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Sorkhou M, Dent EL, George TP. Cannabis use and mood disorders: a systematic review. Front Public Health 2024; 12:1346207. [PMID: 38655516 PMCID: PMC11035759 DOI: 10.3389/fpubh.2024.1346207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Background Problematic cannabis use is highly prevalent among people with mood disorders. This underscores the need to understand the effects of cannabis and cannabinoids in this population, especially considering legalization of recreational cannabis use. Objectives We aimed to (1) systematically evaluate cross-sectional and longitudinal studies investigating the interplay between cannabis use, cannabis use disorder (CUD), and the occurrence of mood disorders and symptoms, with a focus on major depressive disorder (MDD) and bipolar disorder (BD) and; (2) examine the effects of cannabis on the prognosis and treatment outcomes of MDD and BD. Methods Following PRISMA guidelines, we conducted an extensive search for English-language studies investigating the potential impact of cannabis on the development and prognosis of mood disorders published from inception through November 2023, using EMBASE, PsycINFO, PubMed, and MEDLINE databases. Results Our literature search identified 3,262 studies, with 78 meeting inclusion criteria. We found that cannabis use is associated with increased depressive and manic symptoms in the general population in addition to an elevated likelihood of developing MDD and BD. Furthermore, we observed that cannabis use is linked to an unfavorable prognosis in both MDD or BD. Discussion Our findings suggest that cannabis use may negatively influence the development, course, and prognosis of MDD and BD. Future well-designed studies, considering type, amount, and frequency of cannabis use while addressing confounding factors, are imperative for a comprehensive understanding of this relationship. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023481634.
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Affiliation(s)
- Maryam Sorkhou
- Institute for Mental Health Policy and Research at CAMH, Toronto, ON, Canada
- Department of Psychiatry, Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Eliza L. Dent
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Tony P. George
- Institute for Mental Health Policy and Research at CAMH, Toronto, ON, Canada
- Department of Psychiatry, Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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2
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Lowe DJE, Sorkhou M, George TP. Cannabis use in adolescents and anxiety symptoms and disorders: a systematic review and meta-analysis. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:150-161. [PMID: 38285048 DOI: 10.1080/00952990.2023.2299922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 12/11/2023] [Indexed: 01/30/2024]
Abstract
Background: The use of cannabis is highly prevalent during adolescence compared to the general adult population. In addition to the high comorbidity between cannabis use and anxiety disorders, early evidence suggests that cannabis may precede the development of anxiety. Moreover, adolescence represents a major developmental period for both neurobiological and psychological processes, placing these individuals at a heightened vulnerability to the influence of cannabis.Objectives: This systematic review and meta-analysis examined the prospective associations between adolescent cannabis use and subsequent anxiety outcomes (i.e. anxiety disorders and/or symptoms).Methods: Following PRISMA guidelines, a systematic review and meta-analysis were conducted encompassing data from articles published between database inception and September 2022.Results: Six longitudinal studies were identified for quantitative analysis, while twelve non-overlapping longitudinal studies were identified for qualitative review (total N = 18; 33380 subjects). Meta-analytical findings supported an association between adolescent cannabis use and the development of a subsequent anxiety disorder (Odds Ratio = 2.14, 95% CI: 1.37-3.36, p < .01). These findings were consistent with our qualitative synthesis where nine of the twelve longitudinal studies observed a significant relationship between adolescent cannabis use and exacerbation of anxiety symptoms later in life, irrespective of an anxiety disorder diagnosis.Discussion: In summary, the current evidence suggests a prospective association between adolescent cannabis use and later anxiety symptoms and disorders. These findings underscore the importance of refining research methodologies, considering sex-based differences and controlling for confounding factors, as well as implementing educational initiatives and developing clinical interventions to address the mental health risks associated with cannabis use among adolescents.
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Affiliation(s)
- Darby J E Lowe
- Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Maryam Sorkhou
- Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Tony P George
- Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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3
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Choi NG, DiNitto DM, Marti CN, Choi BY. Cannabis and binge alcohol use among older individuals with major depressive episode. Subst Abus 2021; 43:657-665. [PMID: 34666638 DOI: 10.1080/08897077.2021.1986879] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Research shows significant associations of major depression with cannabis and binge alcohol use. However, despite increasing cannabis and binge alcohol use rates among the 50+ age group, research on this age group is scant. Methods: We used the 2015-2019 National Survey on Drug Use and Health data (n = 44,007 age 50+) and multinomial logistic regression models to examine associations of a major depressive episode (MDE) with cannabis and binge alcohol use and co-use and associations of binge alcohol use with nonmedical and medical cannabis use. Results: Of individuals age 50+, 89.6% had no history of MDE, 5.7% had prior-to-past-year MDE, and 4.7% had past-year MDE. The rates of past-month cannabis use were 4.3%, 7.7%, and 11.6% and binge alcohol use were 17.3%, 18.7%, and 19.9% among those with no MDE history, prior-to-past-year MDE, and past-year MDE, respectively. Compared to no MDE history, prior-to-past-year MDE (RRR = 1.70, 95% CI = 1.30-2.23) and past-year MDE (RRR = 1.80, 95% CI = 1.27-2.55) were significantly associated with past-month cannabis use (with or without binge alcohol use). However, MDE status was not associated with past-month binge alcohol use. Among cannabis users, binge alcohol use was significantly associated with nonmedical cannabis use only (RRR = 2.50, 95% CI = 1.95-3.21). Users of cannabis and/or binge alcohol also had a higher likelihood of using tobacco products and illicit drugs. Conclusions: Healthcare professionals treating individuals age 50+ with depression should screen for substance use, provide education on the potential adverse effects of polysubstance use, and help them access treatment for co-occurring depression and substance use problems.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Diana M DiNitto
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - C Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA.,Bayhealth Medical Center, Dover, Delaware, USA
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Paudel P, Ross S, Li XC. Molecular Targets of Cannabinoids Associated with Depression. Curr Med Chem 2021; 29:1827-1850. [PMID: 34165403 DOI: 10.2174/0929867328666210623144658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 11/22/2022]
Abstract
Novel therapeutic strategies are needed to address depression, a major neurological disorder affecting hundreds of millions of people worldwide. Cannabinoids and their synthetic derivatives have demonstrated numerous neurological activities and may potentially be developed into new treatments for depression. This review highlights cannabinoid (CB) receptors, monoamine oxidase (MAO), N-methyl-D-aspartate (NMDA) receptor, gamma-aminobutyric acid (GABA) receptor, and cholecystokinin (CCK) receptor as key molecular targets of cannabinoids that are associated with depression. The anti-depressant activity of cannabinoids and their binding modes with cannabinoid receptors are discussed, providing insights into rational design and discovery of new cannabinoids or cannabimimetic agents with improved druggable properties.
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Affiliation(s)
- Pradeep Paudel
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, Mississippi 38677, United States
| | - Samir Ross
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, Mississippi 38677, United States
| | - Xing-Cong Li
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, Mississippi 38677, United States
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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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Abstract
There is a growing body of evidence pointing to the co-occurrence of cannabis use and depression. There is also some evidence that the use of cannabis may lead to the onset of depression; however, strong evidence points to the inverse association; i.e. that depression may lead to the onset or increase in cannabis use frequency. Observational and epidemiological studies have not indicated a positive long-term effect of cannabis use on the course and outcome of depression. The association between cannabis use and depression may be stronger among men during adolescence and emerging adulthood and stronger in women during midlife. There is an indication for potential genetic correlation contributing to the comorbidity of cannabis dependence and major depression, namely that serotonin (5-HT) may mediate such association and there is also evidence for specific risk alleles for cannabis addiction. There is preclinical evidence that alteration in the endocannabinoid system could potentially benefit patients suffering from depression. However, the issue of using cannabis as an anti-depressant is at an early stage of examination and there is little evidence to support it. Finally, there has been little support to the notion that selective serotonin reuptake inhibitors (SSRIs) may be effective in decreasing depressive symptoms or rates of substance use in adolescents treated for depression and a co-occurring substance use disorder. In conclusion, despite methodological limitations, research in the past decades has broadened our knowledge on the association between cannabis use and depression from epidemiological, neurological, genetic, and pharmacological perspectives.
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Depression level, not pain severity, is associated with smoked medical marijuana dosage among chronic pain patients. J Psychosom Res 2020; 135:110130. [PMID: 32417435 DOI: 10.1016/j.jpsychores.2020.110130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The use of medical marijuana (MM) for the treatment of chronic pain is rapidly growing in the United States and Europe; however there is concern regarding the specificity of its therapeutic effects and the motivation underlying its use. While research indicates that among chronic pain prescribed opioids, depression has been associated with increased opioid dosage (regardless of pain levels), the extent to which depression and pain each contribute to MM dose among chronic pain patients is yet unknown. METHODS This cross-sectional study included 209 chronic pain patients prescribed smoked MM, in flower or other plant form, with no concurrent opioid treatment. Ordinal regression analyses were performed in order to explore the unique contribution of mean pain level (1-10 scale), depression severity (measured by the Patient Health Questionnaire (PHQ-9)) and anxiety severity (measured by the Generalized Anxiety Disorder scale (GAD-7)) to doses of MM, while taking into account additional sociodemographic and clinical factors. RESULTS Individuals with mild depression and those with moderate to severe depression were at significantly increased odds for using higher doses of MM in grams per month(Adjusted Odds Ratio(AOR) = 2.06,95% Confidence Interval(CI) = 1.05-4.01, and AOR = 5.95,95% CI = 1.97-17.98, respectively) compared to those without depression. In addition, individuals with mild depression were at significantly increased odds for smoking more MM joints daily(AOR = 2.07, 95% CI = 1.01-4.23) compared to individuals without depression. Mean levels of pain or anxiety severity were not significantly associated with either dose measures. CONCLUSIONS Depression and MM dose are highly correlated and should be concurrently addressed during chronic pain treatment.
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Forrester SY, Jahan N. Depression Onset in Long-term Adolescent Cannabinoid Use: A Neurobiological Review. Cureus 2020; 12:e7759. [PMID: 32455076 PMCID: PMC7243066 DOI: 10.7759/cureus.7759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Escalating cannabis use may be linked to decreased motivation and anhedonia, which are symptoms of depression. Adolescent cannabis users with subthreshold depressive symptoms such as reduced motivation may be susceptible to the development of significant anhedonia in addition to impaired emotional development. The main issue regarding depression within the context of cannabis use is whether or not there is a neurobiological basis linking the two variables. A Medical Subject Headings (MeSH) function PubMed search using the keywords “cannabis, depression, adolescence, endocannabinoid, and temperament” returned 1,109 articles. Data were included from studies that satisfied the following criteria: (i) published within the last 10 years (older studies were included based on relevance), (ii) on adolescent subjects (animal or human), (iii) published in English, (iv) journal articles, systematic reviews, meta-analyses, clinical trials, observational studies (animal or human), (v) on subjects who had unipolar depression with no comorbidities, and (vi) on subjects who used cannabis [with no confounding variables such as the use of ethanol, nicotine, cocaine, lysergic acid diethylamide (LSD), and heroin; and no medical conditions such as comorbid psychosis, mania, or autism]. Depressive symptoms in cannabinoid users were a common co-occurrence partly explained by pleiotropic linkage of genetic locus identified on chromosome 11q23.1-q23.2 and comprises the gene sequence nuclear cell adhesion molecule 1-tetratricopeptide repeat domain 12-ankyrin repeat and kinase domain containing 1-dopamine receptor D2 (NCAM1-TTC12-ANKK1-DRD2). The relationship between the two is not invariant and is influenced by polymorphic DRD, endocannabinoid receptor (CNR), and 5-HT genes. Anhedonia seemed to be the most important symptom. Cannabinoid-induced long-term neuroplastic changes, particularly in the dorsal striatum, is a possible mechanism resulting in anhedonia and long-term effects on motivation.
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Affiliation(s)
- Shawn Y Forrester
- Psychiatry, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Nusrat Jahan
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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9
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Botsford SL, Yang S, George TP. Cannabis and Cannabinoids in Mood and Anxiety Disorders: Impact on Illness Onset and Course, and Assessment of Therapeutic Potential. Am J Addict 2020; 29:9-26. [PMID: 31577377 PMCID: PMC6925309 DOI: 10.1111/ajad.12963] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/11/2019] [Accepted: 09/17/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cannabis use is common in people with and mood and anxiety disorders (ADs), and rates of problematic use are higher than in the general population. Given recent policy changes in favor of cannabis legalization, it is important to understand how cannabis and cannabinoids may impact people with these disorders. We aimed to assess the effects of cannabis on the onset and course of depression, bipolar disorder, ADs, and post-traumatic stress disorder (PTSD), and also to explore the therapeutic potential of cannabis and cannabinoids for these disorders. METHODS A systematic review of the literature was completed. The PubMed® database from January 1990 to May 2018 was searched. We included longitudinal cohort studies, and also all studies using cannabis or a cannabinoid as an active intervention, regardless of the study design. RESULTS Forty-seven studies were included: 32 reported on illness onset, nine on illness course, and six on cannabinoid therapeutics. Cohort studies varied significantly in design and quality. The literature suggests that cannabis use is linked to the onset and poorer clinical course in bipolar disorder and PTSD, but this finding is not as clear in depression and anxiety disorders (ADs). There have been few high-quality studies of cannabinoid pharmaceuticals in clinical settings. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE These conclusions are limited by a lack of well-controlled longitudinal studies. We suggest that future research be directed toward high-quality, prospective studies of cannabis in clinical populations with mood and ADs, in addition to controlled studies of cannabinoid constituents and pharmaceuticals in these populations. (Am J Addict 2019;00:00-00).
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Affiliation(s)
- Sabrina L Botsford
- Department of Psychiatry, Addictions Division, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Ontario, Canada
| | - Sharon Yang
- Department of Psychiatry, Addictions Division, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Ontario, Canada
| | - Tony P George
- Department of Psychiatry, Addictions Division, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Ontario, Canada
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Abstract
Objective: This review discusses the relationship between cannabis use and psychotic, bipolar, depressive, and anxiety disorders, as well as suicide. It summarizes epidemiological evidence from cross-sectional and long-term prospective studies and considers possible etiological mechanisms. Methods: Systematic reviews and methodologically robust studies in the field (from inception to February 2019) were identified using a comprehensive search of Medline, PsychINFO, and Embase and summarized using a narrative synthesis. Results: Consistent evidence, both from observational and experimental studies, has confirmed the important role of cannabis use in the initiation and persistence of psychotic disorders. The size of the effect is related to the extent of cannabis use, with greater risk for early cannabis use and use of high-potency varieties and synthetic cannabinoids. Accumulating evidence suggests that frequent cannabis use also increases the risk for mania as well as for suicide. However, the effect on depression is less clear and findings on anxiety are contradictory with only a few methodologically robust studies. Furthermore, the relationship with common mental disorders may involve reverse causality, as depression and anxiety are reported to lead to greater cannabis consumption in some studies. Pathogenetic mechanisms focus on the effect of tetrahydrocannabinol (THC, the main psychoactive ingredient of cannabis) interacting with genetic predisposition and perhaps other environmental risk factors. Cannabidiol (CBD), the other important ingredient of traditional cannabis, ameliorates the psychotogenic effects of THC but is absent from the high-potency varieties that are increasingly available. Conclusions: The evidence that heavy use of high-THC/low-CBD types of cannabis increases the risk of psychosis is sufficiently strong to merit public health education. Evidence of similar but smaller effects in mania and suicide is growing, but is not convincing for depression and anxiety. There is much current interest in the possibility that CBD may be therapeutically useful.
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Affiliation(s)
- Lucia Sideli
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK.,Department of Biomedicine, Neurosciences, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Harriet Quigley
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK.,South London and Maudsley NHS Trust Biomedical Research Centre, London, UK
| | - Caterina La Cascia
- Department of Biomedicine, Neurosciences, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Robin M Murray
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK.,Department of Biomedicine, Neurosciences, and Advanced Diagnostic, University of Palermo, Palermo, Italy.,South London and Maudsley NHS Trust Biomedical Research Centre, London, UK
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Gobbi G, Atkin T, Zytynski T, Wang S, Askari S, Boruff J, Ware M, Marmorstein N, Cipriani A, Dendukuri N, Mayo N. Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood: A Systematic Review and Meta-analysis. JAMA Psychiatry 2019; 76:426-434. [PMID: 30758486 PMCID: PMC6450286 DOI: 10.1001/jamapsychiatry.2018.4500] [Citation(s) in RCA: 425] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/26/2018] [Indexed: 11/14/2022]
Abstract
Importance Cannabis is the most commonly used drug of abuse by adolescents in the world. While the impact of adolescent cannabis use on the development of psychosis has been investigated in depth, little is known about the impact of cannabis use on mood and suicidality in young adulthood. Objective To provide a summary estimate of the extent to which cannabis use during adolescence is associated with the risk of developing subsequent major depression, anxiety, and suicidal behavior. Data Sources Medline, Embase, CINAHL, PsycInfo, and Proquest Dissertations and Theses were searched from inception to January 2017. Study Selection Longitudinal and prospective studies, assessing cannabis use in adolescents younger than 18 years (at least 1 assessment point) and then ascertaining development of depression in young adulthood (age 18 to 32 years) were selected, and odds ratios (OR) adjusted for the presence of baseline depression and/or anxiety and/or suicidality were extracted. Data Extraction and Synthesis Study quality was assessed using the Research Triangle Institute item bank on risk of bias and precision of observational studies. Two reviewers conducted all review stages independently. Selected data were pooled using random-effects meta-analysis. Main Outcomes and Measures The studies assessing cannabis use and depression at different points from adolescence to young adulthood and reporting the corresponding OR were included. In the studies selected, depression was diagnosed according to the third or fourth editions of Diagnostic and Statistical Manual of Mental Disorders or by using scales with predetermined cutoff points. Results After screening 3142 articles, 269 articles were selected for full-text review, 35 were selected for further review, and 11 studies comprising 23 317 individuals were included in the quantitative analysis. The OR of developing depression for cannabis users in young adulthood compared with nonusers was 1.37 (95% CI, 1.16-1.62; I2 = 0%). The pooled OR for anxiety was not statistically significant: 1.18 (95% CI, 0.84-1.67; I2 = 42%). The pooled OR for suicidal ideation was 1.50 (95% CI, 1.11-2.03; I2 = 0%), and for suicidal attempt was 3.46 (95% CI, 1.53-7.84, I2 = 61.3%). Conclusions and Relevance Although individual-level risk remains moderate to low and results from this study should be confirmed in future adequately powered prospective studies, the high prevalence of adolescents consuming cannabis generates a large number of young people who could develop depression and suicidality attributable to cannabis. This is an important public health problem and concern, which should be properly addressed by health care policy.
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Affiliation(s)
- Gabriella Gobbi
- Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Tobias Atkin
- Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Tomasz Zytynski
- Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Shouao Wang
- Division of Clinical Epidemiology, McGill University Health Centre-Research Institute, Montreal, Quebec, Canada
| | - Sorayya Askari
- Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University Health Center, McGill University, Montreal, Quebec, Canada
- Division of Clinical Epidemiology, McGill University Health Centre-Research Institute, Montreal, Quebec, Canada
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada
| | - Mark Ware
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
- Oxford Health National Health Service Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Nandini Dendukuri
- Division of Clinical Epidemiology, McGill University Health Centre-Research Institute, Montreal, Quebec, Canada
| | - Nancy Mayo
- Division of Clinical Epidemiology, McGill University Health Centre-Research Institute, Montreal, Quebec, Canada
- Center for Outcomes Research and Evaluation, Department of Medicine, School of Physical and Occupational Therapy, McGill University Health Center Research Institute, McGill University, Montreal, Quebec, Canada
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Otten R, van der Zwaluw CS, Engels RC. Testing bidirectional relationships between alcohol use and depressive symptoms: What is the role of the serotonin transporter gene? Alcohol 2018; 66:69-75. [PMID: 29220746 DOI: 10.1016/j.alcohol.2017.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 07/28/2017] [Accepted: 08/06/2017] [Indexed: 10/19/2022]
Abstract
Alcohol abuse often co-exists with a major depressive disorder. In order to understand the development of this comorbidity, it is important to concentrate on the preceding process. It has been suggested that the link between alcohol use and depressive symptoms is a result of an interaction with genetic factors. The aim of this study was to longitudinally examine the effect of the 5-HTTLPR genotype on the association between depressive symptoms and alcohol use in a Dutch community sample. Following a stepwise approach, bivariate correlations, longitudinal regression analyses, and latent growth curve analyses were separately conducted for 316 males and 321 females. A positive correlation between depressive symptoms and alcohol use was shown in female carriers of the 5-HTTLPR short allele. In addition, latent growth curve analyses showed a positive association between alcohol use and the intercept of depressive symptoms (but not the slope), but only in female carriers of the 5-HTTLPR short allele. These findings show that alcohol use may be positively related, at least cross-sectionally, to depressive symptoms in female carriers of the 5-HTTLPR S allele, and indicate that moderators such as SLC6A4 genotype and sex need to be taken into account when examining associations between depressive symptoms and drinking behavior. In order to gain insight into the longitudinal association between alcohol use and depressive symptoms, studies should concentrate on earlier stages and focus on more fine-grained research designs that allow day-to-day changes in both alcohol use and depressive symptoms.
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Blum K, Gondré-Lewis MC, Baron D, Thanos PK, Braverman ER, Neary J, Elman I, Badgaiyan RD. Introducing Precision Addiction Management of Reward Deficiency Syndrome, the Construct That Underpins All Addictive Behaviors. Front Psychiatry 2018; 9:548. [PMID: 30542299 PMCID: PMC6277779 DOI: 10.3389/fpsyt.2018.00548] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 10/12/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Kenneth Blum
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA, United States.,Department of Psychiatry, Boonshoft School of Medicine, Dayton VA Medical Center, Wright State University, Dayton, OH, United States.,University of Vermont College of Medicine, Burlington, VM, United States.,Division of Addictive Services, Dominion Diagnostics, LLC, North Kingston, RI, United States.,Division of Precision Addiction Management, Geneus Health, LLC, San Antonio, TX, United States.,Institute of Psychology, University of Eötvös Loránd, Budapest, Hungary.,Department of Clinical Neurology, Path Foundation, New York, NY, United States.,Division of Neuroscience and Addiction Therapy, Summit Estate Recovery Center, Los Gatos, CA, United States.,Department of Neurogenetics Research and Addiction Therapy, The Florida House Experience, Deerfield Beach, FL, United States.,National Human Genome Center, Howard University, Washington, DC, United States
| | - Marjorie C Gondré-Lewis
- Division of Precision Addiction Management, Geneus Health, LLC, San Antonio, TX, United States.,Department of Anatomy, Howard University College of Medicine, Washington, DC, United States.,Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical and Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - David Baron
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA, United States.,Division of Precision Addiction Management, Geneus Health, LLC, San Antonio, TX, United States
| | - Panayotis K Thanos
- Division of Precision Addiction Management, Geneus Health, LLC, San Antonio, TX, United States.,Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical and Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States.,Department of Psychology, University at Buffalo, Buffalo, NY, United States
| | - Eric R Braverman
- Department of Clinical Neurology, Path Foundation, New York, NY, United States
| | - Jennifer Neary
- Division of Precision Addiction Management, Geneus Health, LLC, San Antonio, TX, United States
| | - Igor Elman
- Division of Precision Addiction Management, Geneus Health, LLC, San Antonio, TX, United States.,Department of Psychiatry, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Rajendra D Badgaiyan
- Division of Precision Addiction Management, Geneus Health, LLC, San Antonio, TX, United States.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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14
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Esmaeelzadeh S, Moraros J, Thorpe L, Bird Y. The association between depression, anxiety and substance use among Canadian post-secondary students. Neuropsychiatr Dis Treat 2018; 14:3241-3251. [PMID: 30538482 PMCID: PMC6260190 DOI: 10.2147/ndt.s187419] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE This study aims to examine the association between depression, anxiety and substance use among Canadian post-secondary students. METHODS This study used data from the spring 2016, American College Health Association - National College Health Assessment II (ACHA-NCHA II) survey. It includes 43,780 college students from 41 Canadian post-secondary institutions. The exposure variables of interest were alcohol, cannabis and tobacco use, and the outcome variables of interest were diagnosis or treatment for depression and/or anxiety. Descriptive statistics, univariate and multivariate logistic regression models were used to analyze our data. RESULTS Our study found that 14.7% of post-secondary students were diagnosed or treated for depression and 18.4% for anxiety within the past 12 months. Among current (past 30 days) substance use, it was reported that alcohol (69.3%), cannabis (17.9%) and tobacco (11%) were the most common. There was a significant association between depression and current tobacco use (OR =1.36, 95% CI: 1.22-1.52, P<0.001) and current cannabis use (OR =1.17, 95% CI: 1.05-1.31, P<0.001). There was also a gender-specific association between anxiety and female alcohol users (OR =1.41, 95% CI: 1.24-1.62, P<0.001). CONCLUSION The results of this study found significant associations between depression, tobacco use and cannabis use, and anxiety and alcohol use among post-secondary students. These conditions should be screened concurrently for improved outcomes among this vulnerable population.
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Affiliation(s)
| | - John Moraros
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada,
| | - Lilian Thorpe
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Yelena Bird
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada,
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15
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Ihongbe FA, Ihongbe TO, Masho SW, Petrov K. Association between synthetic cannabinoid use and depressive symptomology: Analysis of a US national survey of high-school seniors. JOURNAL OF SUBSTANCE USE 2017. [DOI: 10.1080/14659891.2017.1358306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Faith A. Ihongbe
- Bernard J. Dunn School of Pharmacy, Shenandoah University, Northern Virginia Campus, Ashburn, VA, USA
| | - Timothy O. Ihongbe
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Saba W. Masho
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Katerina Petrov
- Bernard J. Dunn School of Pharmacy, Shenandoah University, Northern Virginia Campus, Ashburn, VA, USA
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16
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Hser YI, Mooney LJ, Huang D, Zhu Y, Tomko RL, McClure E, Chou CP, Gray KM. Reductions in cannabis use are associated with improvements in anxiety, depression, and sleep quality, but not quality of life. J Subst Abuse Treat 2017; 81:53-58. [PMID: 28847455 DOI: 10.1016/j.jsat.2017.07.012] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 12/28/2022]
Abstract
AIMS This study examined the longitudinal association between reductions in cannabis use and changes in anxiety, depression, sleep quality, and quality of life. METHODS Secondary analyses were conducted based on data from a cannabis use disorder medication trial in 302 adults (ages 18-50). Changes in symptoms of anxiety and depression, sleep quality, and quality of life were assessed in relation to changes in cannabis use during the 12-week trial of treatment. RESULTS Based on the slope of individual cannabis use trajectory, the sample was classified into two groups (Cannabis Use Reduction, n=152 vs. Cannabis Use Increase, n=150) which was included as a binary covariate in subsequent modeling. Controlling for demographics (age, gender, race/ethnicity), treatment condition, and time-varying tobacco and alcohol use, separate latent growth curve models showed a significant association between the Cannabis Use Reduction group and improvement (i.e., lower values in slope) in anxiety (β=-0.09, SE=0.04; p<0.05), depression (β=-0.11, SE=0.04; p<0.01), and sleep quality (β=-0.07, SE=0.03; p<0.05) over the observation period, but not in quality of life. CONCLUSIONS These results indicate a longitudinal relationship between reductions in cannabis use and improvements in anxiety, depression, and sleep quality. Clinicians treating patients with co-occurring cannabis use and problems with anxiety, depression, or sleep quality should attend to cannabis use reduction as a component of treatment.
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Affiliation(s)
- Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, United States.
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, United States.
| | - David Huang
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, United States.
| | - Yuhui Zhu
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, United States.
| | - Rachel L Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.
| | - Erin McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.
| | - Chih-Ping Chou
- Institute of Preventive Medicine, University of Southern California, United States.
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.
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17
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Otten R, Huizink AC, Monshouwer K, Creemers HE, Onrust S. Cannabis use and symptoms of anxiety in adolescence and the moderating effect of the serotonin transporter gene. Addict Biol 2017; 22:1081-1089. [PMID: 26860734 DOI: 10.1111/adb.12372] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 01/12/2016] [Accepted: 01/12/2016] [Indexed: 12/31/2022]
Abstract
There is substantial evidence for the assumption that particularly heavy cannabis usett is associated with a variety of psychopathologic conditions. Little is known about the relationship between cannabis and anxiety. Prior studies have concluded that cannabis use alone is not sufficient for the development of long-term anxiety, and it has been suggested that cannabis is simply a risk factor that operates in conjunction with other risk factors. One such risk factor may be an individuals' genetic vulnerability. The present study examines the relationship between cannabis use and symptoms of anxiety by taking a developmental molecular-genetic perspective with a focus on a polymorphism involved in the regulation of serotonin. Specifically, we concentrated on changes in cannabis use and symptoms of anxiety over time and differences herein for individuals with and without the short allele of the 5-HTTLPR genotype. Data were from 1424 adolescents over a period of 5 years. We used different statistical analyses to test co-development of cannabis use and symptoms of anxiety throughout adolescence and the possible role of the 5-HTTLPR genotype in this process. Results from different analyses showed that cannabis use is associated with an increase in symptoms of anxiety, but only in carriers of the short allele of the 5-HTTLPR genotype, not in non-carriers. The findings of the present study show first evidence that the links between cannabis use and symptoms of anxiety are conditional on the individuals' genetic make-up.
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Affiliation(s)
- Roy Otten
- Research & Development; Pluryn; Nijmegen The Netherlands
- Behavioural Science Institute; Radboud University Nijmegen; Nijmegen The Netherlands
| | - Anja C. Huizink
- Faculty of Psychology and Education; VU University Amsterdam; Amsterdam The Netherlands
| | - Karin Monshouwer
- Netherlands Institute for Mental Health and Addiction; Trimbos Institute; Utrecht The Netherlands
| | - Hanneke E. Creemers
- Research Institute Child Development and Education; University of Amsterdam; Amsterdam The Netherlands
| | - Simone Onrust
- Netherlands Institute for Mental Health and Addiction; Trimbos Institute; Utrecht The Netherlands
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18
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Feingold D, Rehm J, Lev-Ran S. Cannabis use and the course and outcome of major depressive disorder: A population based longitudinal study. Psychiatry Res 2017; 251:225-234. [PMID: 28214781 DOI: 10.1016/j.psychres.2017.02.027] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 12/08/2016] [Accepted: 02/11/2017] [Indexed: 02/06/2023]
Abstract
Cannabis use has been reported to affect the course of various psychiatric disorders, however its effect on the course of major depressive disorder (MDD) is not yet clear. We used data from Wave 1 and Wave 2 of the National Epidemiologic survey on Alcohol and Related Conditions (NESARC). Individuals with baseline MDD (N=2,348) were included in the study. Cannabis users without a Cannabis Use Disorder (CUDs) and individuals with a CUD were compared to nonusers using linear and logistic regression analyses controlling for sociodemographics, psychiatric disorders and substance use disorders at baseline. No differences were found in rates of remission between the groups. Level of cannabis use was associated with significantly more depressive symptoms at follow-up, particularly anhedonia, changes in body weight, insomnia or hypersomnia and psychomotor problems. After adjusting for baseline confounding factors, no associations were found between cannabis use and suicidality, functionality and quality of life. We conclude that many of the associations between cannabis use and a more severe course of MDD do not seem to be attributed to cannabis use itself but to associated sociodemographic and clinical factors. Further longitudinal studies using depression severity indices are required.
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Affiliation(s)
- Daniel Feingold
- Ariel University, Ariel, Israel; Lev-Hasharon Medical Center, Pardesiya, Israel.
| | - Jürgen Rehm
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Technische Universität Dresden, Klinische Psychologie & Psychotherapie, Dresden, Germany
| | - Shaul Lev-Ran
- Lev-Hasharon Medical Center, Pardesiya, Israel; Social and Epidemiological Research Department, 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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Osuch EA, Manning K, Hegele RA, Théberge J, Neufeld R, Mitchell D, Williamson P, Gardner RC. Depression, marijuana use and early-onset marijuana use conferred unique effects on neural connectivity and cognition. Acta Psychiatr Scand 2016; 134:399-409. [PMID: 27565994 DOI: 10.1111/acps.12629] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Marijuana (MJ) use is common. Research shows risks for psychiatric illnesses, including major depressive disorder (MDD) and cognitive deficits with MJ use, particularly early-onset use. We investigated cognitive function, functional connectivity, and genetic risk with MDD alone and combined with MJ use, and differences between early-vs. late-onset/non-MJ use in youth. METHOD A total of 74 youth in four groups were studied: healthy control, MDD, frequent MJ use and current/past MDD plus frequent MJ use. Psychiatric symptoms, cognitive performance and demographics were measured. Default mode network (DMN) brain connectivity was determined. Risk alleles in six genes of interest were evaluated. RESULTS DMN differences among groups in reward-processing and motor control regions were found; the effects of MJ use and MDD were distinct. Early-onset MJ use was associated with lower IQ and hyperconnectivity within areas of the DMN. Early-onset MJ use was associated with the BDNF risk allele. CONCLUSIONS Cognitive deficits linked with early-onset MJ use were present within several years after MJ use began and may result from, predispose to, or share a common cause with early-onset MJ use. The DMN was affected by MDD, MJ and their combination, as well as by early-onset MJ use. BDNF carrier state may predispose to early-onset MJ use.
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Affiliation(s)
- E A Osuch
- Department of Psychiatry, University of Western Ontario, London, ON, Canada. .,Department of Medical Biophysics, University of Western Ontario, London, ON, Canada. .,Program in Neuroscience, University of Western Ontario, London, ON, Canada. .,Lawson Health Research Institute, London, ON, Canada.
| | - K Manning
- Robarts Research Institute, London, ON, Canada
| | - R A Hegele
- Robarts Research Institute, London, ON, Canada
| | - J Théberge
- Department of Psychiatry, University of Western Ontario, London, ON, Canada.,Department of Medical Biophysics, University of Western Ontario, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Department of Medical Imaging, University of Western Ontario, London, ON, Canada.,Department of Diagnostic Imaging, St. Joseph's Hospital, London, ON, Canada
| | - R Neufeld
- Department of Psychiatry, University of Western Ontario, London, ON, Canada.,Program in Neuroscience, University of Western Ontario, London, ON, Canada.,Department of Psychology, University of Western Ontario, London, ON, Canada
| | - D Mitchell
- Department of Psychiatry, University of Western Ontario, London, ON, Canada.,Department of Psychology, University of Western Ontario, London, ON, Canada.,Brain and Mind Institute, London, ON, Canada
| | - P Williamson
- Department of Psychiatry, University of Western Ontario, London, ON, Canada.,Department of Medical Biophysics, University of Western Ontario, London, ON, Canada.,Program in Neuroscience, University of Western Ontario, London, ON, Canada
| | - R C Gardner
- Department of Psychology, University of Western Ontario, London, ON, Canada
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20
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Relationship between marijuana and other illicit drug use and depression/suicidal thoughts among late middle-aged and older adults. Int Psychogeriatr 2016; 28:577-89. [PMID: 26542746 DOI: 10.1017/s1041610215001738] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite growing numbers of older-adult illicit drug users, research on this topic is rare. This study examined the relationship between marijuana and/or other illicit drug use and major depressive episode (MDE) and serious suicidal thoughts among those aged 50+ years in the USA. METHODS The public use files of the 2008 to 2012 US National Survey on Drug Use and Health (NSDUH) provided data on 29,634 individuals aged 50+ years. Logistic regression analysis was used to test hypothesized associations between past-year marijuana and/or other illicit drug use and MDE and serious suicidal thoughts. RESULTS Nearly 6% of the 50+ years age group reported past-year marijuana and/or other illicit drug use. Compared to non-users of any illicit drug, the odds of past-year MDE among those who used marijuana only, other illicit drugs only, and marijuana and other illicit drugs were 1.54 (95% CI = 1.17-2.03), 2.75 (95% CI = 1.75-4.33), and 2.12 (95% CI = 1.45-3.09), respectively. Those who used marijuana and other drugs also had higher odds (2.44, 95% CI = 1.58-3.77) of suicidal thoughts than non-users of any illicit drug. However, among users of any illicit drug, no difference was found among users of marijuana only, marijuana and other illicit drugs, and other illicit drugs only. Among marijuana users, marijuana use frequency was a significant correlate of suicidal thoughts only among those with MDE. CONCLUSIONS Health and mental health (MH) service providers should pay close attention to the potential reciprocal effects of marijuana and other illicit drug use and MDE and suicidal thoughts among late middle-aged and older adults.
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21
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Xia L, Yao S. The Involvement of Genes in Adolescent Depression: A Systematic Review. Front Behav Neurosci 2015; 9:329. [PMID: 26733829 PMCID: PMC4685064 DOI: 10.3389/fnbeh.2015.00329] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/14/2015] [Indexed: 01/20/2023] Open
Abstract
Numerous studies have reported on the roles of genetic factors in the development of depression in adolescents and young adults. However, there are few systematic reviews that update our understanding of adolescent depression with the biological findings identifying the roles of gene expression and/or polymorphism(s). This review systematically summarized the findings that clearly identified the contribution of a gene to the risk of depression in adolescents between the ages of 10 and 19 years old and young adults between the ages of 20 and 25 years old. Data were obtained through searching PubMed, Embase, and Web of Science. A total of 47 studies on early adolescence and three studies on young adults were included in the current review. Most articles studied genes in the serotonergic system (n = 26), dopaminergic system (n = 3), and the Brain-derived neurotropic factor (BDNF) gene (n = 12). 92.3% of studies (24/26) identified positive associations of 5-HTTLPR polymorphism with depressive illness or depressive symptoms. 83.3% of studies (10/12) found positive association between BDNF Val66Met genotype and adolescent depressive symptoms. More studies should be conducted on the 18 genes reported in a few studies to clarify their roles in the risk for adolescent depression.
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Affiliation(s)
- Liangwei Xia
- Medical Psychological Institute, Second Xiangya Hospital, Central South University Changsha, Hunan, China
| | - Shuqiao Yao
- Medical Psychological Institute, Second Xiangya Hospital, Central South UniversityChangsha, Hunan, China; National Technology Institute of PsychiatryChangsha, Hunan, China
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22
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González-Ortega I, Alberich S, Echeburúa E, Aizpuru F, Millán E, Vieta E, Matute C, González-Pinto A. Subclinical depressive symptoms and continued cannabis use: predictors of negative outcomes in first episode psychosis. PLoS One 2015; 10:e0123707. [PMID: 25875862 PMCID: PMC4398379 DOI: 10.1371/journal.pone.0123707] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/06/2015] [Indexed: 01/21/2023] Open
Abstract
Background Although depressive symptoms in first episode psychosis have been associated with cannabis abuse, their influence on the long-term functional course of FEP patients who abuse cannabis is unknown. The aims of the study were to examine the influence of subclinical depressive symptoms on the long-term outcome in first episode-psychosis patients who were cannabis users and to assess the influence of these subclinical depressive symptoms on the ability to quit cannabis use. Methods 64 FEP patients who were cannabis users at baseline were followed-up for 5 years. Two groups were defined: (a) patients with subclinical depressive symptoms at least once during follow-up (DPG), and (b) patients without subclinical depressive symptoms during follow-up (NDPG). Psychotic symptoms were measured using the Positive and Negative Syndrome Scale (PANSS), depressive symptoms using the Hamilton Depression Rating Scale (HDRS)-17, and psychosocial functioning was assessed using the Global Assessment of Functioning (GAF). A linear mixed-effects model was used to analyze the combined influence of cannabis use and subclinical depressive symptomatology on the clinical outcome. Results Subclinical depressive symptoms were associated with continued abuse of cannabis during follow-up (β= 4.45; 95% confidence interval [CI]: 1.78 to 11.17; P = .001) and with worse functioning (β = -5.50; 95% CI: -9.02 to -0.33; P = .009). Conclusions Subclinical depressive symptoms and continued cannabis abuse during follow-up could be predictors of negative outcomes in FEP patients.
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Affiliation(s)
- Itxaso González-Ortega
- Department of Psychiatry, University Hospital of Alava-Santiago, University of the Basque Country, CIBERSAM, Vitoria, Spain
- * E-mail:
| | - Susana Alberich
- Department of Psychiatry, University Hospital of Alava-Santiago, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - Enrique Echeburúa
- Department of Psychiatry, University Hospital of Alava-Santiago, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | | | - Eduardo Millán
- Dirección de Asistencia Sanitaria, Osakidetza, Vitoria, Spain
| | - Eduard Vieta
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Carlos Matute
- Achucarro Basque Center for Neuroscience, University of the Basque Country, CIBERNED, Leioa, Spain
| | - Ana González-Pinto
- Department of Psychiatry, University Hospital of Alava-Santiago, University of the Basque Country, CIBERSAM, Vitoria, Spain
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23
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Genetic Addiction Risk Score (GARS): molecular neurogenetic evidence for predisposition to Reward Deficiency Syndrome (RDS). Mol Neurobiol 2014; 50:765-96. [PMID: 24878765 PMCID: PMC4225054 DOI: 10.1007/s12035-014-8726-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 04/29/2014] [Indexed: 12/21/2022]
Abstract
We have published extensively on the neurogenetics of brain reward systems with reference to the genes related to dopaminergic function in particular. In 1996, we coined “Reward Deficiency Syndrome” (RDS), to portray behaviors found to have gene-based association with hypodopaminergic function. RDS as a useful concept has been embraced in many subsequent studies, to increase our understanding of Substance Use Disorder (SUD), addictions, and other obsessive, compulsive, and impulsive behaviors. Interestingly, albeit others, in one published study, we were able to describe lifetime RDS behaviors in a recovering addict (17 years sober) blindly by assessing resultant Genetic Addiction Risk Score (GARS™) data only. We hypothesize that genetic testing at an early age may be an effective preventive strategy to reduce or eliminate pathological substance and behavioral seeking activity. Here, we consider a select number of genes, their polymorphisms, and associated risks for RDS whereby, utilizing GWAS, there is evidence for convergence to reward candidate genes. The evidence presented serves as a plausible brain-print providing relevant genetic information that will reinforce targeted therapies, to improve recovery and prevent relapse on an individualized basis. The primary driver of RDS is a hypodopaminergic trait (genes) as well as epigenetic states (methylation and deacetylation on chromatin structure). We now have entered a new era in addiction medicine that embraces the neuroscience of addiction and RDS as a pathological condition in brain reward circuitry that calls for appropriate evidence-based therapy and early genetic diagnosis and that requires further intensive investigation.
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24
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Amchova P, Kucerova J, Giugliano V, Babinska Z, Zanda MT, Scherma M, Dusek L, Fadda P, Micale V, Sulcova A, Fratta W, Fattore L. Enhanced self-administration of the CB1 receptor agonist WIN55,212-2 in olfactory bulbectomized rats: evaluation of possible serotonergic and dopaminergic underlying mechanisms. Front Pharmacol 2014; 5:44. [PMID: 24688470 PMCID: PMC3960502 DOI: 10.3389/fphar.2014.00044] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 02/25/2014] [Indexed: 11/13/2022] Open
Abstract
Depression has been associated with drug consumption, including heavy or problematic cannabis use. According to an animal model of depression and substance use disorder comorbidity, we combined the olfactory bulbectomy (OBX) model of depression with intravenous drug self-administration procedure to verify whether depressive-like rats displayed altered voluntary intake of the CB1 receptor agonist WIN55,212-2 (WIN, 12.5 μg/kg/infusion). To this aim, olfactory-bulbectomized (OBX) and sham-operated (SHAM) Lister Hooded rats were allowed to self-administer WIN by lever-pressing under a continuous [fixed ratio 1 (FR-1)] schedule of reinforcement in 2 h daily sessions. Data showed that both OBX and SHAM rats developed stable WIN intake; yet, responses in OBX were constantly higher than in SHAM rats soon after the first week of training. In addition, OBX rats took significantly longer to extinguish the drug-seeking behavior after vehicle substitution. Acute pre-treatment with serotonin 5HT1B receptor agonist, CGS-12066B (2.5-10 mg/kg), did not significantly modify WIN intake in OBX and SHAM Lister Hooded rats. Furthermore, acute pre-treatment with CGS-12066B (10 and 15 mg/kg) did not alter responses in parallel groups of OBX and SHAM Sprague Dawley rats self-administering methamphetamine under higher (FR-2) reinforcement schedule with nose-poking as operandum. Finally, dopamine levels in the nucleus accumbens (NAc) of OBX rats did not increase in response to a WIN challenge, as in SHAM rats, indicating a dopaminergic dysfunction in bulbectomized rats. Altogether, our findings suggest that a depressive-like state may alter cannabinoid CB1 receptor agonist-induced brain reward function and that a dopaminergic rather than a 5-HT1B mechanism is likely to underlie enhanced WIN self-administration in OBX rats.
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Affiliation(s)
- Petra Amchova
- Central European Institute of Technology, Masaryk University Brno, Czech Republic ; Department of Pharmacology, Faculty of Medicine, Masaryk University Brno, Czech Republic
| | - Jana Kucerova
- Central European Institute of Technology, Masaryk University Brno, Czech Republic ; Department of Pharmacology, Faculty of Medicine, Masaryk University Brno, Czech Republic
| | - Valentina Giugliano
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari Monserrato, Italy
| | - Zuzana Babinska
- Central European Institute of Technology, Masaryk University Brno, Czech Republic ; Department of Pharmacology, Faculty of Medicine, Masaryk University Brno, Czech Republic
| | - Mary T Zanda
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari Monserrato, Italy
| | - Maria Scherma
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari Monserrato, Italy
| | - Ladislav Dusek
- Institute of Biostatistics and Analyses of Faculty of Medicine, Masaryk University Brno, Czech Republic
| | - Paola Fadda
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari Monserrato, Italy ; Center of Excellence "Neurobiology of Addiction," University of Cagliari Monserrato, Italy ; National Institute of Neuroscience (INN), University of Cagliari Monserrato, Italy
| | - Vincenzo Micale
- Central European Institute of Technology, Masaryk University Brno, Czech Republic
| | - Alexandra Sulcova
- Central European Institute of Technology, Masaryk University Brno, Czech Republic
| | - Walter Fratta
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari Monserrato, Italy ; Center of Excellence "Neurobiology of Addiction," University of Cagliari Monserrato, Italy ; National Institute of Neuroscience (INN), University of Cagliari Monserrato, Italy
| | - Liana Fattore
- Center of Excellence "Neurobiology of Addiction," University of Cagliari Monserrato, Italy ; CNR Institute of Neuroscience-Cagliari, National Research Council-Italy Monserrato, Italy
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Verdejo-García A, Fagundo AB, Cuenca A, Rodriguez J, Cuyás E, Langohr K, de Sola Llopis S, Civit E, Farré M, Peña-Casanova J, de la Torre R. COMT val158met and 5-HTTLPR genetic polymorphisms moderate executive control in cannabis users. Neuropsychopharmacology 2013; 38:1598-606. [PMID: 23449176 PMCID: PMC3682154 DOI: 10.1038/npp.2013.59] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 02/20/2013] [Accepted: 02/22/2013] [Indexed: 11/09/2022]
Abstract
The adverse effects of cannabis use on executive functions are still controversial, fostering the need for novel biomarkers able to unveil individual differences in the cognitive impact of cannabis consumption. Two common genetic polymorphisms have been linked to the neuroadaptive impact of Δ9-tetrahydrocannabinol (THC) exposure and to executive functions in animals: the catechol-O-methyltransferase (COMT) gene val158met polymorphism and the SLC6A4 gene 5-HTTLPR polymorphism. We aimed to test if these polymorphisms moderate the harmful effects of cannabis use on executive function in young cannabis users. We recruited 144 participants: 86 cannabis users and 58 non-drug user controls. Both groups were genotyped and matched for genetic makeup, sex, age, education, and IQ. We used a computerized neuropsychological battery to assess different aspects of executive functions: sustained attention (CANTAB Rapid Visual Information Processing Test, RVIP), working memory (N-back), monitoring/shifting (CANTAB ID/ED set shifting), planning (CANTAB Stockings of Cambridge, SOC), and decision-making (Iowa Gambling Task, IGT). We used general linear model-based analyses to test performance differences between cannabis users and controls as a function of genotypes. We found that: (i) daily cannabis use is not associated with executive function deficits; and (ii) COMT val158met and 5-HTTLPR polymorphisms moderate the link between cannabis use and executive performance. Cannabis users carrying the COMT val/val genotype exhibited lower accuracy of sustained attention, associated with a more strict response bias, than val/val non-users. Cannabis users carrying the COMT val allele also committed more monitoring/shifting errors than cannabis users carrying the met/met genotype. Finally, cannabis users carrying the 5-HTTLPR s/s genotype had worse IGT performance than s/s non-users. COMT and SLC6A4 genes moderate the impact of cannabis use on executive functions.
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Ewing SWF, Mead HK, Yezhuvath U, DeWitt S, Hutchison KE, Filbey FM. A preliminary examination of how serotonergic polymorphisms influence brain response following an adolescent cannabis intervention. Psychiatry Res 2012; 204:112-6. [PMID: 23217578 PMCID: PMC3544473 DOI: 10.1016/j.pscychresns.2012.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 10/04/2012] [Accepted: 10/09/2012] [Indexed: 11/28/2022]
Abstract
Given the link between depression, anxiety, and cannabis abuse, a serotonin receptor (rs6311) and transporter polymorphism (rs2020936) were examined as moderators of neural response as measured by functional magnetic resonance imaging following a psychosocial treatment for cannabis use disorders (CUDs). While the proposed hypotheses were unsupported, we found that the rs6311 C allele was significantly related to brain activation (medial frontal gyrus, precuneus), indicating the role of this serotonin receptor in adolescent treatment response.
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Affiliation(s)
- Sarah W. Feldstein Ewing
- University Honors/University of New Mexico Center on Alcohol and Substance Abuse Addictions (UNM CASAA), 1 University of New Mexico, MSC06 3890, Albuquerque, NM 87131, USA
,Corresponding author telephone: +1-505-277-4211, fax: +1-505-277-4271,
| | - Hilary K. Mead
- Seattle Children’s Hospital, Psychiatry and Behavioral Medicine, 4800 Sand Point Way NE Seattle, WA, 98105, USA
| | | | - Sam DeWitt
- Center for Brain Health, School of Behavioral and Brain Sciences, The University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX 75235, USA
| | - Kent E. Hutchison
- The University of Colorado at Boulder, Department of Psychology and Neuroscience, Muenzinger D244, 345 UCB, Boulder, CO 80309-0345 USA
| | - Francesca M. Filbey
- Center for Brain Health, School of Behavioral and Brain Sciences, The University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX 75235, USA
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Otten R, Barker ED, Huizink AC, Engels RCME. The interplay between parental monitoring and the dopamine D4 receptor gene in adolescent cannabis use. PLoS One 2012; 7:e49432. [PMID: 23209577 PMCID: PMC3509099 DOI: 10.1371/journal.pone.0049432] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 10/07/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Both environmental risk and genetic variation is believed to play a role in substance use. A candidate environmental variable is parenting. Recent studies have found support for the idea that the dopamine system affects the susceptibility to environmental influences. In the present study we will examine the interplay between effects of parental monitoring and the presence of the DRD4 7-repeat allele in adolescent lifetime cannabis use and the developmental course of cannabis use. METHODS A total of 311 adolescents participated in a five-wave longitudinal design. First, we conducted logistic regression analyses to examine the prospective associations between parental monitoring, the DRD4 polymorphism, their interaction and lifetime cannabis use. Second, individual growth parameters were calculated for frequency of cannabis use. Linear regression was used to assess the relationship between parental monitoring, the DRD4 polymorphism, their interaction, and the frequency of cannabis use. RESULTS There were no significant main effects of parental monitoring or the DRD4 polymorphism. However, both analyses showed that over a period of four years, a) when experiencing low levels of parental monitoring, individuals with the 7-repeat allele were more likely to show lifetime cannabis use and a stronger increase in frequency of cannabis use than individuals without this allele; b) when experiencing high levels of parental monitoring, individuals with the 7-repeat allele were less likely to show lifetime cannabis use and they showed a smaller increase in frequency of cannabis use than individuals without the 7-repeat allele. CONCLUSIONS This study shows that carriers of the DRD4 7-repeat allele are disproportionally affected by the negative and positive effects of parental monitoring such that carriers of the DRD4 7-repeat allele, as compared to non-carriers, are more likely to use cannabis when levels of parental monitoring are low, and less likely to use cannabis when parental monitoring levels are high.
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Affiliation(s)
- Roy Otten
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | | | - Anja C. Huizink
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
- Developmental Psychology, VU University Amsterdam, Amsterdam, The Netherlands
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