reporting System (N = 81,809). RESULTS Across all years, 20.1% of patients reported cannabis use within 30 days of first admission. Use increased from 16.7% in 2007 to 25.9% in 2017, and the proportion with cannabis use disorders increased from 3.8% to 6.0%. In 2017, 47.9% of patients aged 18 to 24 and 39.2% aged 25 to 34 used cannabis, representing absolute increases of 8.3% and 10.7%, respectively. Increases in cannabis use were found across almost all diagnostic groups, with the largest increases among patients with personality disorders (15% increase), schizophrenia or other psychotic disorders (14% increase), and substance use disorders (14% increase). A number of demographic and clinical factors were significantly associated with cannabis use, including interactions between schizophrenia and gender (area under the curve = 0.88). CONCLUSIONS As medical cannabis policies in Canada have evolved, cannabis use reported prior to first admission to inpatient psychiatry has increased. The findings of this study establish a baseline for evaluating the impact of changes in cannabis-related policies in Ontario on cannabis use prior to admission to inpatient psychiatry.
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Affiliation(s)
- Taylor McGuckin
- School of Public Health and Health Systems, University of Waterloo, Ontario, Canada
| | - Mark A Ferro
- School of Public Health and Health Systems, University of Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Ontario, Canada
| | - Shannon Stewart
- Faculty of Education, Applied Psychology, Western University, London, Ontario, Canada
| | | | - Nawaf Madi
- Canadian Institute for Health Information, Ottawa, Ontario, Canada
| | - Amy Porath
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
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7
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Chen C, Xiao X, Belkacem AN, Lu L, Wang X, Yi W, Li P, Wang C, Sha S, Zhao X, Ming D. Efficacy Evaluation of Neurofeedback-Based Anxiety Relief. Front Neurosci 2021; 15:758068. [PMID: 34776855 PMCID: PMC8581142 DOI: 10.3389/fnins.2021.758068] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/22/2021] [Indexed: 01/02/2023] Open
Abstract
Anxiety disorder is a mental illness that involves extreme fear or worry, which can alter the balance of chemicals in the brain. This change and evaluation of anxiety state are accompanied by a comprehensive treatment procedure. It is well-known that the treatment of anxiety is chiefly based on psychotherapy and drug therapy, and there is no objective standard evaluation. In this paper, the proposed method focuses on examining neural changes to explore the effect of mindfulness regulation in accordance with neurofeedback in patients with anxiety. We designed a closed neurofeedback experiment that includes three stages to adjust the psychological state of the subjects. A total of 34 subjects, 17 with anxiety disorder and 17 healthy, participated in this experiment. Through the three stages of the experiment, electroencephalography (EEG) resting state signal and mindfulness-based EEG signal were recorded. Power spectral density was selected as the evaluation index through the regulation of neurofeedback mindfulness, and repeated analysis of variance (ANOVA) method was used for statistical analysis. The findings of this study reveal that the proposed method has a positive effect on both types of subjects. After mindfulness adjustment, the power map exhibited an upward trend. The increase in the average power of gamma wave indicates the relief of anxiety. The enhancement of the wave power represents an improvement in the subjects’ mindfulness ability. At the same time, the results of ANOVA showed that P < 0.05, i.e., the difference was significant. From the aspect of neurophysiological signals, we objectively evaluated the ability of our experiment to relieve anxiety. The neurofeedback mindfulness regulation can effect on the brain activity pattern of anxiety disorder patients.
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Affiliation(s)
- Chao Chen
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.,Key Laboratory of Complex System Control Theory and Application, Tianjin University of Technology, Tianjin, China
| | - Xiaolin Xiao
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Abdelkader Nasreddine Belkacem
- Department of Computer and Network Engineering, College of Information Technology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Lin Lu
- Zhonghuan Information College, Tianjin University of Technology, Tianjin, China
| | - Xin Wang
- Key Laboratory of Complex System Control Theory and Application, Tianjin University of Technology, Tianjin, China
| | - Weibo Yi
- Beijing Machine and Equipment Institute, Beijing, China
| | - Penghai Li
- Key Laboratory of Complex System Control Theory and Application, Tianjin University of Technology, Tianjin, China
| | - Changming Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Brain-Inspired Intelligence and Clinical Translational Research Center, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Sha Sha
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xixi Zhao
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
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8
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Stiles-Shields C, Archer J, Zhang J, Burnside A, Draxler J, Potthoff LM, Reyes KM, Summersett Williams F, Westrick J, Karnik NS. A Scoping Review of Associations Between Cannabis Use and Anxiety in Adolescents and Young Adults. Child Psychiatry Hum Dev 2021; 54:639-658. [PMID: 34724134 PMCID: PMC9310430 DOI: 10.1007/s10578-021-01280-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 12/22/2022]
Abstract
Cannabis and anxiety are both rising issues that impact young people. This review seeks to explore the association between anxiety and cannabis in adolescents and young adults (AYA). A database search was run retrospectively from July 2020 through calendar year 2013. Articles had to present outcomes examining cannabis use and symptoms of anxiety, be written in English, contain samples with ≥ 50% who are age 25 or younger, and be published in a peer-reviewed journal. Forty-seven studies were identified that examined the relationship between anxiety and cannabis use. Twenty-three studies found a positive association that greater anxiety among AYA was associated with greater cannabis use. In contrast, seven studies found a negative association that greater anxiety was related to less cannabis use. And finally, 17 studies found no clear association between anxiety and cannabis use. Further research is needed to better understand the relationship between anxiety and cannabis use.
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Affiliation(s)
- Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 302, Chicago, IL 60612, USA
| | - Joseph Archer
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 302, Chicago, IL 60612, USA,School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Jim Zhang
- Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
| | - Amanda Burnside
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Janel Draxler
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 302, Chicago, IL 60612, USA
| | | | - Karen M. Reyes
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 302, Chicago, IL 60612, USA
| | | | - Jennifer Westrick
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 302, Chicago, IL 60612, USA
| | - Niranjan S. Karnik
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 302, Chicago, IL 60612, USA
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9
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Tobias MR, Ito TA. Anxiety increases sensitivity to errors and negative feedback over time. Biol Psychol 2021; 162:108092. [PMID: 33865907 DOI: 10.1016/j.biopsycho.2021.108092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 03/16/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Anxiety is characterized by sensitivity to negative external and internal information, apparent both in symptoms (e.g., hypervigilance and worry) and neural performance monitoring measures (i.e., feedback- and error-related negativity (FRN and ERN)). Here we examine whether anxiety is associated with persistent neural sensitivity to negative performance markers reflected in both the FRN and ERN (n = 273). Higher anxiety was associated with larger responses to both negative feedback and errors as the task progressed compared to those with lower anxiety particularly in women, suggesting that anxiety makes reactions to negative cues more persistent. Similar hypotheses were investigated for depression, which is associated with similar negative cognitive biases and deficits in reward-related processing, but results were mixed. Together, the findings identify variation over time-in-task as an overlooked dimension by which FRN and ERN may serve as a biomarker of anxiety but suggest that depression is not consistently related to performance monitoring.
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Affiliation(s)
- Margaret R Tobias
- Department of Psychology and Neuroscience, University of Colorado Boulder, United States.
| | - Tiffany A Ito
- Department of Psychology and Neuroscience, University of Colorado Boulder, United States
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10
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Sorkhou M, Bedder RH, George TP. The Behavioral Sequelae of Cannabis Use in Healthy People: A Systematic Review. Front Psychiatry 2021; 12:630247. [PMID: 33664685 PMCID: PMC7920961 DOI: 10.3389/fpsyt.2021.630247] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/25/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Cannabis is known to have a broad range of effects on behavior, including experiencing a "high" and tranquility/relaxation. However, there are several adverse behavioral sequalae that can arise from cannabis use, depending on frequency of use, potency (e.g., THC content), age of onset, and cumulative exposure. This systematic review examined evidence for cannabis-related adverse behavioral sequalae in otherwise healthy human subjects. Methods: Following PRISMA guidelines, we conducted a systematic review of cross-sectional and longitudinal studies from 1990 to 2020 that identified cannabis-related adverse behavioral outcomes in subjects without psychiatric and medical co-morbidities from PubMed and PsychInfo searches. Key search terms included "cannabis" OR "tetrahydrocannabinol" OR "cannabidiol" OR "marijuana" AND "anxiety" OR "depression" OR "psychosis" OR "schizophrenia" "OR "IQ" OR "memory" OR "attention" OR "impulsivity" OR "cognition" OR "education" OR "occupation". Results: Our search detected a total of 2,870 studies, from which we extracted 124 relevant studies from the literature on cannabis effects in the non-clinical population. Effects of cannabis on several behavioral sequelae including cognition, motivation, impulsivity, mood, anxiety, psychosis intelligence, and psychosocial functioning were identified. The preponderance of the evidence suggests that frequency of cannabis use, THC (but not CBD) content, age of onset, and cumulative cannabis exposure can all contribute to these adverse outcomes in individuals without a pre-existing medical condition or psychiatric disorder. The strongest evidence for the negative effects of cannabis are for psychosis and psychosocial functioning. Conclusions: Although more research is needed to determine risk factors for development of adverse behavioral sequelae of cannabis use, these findings underline the importance of understanding vulnerability to the adverse effects of cannabis, which has implications for prevention and treatment of problematic cannabis use.
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Affiliation(s)
- Maryam Sorkhou
- Addictions Division, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Rachel H Bedder
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Tony P George
- Addictions Division, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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11
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Maldonado R, Cabañero D, Martín-García E. The endocannabinoid system in modulating fear, anxiety, and stress
. DIALOGUES IN CLINICAL NEUROSCIENCE 2020; 22:229-239. [PMID: 33162766 PMCID: PMC7605023 DOI: 10.31887/dcns.2020.22.3/rmaldonado] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The endocannabinoid system is widely expressed in the limbic system, prefrontal
cortical areas, and brain structures regulating neuroendocrine stress responses, which
explains the key role of this system in the control of emotions. In this review, we
update recent advances on the function of the endocannabinoid system in determining the
value of fear-evoking stimuli and promoting appropriate behavioral responses for stress
resilience. We also review the alterations in the activity of the endocannabinoid system
during fear, stress, and anxiety, and the pathophysiological role of each component of
this system in the control of these protective emotional responses that also trigger
pathological emotional disorders. In spite of all the evidence, we have not yet taken
advantage of the therapeutic implications of this important role of the endocannabinoid
system, and possible future strategies to improve the treatment of these emotional
disorders are discussed.
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Affiliation(s)
- Rafael Maldonado
- Laboratory of Neuropharmacology-Neurophar, Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - David Cabañero
- Laboratory of Neuropharmacology-Neurophar, Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Elena Martín-García
- Laboratory of Neuropharmacology-Neurophar, Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
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12
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Connolly MD, Dankerlui DN, Eljallad T, Dodard-Friedman I, Tang A, Joseph CL. Outcomes of a PrEP Demonstration Project with LGBTQ Youth in a Community-Based Clinic Setting with Integrated Gender-Affirming Care. Transgend Health 2020; 5:75-79. [PMID: 32656351 PMCID: PMC7347018 DOI: 10.1089/trgh.2019.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Tony Eljallad
- Department of Pediatrics, Henry Ford Health System, Detroit, Michigan, USA
| | - Isadore Dodard-Friedman
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amy Tang
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Christine L.M. Joseph
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
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13
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Abstract
PURPOSE OF REVIEW Cannabis is widely used worldwide and cannabis use disorders are highly comorbid with anxiety disorders. In this review, we consider the recent literature on the effects of cannabis on the incidence, course, and treatment outcomes of anxiety disorders. RECENT FINDINGS Although cannabis use is mostly found to be associated with increased incidence of anxiety disorders, these findings are generally not sustained in adjusted analyses controlling for multiple confounders. There are some equivocal data suggesting higher risk for anxiety disorders among heavy cannabis users. The scarce data available indicates no clear effect of cannabis use on the course and treatment outcomes of anxiety disorders. SUMMARY Further research is needed focusing on trajectories of cannabis-induced acute anxiety, effects of cannabis use on treatment outcomes in anxiety disorders, and common genetic factors. Future epidemiological studies should utilize more precise measures of cannabis use and address several confounding factors which may affect the association between cannabis use and anxiety disorders.
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14
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15
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Sartori SB, Singewald N. Novel pharmacological targets in drug development for the treatment of anxiety and anxiety-related disorders. Pharmacol Ther 2019; 204:107402. [PMID: 31470029 DOI: 10.1016/j.pharmthera.2019.107402] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/19/2019] [Indexed: 12/24/2022]
Abstract
Current medication for anxiety disorders is suboptimal in terms of efficiency and tolerability, highlighting the need for improved drug treatments. In this review an overview of drugs being studied in different phases of clinical trials for their potential in the treatment of fear-, anxiety- and trauma-related disorders is presented. One strategy followed in drug development is refining and improving compounds interacting with existing anxiolytic drug targets, such as serotonergic and prototypical GABAergic benzodiazepines. A more innovative approach involves the search for compounds with novel mechanisms of anxiolytic action using the growing knowledge base concerning the relevant neurocircuitries and neurobiological mechanisms underlying pathological fear and anxiety. The target systems evaluated in clinical trials include glutamate, endocannabinoid and neuropeptide systems, as well as ion channels and targets derived from phytochemicals. Examples of promising novel candidates currently in clinical development for generalised anxiety disorder, social anxiety disorder, panic disorder, obsessive compulsive disorder or post-traumatic stress disorder include ketamine, riluzole, xenon with one common pharmacological action of modulation of glutamatergic neurotransmission, as well as the neurosteroid aloradine. Finally, compounds such as D-cycloserine, MDMA, L-DOPA and cannabinoids have shown efficacy in enhancing fear-extinction learning in humans. They are thus investigated in clinical trials as an augmentative strategy for speeding up and enhancing the long-term effectiveness of exposure-based psychotherapy, which could render chronic anxiolytic drug treatment dispensable for many patients. These efforts are indicative of a rekindled interest and renewed optimism in the anxiety drug discovery field, after decades of relative stagnation.
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Affiliation(s)
- Simone B Sartori
- Institute of Pharmacy, Department of Pharmacology and Toxicology, Center for Molecular Biosciences Innsbruck (CMBI), Leopold Franzens University Innsbruck, Innsbruck, Austria
| | - Nicolas Singewald
- Institute of Pharmacy, Department of Pharmacology and Toxicology, Center for Molecular Biosciences Innsbruck (CMBI), Leopold Franzens University Innsbruck, Innsbruck, Austria.
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16
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Wallis AL, Gretz DP, Rings JA, Eberle KM. Assessing Marijuana Use, Anxiety, and Academic Performance Among College Students. JOURNAL OF COLLEGE COUNSELING 2019. [DOI: 10.1002/jocc.12125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Aaron L. Wallis
- Department of Applied Psychology and Counselor EducationUniversity of Northern Colorado, Greeley
- Now at Open Sky Wilderness Therapy, Durango Colorado
| | - David P. Gretz
- Department of Applied Psychology and Counselor EducationUniversity of Northern Colorado, Greeley
| | - Jeffrey A. Rings
- Department of Applied Psychology and Counselor EducationUniversity of Northern Colorado, Greeley
| | - Kiersten M. Eberle
- Department of Applied Psychology and Counselor EducationUniversity of Northern Colorado, Greeley
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17
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Subramaniam P, Rogowska J, DiMuzio J, Lopez-Larson M, McGlade E, Yurgelun-Todd D. Orbitofrontal connectivity is associated with depression and anxiety in marijuana-using adolescents. J Affect Disord 2018; 239:234-241. [PMID: 30025312 DOI: 10.1016/j.jad.2018.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/17/2018] [Accepted: 07/01/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Prevalence of marijuana (MJ) use among adolescents has been on the rise. MJ use has been reported to impact several brain regions, including frontal regions such as the orbitofrontal cortex (OFC). The OFC is involved in emotion regulation and processing and has been associated with symptoms of depression and anxiety. Therefore, we hypothesized that adolescent MJ users would show disruptions in OFC connectivity compared with healthy adolescents (HC) which would be associated with symptoms of mood and anxiety. METHODS 43 MJ-using and 31 HC adolescents completed clinical measures including the Hamilton Anxiety Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D). Resting-state functional magnetic resonance imaging data was also acquired for all participants. RESULTS In MJ users, increased depressive symptoms were associated with increased connectivity between the left OFC and left parietal regions. In contrast, lower ratings of anxiety were associated with increased connectivity between right and left OFC and right occipital and temporal regions. These findings indicate significant differences in OFC connectivity in MJ-using adolescents, which correlated with mood/anxiety. LIMITATIONS Future studies with an increased number of female participants is required to address potential sex differences in connectivity patterns related to symptoms of depression and anxiety. CONCLUSIONS This study highlights the association between OFC connectivity, MJ use, and symptoms of depression and anxiety in adolescents. These findings provide further insight into understanding the neural correlates that modulate the relationship between comorbid MJ use and mood disorders and could potentially help us better develop preventive and treatment measures.
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Affiliation(s)
- Punitha Subramaniam
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, UT, USA; Department of Psychiatry, University of Utah, Salt Lake City, UT, USA.
| | - Jadwiga Rogowska
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA
| | - Jennifer DiMuzio
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA
| | | | - Erin McGlade
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; Department of Psychiatry, University of Utah, Salt Lake City, UT, USA; Department of Veteran Affairs, Rocky Mountain MIRECC, Salt Lake City, UT, USA
| | - Deborah Yurgelun-Todd
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, UT, USA; Department of Psychiatry, University of Utah, Salt Lake City, UT, USA; Department of Veteran Affairs, Rocky Mountain MIRECC, Salt Lake City, UT, USA
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18
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Feingold D, Rehm J, Factor H, Redler A, Lev-Ran S. Clinical and functional outcomes of cannabis use among individuals with anxiety disorders: A 3-year population-based longitudinal study. Depress Anxiety 2018; 35:490-501. [PMID: 29486095 DOI: 10.1002/da.22735] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/09/2018] [Accepted: 01/29/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cannabis use has been reported to negatively affect the course and outcome of various psychiatric disorders, yet little is known on its effect on rates of remission from anxiety disorders and associated clinical and functional outcomes. METHODS In this study, data were drawn from Waves 1 and 2 of the National Epidemiologic survey on Alcohol and Related Conditions, focusing on individuals who qualified for a diagnosis of any anxiety disorder (social anxiety, panic disorder, generalized anxiety disorder, and specific phobias) at Wave 1 (N = 3,723). Cannabis users and individuals with cannabis use disorders (CUDs) throughout a 4-year period were compared to nonusers in rates of remission, suicidality, general functioning, and quality of life at Wave 2, while controlling for baseline confounders. RESULTS Although rates of remission decreased with level of cannabis use, this was not maintained in adjusted models. Aside from specific outcomes (individuals with CUDs were significantly more prone to report breaking up from a romantic relationship; adjusted odds ratio [AOR] = 3.85, 95% confidence interval [CI] = 1.66-8.97) and repeatedly quitting school (AOR = 6.02, 95% CI = 2.65-13.66)), following adjustment no additional differences were found in outcome measures. CONCLUSIONS These findings add to previous reports suggesting that poorer outcome of anxiety disorders among cannabis users may be attributed mainly to differences in baseline factors and not cannabis use.
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Affiliation(s)
- Daniel Feingold
- Psychology Department, Ariel University, Ariel, Israel.,Lev-Hasharon Medical Center, Pardesiya, Israel
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Klinische Psychologie & Psychotherapie, Technische Universität Dresden, Dresden, Germany
| | - Hagai Factor
- Masters Program, Psychology Department, Ariel University, Ariel, Israel
| | - Avigayil Redler
- Masters Program, Psychology Department, Ariel University, Ariel, Israel
| | - Shaul Lev-Ran
- Lev-Hasharon Medical Center, Pardesiya, Israel.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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19
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VanderVeen JD, Hershberger AR, Cyders MA. UPPS-P model impulsivity and marijuana use behaviors in adolescents: A meta-analysis. Drug Alcohol Depend 2016; 168:181-190. [PMID: 27682358 DOI: 10.1016/j.drugalcdep.2016.09.016] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Impulsivity is often included as a risk factor in models of adolescent marijuana use behaviors; however, the magnitude of the association between impulsivity and marijuana use behaviors is variable across studies. The present study reviewed existent literature to 1) quantify the relationship between separable impulsivity-related traits and both marijuana use and negative marijuana consequences and 2) quantify the size of the effect of gender on these relationships. METHOD Thirty-eight studies (41 independent samples) were meta-analyzed using a random effects model to examine the relationship between impulsivity traits and marijuana use behaviors. RESULTS Marijuana use was significantly related to all impulsivity-related traits except lack of perseverance (r's ranging from 0.13-0.23, p's<0.01). Negative marijuana consequences were only significantly related to sensation seeking, lack of planning, and positive urgency (r's ranging from 0.37-0.39, p's<0.01). Effects were small for marijuana use, but medium for negative marijuana consequences. Gender was not a significant moderator of any relationships. CONCLUSIONS Impulsivity-related traits had more robust relationships with negative marijuana consequences than marijuana use, suggesting impulsivity-related traits are important in differentiating adolescents most likely to experience negative consequences from marijuana use. Few relationships examined gender and many of the impulsivity-related traits, other than sensation seeking. Data and trends suggest a more multi-dimensional approach to marijuana use and consequences is warranted.
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Affiliation(s)
- J Davis VanderVeen
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N Blackford St., Indianapolis, IN 46202, USA.
| | - Alexandra R Hershberger
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N Blackford St., Indianapolis, IN 46202, USA
| | - Melissa A Cyders
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N Blackford St., Indianapolis, IN 46202, USA
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20
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Fidalgo TM, Sanchez ZM, Caetano SC, Maia LO, Carlini EA, Martins SS. The association of psychiatric symptomatology with patterns of alcohol, tobacco, and marijuana use among Brazilian high school students. Am J Addict 2016; 25:416-25. [PMID: 27437619 DOI: 10.1111/ajad.12407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 05/29/2016] [Accepted: 07/06/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Studies have highlighted psychosocial factors associated with drug use among adolescents. Association of specific psychiatric comorbidity with substance use has not been properly established in Brazil. This study aimed to investigate alcohol, tobacco, and marijuana use by 15-18-year-old high school Brazilian students and to estimate associations with psychiatric symptoms. METHODS A cross-sectional survey of 4,034 students from 128 public and private schools in São Paulo State was carried out using a two-step probability sample. Data were collected through self-report standardized questionnaires including questions on substance use patterns and the Strengths and Difficulties Questionnaire (SDQ). Key outcome variables were past-month use and past-month frequent use of alcohol, tobacco and marijuana. Questionnaires with missing information were excluded, resulting in a final sample of 2,532 adolescents. Weighted data was analyzed through logistic regressions, adjusted by gender and by socio-economic status (SES). RESULTS Regarding SDQ total score, 43.6% of students had no psychiatric symptoms, 7.9% had subclinical symptoms and 48.5% presented clinically significant symptoms. Respondents with a clinically significant SDQ score were more likely to be past month alcohol (aOR = 1.51; 95%CI 1.22-1.88), tobacco (aOR = 1.82; 95%CI 1.25-2.66), and marijuana (aOR = 1.79; 95%CI 1.21-2.64) users as compared to those with no symptomatology. DISCUSSION AND CONCLUSIONS Psychopathological symptoms were associated with alcohol, tobacco and marijuana use by 15-18-year-old adolescents. These associations should also be considered when planning public policies of mental health promotion. SCIENTIFIC SIGNIFICANCE This study discusses the importance of the association between psychopathological symptoms and substance use in a middle-income country, with high level of social inequalities, in a state representative sample. (Am J Addict 2016;25:416-425).
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Affiliation(s)
- Thiago M Fidalgo
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Zila M Sanchez
- Department of Preventive Medicine, Brazilian Center of Information on Psychotropic Drugs (CEBRID), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sheila C Caetano
- Department of Psychiatry, Child and Adolescent Psychiatry Unit (UPIA), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lucas O Maia
- Department of Preventive Medicine, Brazilian Center of Information on Psychotropic Drugs (CEBRID), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Elisaldo A Carlini
- Department of Preventive Medicine, Brazilian Center of Information on Psychotropic Drugs (CEBRID), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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