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Maehashi S, Arora K, Fisher AL, Schweitzer DR, Akefe IO. Neurolipidomic insights into anxiety disorders: Uncovering lipid dynamics for potential therapeutic advances. Neurosci Biobehav Rev 2024; 163:105741. [PMID: 38838875 DOI: 10.1016/j.neubiorev.2024.105741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 06/07/2024]
Abstract
Anxiety disorders constitute a spectrum of psychological conditions affecting millions of individuals worldwide, imposing a significant health burden. Historically, the development of anxiolytic medications has been largely focused on neurotransmitter function and modulation. However, in recent years, neurolipids emerged as a prime target for understanding psychiatric pathogenesis and developing novel medications. Neurolipids influence various neural activities such as neurotransmission and cellular functioning, as well as maintaining cell membrane integrity. Therefore, this review aims to elucidate the alterations in neurolipids associated with an anxious mental state and explore their potential as targets of novel anxiolytic medications. Existing evidence tentatively associates dysregulated neurolipid levels with the etiopathology of anxiety disorders. Notably, preclinical investigations suggest that several neurolipids, including endocannabinoids and polyunsaturated fatty acids, may hold promise as potential pharmacological targets. Overall, the current literature tentatively suggests the involvement of lipids in the pathogenesis of anxiety disorders, hinting at potential prospects for future pharmacological interventions.
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Affiliation(s)
- Saki Maehashi
- Medical School, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Kabir Arora
- Medical School, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Andre Lara Fisher
- Medical School, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | - Isaac Oluwatobi Akefe
- Academy for Medical Education, The University of Queensland, Herston, QLD 4006, Australia.
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Mallick K, Khan MF, Banerjee S. The anxiolytic effects of cannabinoids: A comprehensive review. Pharmacol Biochem Behav 2024; 243:173828. [PMID: 39032530 DOI: 10.1016/j.pbb.2024.173828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/23/2024]
Abstract
Cannabinoids, notably cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC), have emerged as promising candidates for anxiety disorder treatment, supported by both preclinical and clinical evidence. CBD exhibits notable anxiolytic effects with a favourable safety profile, though concerns regarding mild side effects and drug interactions remain. Conversely, THC, the primary psychoactive compound, presents a range of side effects, underscoring the importance of careful dosage management and individualized treatment strategies. So far there are no FDA approved cannabinoid medications for anxiety. The review highlights challenges in cannabinoid research, including dosage variability, variable preclinical data, and limited long-term data. Despite these limitations, cannabinoids represent a promising avenue for anxiety management, with the potential for further optimization in formulation, dosing protocols, and consideration of interactions with conventional therapies. Addressing these challenges could pave the way for novel and personalized approaches to treating anxiety disorders using cannabinoid-based therapies.
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Affiliation(s)
- Keya Mallick
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Kolkata, West Bengal, India
| | - Mohd Faiz Khan
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Kolkata, West Bengal, India
| | - Sugato Banerjee
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Kolkata, West Bengal, India.
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3
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Ferron JC, Brunette MF, Aschbrenner KA, ElSayed MW, Pratt SI. Tobacco, Alcohol, and Drug Use Among Young Adults with Serious Mental Illness. Community Ment Health J 2024; 60:945-954. [PMID: 38427276 DOI: 10.1007/s10597-024-01246-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/01/2024] [Indexed: 03/02/2024]
Abstract
To inform early intervention, this study describes correlates of substance use among young people with serious mental illness (SMI) enrolled in integrated care in community mental health settings. 227 adults ages 18-35 were assessed for clinical characteristics and substance use. Logistic regressions were used to describe relationships between substance use and participant characteristics. Over a third (38.9%) reported daily cannabis, 15.9% past month other illicit drug, 13.5% frequent/heavy alcohol and 47.4% any of these; 50.2% reported daily tobacco smoking and 23.3% current vaping. Daily cannabis and tobacco were the most common combination. Alcohol, drug, and cannabis with tobacco were associated with higher mental health symptoms but not with emergency room or hospital utilization. Cannabis and other substance use was common and associated with higher symptoms but not with greater hospital utilization, suggesting that early intervention could prevent long-term negative consequences.
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Affiliation(s)
- Joelle C Ferron
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA.
- The Dartmouth Institute, Dartmouth College, Hanover, USA.
- Dartmouth Hitchcock Health System, Lebanon, USA.
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA
- Department of Family Medicine, Geisel School of Medicine at Dartmouth College, Concord, USA
- The Dartmouth Institute, Dartmouth College, Hanover, USA
- Dartmouth Hitchcock Health System, Lebanon, USA
| | - Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA
- Dartmouth Hitchcock Health System, Lebanon, USA
| | - Mohamed W ElSayed
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA
- Dartmouth Hitchcock Health System, Lebanon, USA
- New Hampshire Hospital, Concord, USA
| | - Sarah I Pratt
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA
- The Dartmouth Institute, Dartmouth College, Hanover, USA
- Dartmouth Hitchcock Health System, Lebanon, USA
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Sera L, Hempel-Sanderoff C. Cannabis Science and Therapeutics: An Overview for Clinicians. J Clin Pharmacol 2024; 64:499-513. [PMID: 38145388 DOI: 10.1002/jcph.2400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
Cannabis-based therapeutics have garnered increasing attention in recent years as patients seek alternative treatments for various medical conditions. This narrative review provides a comprehensive overview of the science behind the medical use of cannabis, focusing on the medical evidence for commonly treated conditions. In addition, the review addresses the practical considerations of using cannabis as a therapeutic agent, offering insights into dosing strategies, variations in cannabinoid formulation, and individual patient responses. Precautions, adverse consequences, and drug interactions are also discussed, with a focus on patient safety and the potential risks associated with cannabis use.
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Affiliation(s)
- Leah Sera
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Carrie Hempel-Sanderoff
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
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Zaman T, Bravata DM, Byers A, Krebs E, Leonard S, Austin C, Sandbrink F, Hasin DS, Keyhani S. A national study of clinical discussions about cannabis use among Veteran patients prescribed opioids. J Cannabis Res 2024; 6:12. [PMID: 38493111 PMCID: PMC10943860 DOI: 10.1186/s42238-024-00221-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/15/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The Veterans Health Administration tracks urine drug tests (UDTs) among patients on long-term opioid therapy (LTOT) and recommends discussing the health effects of cannabis use. OBJECTIVE To determine the occurrence of cannabis-related discussions between providers and patients on LTOT during six months following UDT positive for cannabis, and examine factors associated with documenting cannabis use. DESIGN We identified patients prescribed LTOT with a UDT positive for cannabis in 2019. We developed a text-processing tool to extract discussions around cannabis use from their charts. SUBJECTS Twelve thousand seventy patients were included. Chart review was conducted on a random sample of 1,946 patients. MAIN MEASURES The presence of a cannabis term in the chart suggesting documented cannabis use or cannabis-related discussions. Content of those discussions was extracted in a subset of patients. Logistic regression was used to examine the association between patient factors, including state of residence legal status, with documentation of cannabis use. KEY RESULTS Among the 12,070 patients, 65.8% (N = 7,948) had a cannabis term, whereas 34.1% (N = 4,122) of patients lacked a cannabis term, suggesting that no documentation of cannabis use or discussion between provider and patient took place. Among the subset of patients who had a discussion documented, 47% related to cannabis use for medical reasons, 35% related to a discussion of VA policy or legal issues, and 17% related to a discussion specific to medical risks or harm reduction strategies. In adjusted analyses, residents of states with legalized recreational cannabis were less likely to have any cannabis-related discussion compared to patients in non-legal states [OR 0.73, 95% CI 0.64-0.82]. CONCLUSIONS One-third of LTOT patients did not have documentation of cannabis use in the chart in the 6 months following a positive UDT for cannabis. Discussions related to the medical risks of cannabis use or harm reduction strategies were uncommon.
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Affiliation(s)
- Tauheed Zaman
- Addiction Recovery and Treatments Services, San Francisco VA Health Care System, 4150 Clement Street, #116F, San Francisco VA Medical Center, San Francisco, CA, 94121, USA.
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.
| | - Dawn M Bravata
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Departments of Medicine and Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
- Regenstrief Institute, Indianapolis, IN, USA
| | - Amy Byers
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
- Medical Service, San Francisco VA Health Care System, San Francisco, USA
| | - Erin Krebs
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Samuel Leonard
- Medical Service, San Francisco VA Health Care System, San Francisco, USA
| | - Charles Austin
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Friedhelm Sandbrink
- National Pain Management, Opioid Safety and Prescription Drug Monitoring Program, Veterans Health Administration, Washington, DC, USA
- Department of Neurology, George Washington University, Washington, DC, USA
| | - Deborah S Hasin
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Salomeh Keyhani
- Medical Service, San Francisco VA Health Care System, San Francisco, USA
- Division of General Internal Medicine, Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
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Bidwell LC, Sznitman SR, Martin-Willett R, Hitchcock LH. Daily associations with cannabis use and sleep quality in anxious cannabis users. Behav Sleep Med 2024; 22:150-167. [PMID: 37255232 PMCID: PMC10687319 DOI: 10.1080/15402002.2023.2217969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Cannabis is increasingly used to self-treat anxiety and related sleep problems, without clear evidence of either supporting or refuting its anxiolytic or sleep aid effects. In addition, different forms of cannabis and primary cannabinoids ∆9-tetrahydrocannabinol (THC) and cannabidiol (CBD) have differing pharmacological effects. METHODS Thirty days of daily data on sleep quality and cannabis use were collected in individuals who use cannabis for mild-to-moderate anxiety (n = 347; 36% male, 64% female; mean age = 33 years). Participants self-reported both the form (flower or edible) and the ratio of THC to CBD in the cannabis used during the observation period. RESULTS Individuals who reported cannabis use on a particular day also reported better sleep quality the following night. Moderation analyses showed that better perceived sleep after cannabis use days was stronger for respondents with higher baseline affective symptoms. Further, respondents who used cannabis edibles with high CBD concentration reported the highest perceived quality of sleep. CONCLUSIONS Among individuals with affective symptoms, naturalistic use of cannabis was associated with better sleep quality, particularly for those using edible and CBD dominant products.
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Affiliation(s)
- L C Bidwell
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - S R Sznitman
- School of Public Health, University of Haifa Faculty of Social Welfare and Health Sciences, Haifa, Israel
| | - R Martin-Willett
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - L H Hitchcock
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
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Livne O, Malte CA, Olfson M, Wall MM, Keyes KM, Maynard C, Gradus JL, Saxon AJ, Martins SS, Keyhani S, McDowell Y, Fink DS, Mannes ZL, Gutkind S, Hasin DS. Trends in Prevalence of Cannabis Use Disorder Among U.S. Veterans With and Without Psychiatric Disorders Between 2005 and 2019. Am J Psychiatry 2024; 181:144-152. [PMID: 38018141 PMCID: PMC10843609 DOI: 10.1176/appi.ajp.20230168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Cannabis use disorder diagnoses are increasing among U.S. adults and are more prevalent among people with comorbid psychiatric disorders. Recent changes in cannabis laws, increasing cannabis availability, and higher-potency cannabis may have placed people with cannabis use and psychiatric disorders at disproportionately increasing risk for cannabis use disorder. The authors used Veterans Health Administration (VHA) data to examine whether trends in cannabis use disorder prevalence among VHA patients differ by whether they have psychiatric disorders. METHODS VHA electronic health records from 2005 to 2019 (N range, 4,332,165-5,657,277) were used to identify overall and age-group-specific (<35, 35-64, and ≥65 years) trends in prevalence of cannabis use disorder diagnoses among patients with depressive, anxiety, posttraumatic stress, bipolar, or psychotic spectrum disorders and to compare these to corresponding trends among patients without any of these disorders. Given transitions in ICD coding, differences in trends were tested within two periods: 2005-2014 (ICD-9-CM) and 2016-2019 (ICD-10-CM). RESULTS Greater increases in prevalence of cannabis use disorder diagnoses were observed among patients with psychiatric disorders compared to those without (difference in prevalence change, 2005-2014: 1.91%, 95% CI=1.87-1.96; 2016-2019: 0.34%, 95% CI=0.29-0.38). Disproportionate increases in cannabis use disorder prevalence among patients with psychiatric disorders were greatest among those under age 35 between 2005 and 2014, and among those age 65 or older between 2016 and 2019. Among patients with psychiatric disorders, the greatest increases in cannabis use disorder prevalences were observed among those with bipolar and psychotic spectrum disorders. CONCLUSIONS The findings highlight disproportionately increasing disparities in risk of cannabis use disorder among VHA patients with common psychiatric disorders. Greater public health and clinical efforts are needed to monitor, prevent, and treat cannabis use disorder in this population.
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Affiliation(s)
- Ofir Livne
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Carol A Malte
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Mark Olfson
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Melanie M Wall
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Katherine M Keyes
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Charles Maynard
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Jaimie L Gradus
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Andrew J Saxon
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Silvia S Martins
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Salomeh Keyhani
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Yoanna McDowell
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - David S Fink
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Zachary L Mannes
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Sarah Gutkind
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Deborah S Hasin
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
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Rice LJ, Cannon L, Dadlani N, Cheung MMY, Einfeld SL, Efron D, Dossetor DR, Elliott EJ. Efficacy of cannabinoids in neurodevelopmental and neuropsychiatric disorders among children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2024; 33:505-526. [PMID: 36864363 PMCID: PMC10869397 DOI: 10.1007/s00787-023-02169-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/14/2023] [Indexed: 03/04/2023]
Abstract
A better understanding of the endocannabinoid system and a relaxation in regulatory control of cannabis globally has increased interest in the medicinal use of cannabinoid-based products (CBP). We provide a systematic review of the rationale and current clinical trial evidence for CBP in the treatment of neuropsychiatric and neurodevelopmental disorders in children and adolescents. A systematic search of MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Trials was performed to identify articles published after 1980 about CBP for medical purposes in individuals aged 18 years or younger with selected neuropsychiatric or neurodevelopmental conditions. Risk of bias and quality of evidence was assessed for each article. Of 4466 articles screened, 18 were eligible for inclusion, addressing eight conditions (anxiety disorders (n = 1); autism spectrum disorder (n = 5); foetal alcohol spectrum disorder (n = 1); fragile X syndrome (n = 2); intellectual disability (n = 1); mood disorders (n = 2); post-traumatic stress disorder (n = 3); and Tourette syndrome (n = 3)). Only one randomised controlled trial (RCT) was identified. The remaining seventeen articles included one open-label trial, three uncontrolled before-and-after trials, two case series and 11 case reports, thus the risk of bias was high. Despite growing community and scientific interest, our systematic review identified limited and generally poor-quality evidence for the efficacy of CBP in neuropsychiatric and neurodevelopmental disorders in children and adolescents. Large rigorous RCTs are required to inform clinical care. In the meantime, clinicians must balance patient expectations with the limited evidence available.
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Affiliation(s)
- Lauren J Rice
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia.
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia.
- The University of Sydney, Faculty of Medicine and Health, Brain and Mind Centre, Sydney, NSW, Australia.
| | - Lisa Cannon
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia
| | - Navin Dadlani
- The University of Sydney, Faculty of Medicine and Health, Brain and Mind Centre, Sydney, NSW, Australia
| | - Melissa Mei Yin Cheung
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia
| | - Stewart L Einfeld
- The University of Sydney, Faculty of Medicine and Health, Brain and Mind Centre, Sydney, NSW, Australia
| | - Daryl Efron
- Department of General Paediatrics, Health Services, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - David R Dossetor
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia
| | - Elizabeth J Elliott
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia
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9
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Johnstad PG. Unhealthy behaviors associated with mental health disorders: a systematic comparative review of diet quality, sedentary behavior, and cannabis and tobacco use. Front Public Health 2024; 11:1268339. [PMID: 38249418 PMCID: PMC10797041 DOI: 10.3389/fpubh.2023.1268339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/14/2023] [Indexed: 01/23/2024] Open
Abstract
Background There are well-established literatures documenting the associations between mental disorders and unhealthy behaviors such as poor diet quality, sedentary behavior, and cannabis and tobacco use. Few studies have attempted to understand the respective findings in light of each other, however. Objective The purpose of this review was to assemble comparable data for each behavior-disorder association and assess the associations in terms of their overall strength. The review aimed to include a representative, but not exhaustive, range of studies that would allow for explorative comparisons. Methods Eligible studies were identified via Pubmed searches and citation searching, restricted to publications no older than 2015 written in English. To obtain comparable data, only studies that reported findings as odds ratios were included, and risk of bias related to study samples, behavioral measurement disparities, and control variables was assessed via sensitivity analyses. Findings for each disorder were compared on the basis of different measures of central tendency. Results From 3,682 records, 294 studies were included. The review found evidence of associations between each of the four unhealthy behaviors and psychosis, depression, anxiety, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), while personality disorder was only investigated in relation to cannabis and tobacco use. In overall comparison, the associations were generally of similar strength, and only the association between cannabis use and personality disorder was exceptional in terms of being significantly stronger than its counterparts across disorders and across behaviors. Analyses of bias risk identified some influence from behavioral measurement disparities and lack of adequate statistical control, but findings were generally robust across a range of sensitivity analyses. Conclusion This explorative and comparative review found that poor diet quality, sedentary behavior, and cannabis and tobacco use are about equally strongly associated with a range of different mental disorders. Given the general nature of these associations, we should probably understand them to reflect a general and shared etiology. However, the findings in this review should be regarded as tentative until confirmed by more comprehensive investigations.
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Espinoza S, Lagunas MA, Claudia R, Lovell JL. Perceived Risks and Therapeutic Benefits of Cannabis Among College Students Amidst the COVID-19 Pandemic. CANNABIS (ALBUQUERQUE, N.M.) 2023; 6:18-33. [PMID: 38035168 PMCID: PMC10683751 DOI: 10.26828/cannabis/2023/000157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
More than half of the United States has legalized medicinal and/or recreational cannabis. The purpose of the study is to understand cannabis use and perceptions among college students with cannabis experience - 21 years and older - in a legalized cannabis state. Participants included 170 college students, the majority identified as female (72.9%, n = 124) and Latinx/Hispanic (55.9%, n = 95). The online survey included demographic questions and questionnaires measuring cannabis consumption, cannabis use disorder, and quality of life. Participants answered open-ended questions about the negative, positive, and spiritual impact/s of cannabis on their life and health, and how the COVID-19 pandemic impacted their cannabis use. A paired-sample t-test indicated participants significantly found more relief using cannabis compared to non-cannabis treatments or medications. There was no significant correlation between quality of life and cannabis use disorder symptoms. Inductive content analysis of 112 written responses revealed perceived negative effects (e.g., anxiety/mental health issues) and positive effects (e.g., relaxation/stress reduction) from using cannabis. Most participants reported no spiritual benefits; however, some participants discussed cannabis use improving connection to self and self-awareness. Regarding the impact of the COVID-19 pandemic on use, most participants (27.8%) reported increased cannabis use, while some reported decreased cannabis use. These findings reflect the importance of understanding the wide-range of benefits and risks perceived by college students who consume cannabis and how these results can inform the development of university prevention and wellness strategies within states that have legalized recreational and medical cannabis.
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Hill MN, Haney M, Hillard CJ, Karhson DS, Vecchiarelli HA. The endocannabinoid system as a putative target for the development of novel drugs for the treatment of psychiatric illnesses. Psychol Med 2023; 53:7006-7024. [PMID: 37671673 PMCID: PMC10719691 DOI: 10.1017/s0033291723002465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 09/07/2023]
Abstract
Cannabis is well established to impact affective states, emotion and perceptual processing, primarily through its interactions with the endocannabinoid system. While cannabis use is quite prevalent in many individuals afflicted with psychiatric illnesses, there is considerable controversy as to whether cannabis may worsen these conditions or provide some form of therapeutic benefit. The development of pharmacological agents which interact with components of the endocannabinoid system in more localized and discrete ways then via phytocannabinoids found in cannabis, has allowed the investigation if direct targeting of the endocannabinoid system itself may represent a novel approach to treat psychiatric illness without the potential untoward side effects associated with cannabis. Herein we review the current body of literature regarding the various pharmacological tools that have been developed to target the endocannabinoid system, their impact in preclinical models of psychiatric illness and the recent data emerging of their utilization in clinical trials for psychiatric illnesses, with a specific focus on substance use disorders, trauma-related disorders, and autism. We highlight several candidate drugs which target endocannabinoid function, particularly inhibitors of endocannabinoid metabolism or modulators of cannabinoid receptor signaling, which have emerged as potential candidates for the treatment of psychiatric conditions, particularly substance use disorder, anxiety and trauma-related disorders and autism spectrum disorders. Although there needs to be ongoing clinical work to establish the potential utility of endocannabinoid-based drugs for the treatment of psychiatric illnesses, the current data available is quite promising and shows indications of several potential candidate diseases which may benefit from this approach.
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Affiliation(s)
- Matthew N. Hill
- Departments of Cell Biology and Anatomy & Psychiatry, Cumming School of Medicine, Hotchkiss Brain Institute and The Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Canada
| | - Margaret Haney
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, USA
| | - Cecilia J. Hillard
- Department of Pharmacology and Toxicology, Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, USA
| | - Debra S. Karhson
- Department of Psychology, University of New Orleans, New Orleans, USA
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Denson RK, Brooks J, Pinna G, Crane NA. Effects of Cannabidiol in Adolescent and Young Adult Depressive and Anxiety Disorders: A Systematic Review of Clinical and Preclinical Research. ADOLESCENT PSYCHIATRY 2023; 13:176-194. [PMID: 38919887 PMCID: PMC11198978 DOI: 10.2174/0122106766233339230919143924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 06/27/2024]
Abstract
Background Adolescents and young adults may use cannabidiol (CBD) products in an attempt to reduce depression and anxiety symptoms, despite little research examining this use. This systematic review evaluated preclinical and clinical research on the effects of CBD on depressive and anxiety disorders in adolescence and young adulthood. To provide context, we discuss CBD's mechanism of action and neurodevelopmental effects. Methods PubMed was searched for articles published through June 2022. Preclinical or clinical CBD administration studies with N > 1 that examined depressive and/or anxiety disorders were eligible. Results Initially, 224 publications were identified. After excluding duplicates and applying eligibility criteria, 6 preclinical (depression: n≈133; anxiety: n≈161) and 4 clinical (anxiety: n=113) articles remained. Due to the low number of studies, results were synthesized qualitatively. The Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence were used to rate each study's evidence. The preclinical effects of CBD on depression-like behavior appear to differ by sex, early life stress, and duration of use. Despite no evidence that CBD exerts anxiolytic effects in preclinical adolescent models, CBD may reduce anxiety symptoms in human adolescents and young adults with anxiety disorders. Conclusions The existing evidence suggests that CBD may reduce symptoms of anxiety in adolescents and young adults. However, the evidence is sparse and limited by variations in samples and CBD dosing duration. Further research is needed to understand the potential benefits and/or harms of CBD for depression and anxiety disorders in this population. Implications for clinical practice and research are discussed.
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Affiliation(s)
| | - Julia Brooks
- Department of Psychology, University of Illinois at Chicago
| | - Graziano Pinna
- Department of Psychiatry, University of Illinois at Chicago
- UI Center on Depression and Resilience (UICDR), University of Illinois at Chicago
- Center for Alcohol Research in Epigenetics, University of Illinois at Chicago
- The Psychiatric Institute, University of Illinois at Chicago
| | - Natania A. Crane
- Department of Psychiatry, University of Illinois at Chicago
- UI Center on Depression and Resilience (UICDR), University of Illinois at Chicago
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13
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Stack SK, Wheate NJ, Moloney NC, Abelev SV, Barlow JW, Schubert EA. The Effectiveness and Adverse Events of Cannabidiol and Tetrahydrocannabinol Used in the Treatment of Anxiety Disorders in a PTSD Subpopulation: An Interim Analysis of an Observational Study. J Pharm Technol 2023; 39:172-182. [PMID: 37529155 PMCID: PMC10387818 DOI: 10.1177/87551225231180796] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Background: Anxiety is a condition for which current treatments are often limited by adverse events (AEs). Components of medicinal cannabis, cannabidiol (CBD) and tetrahydrocannabinol (THC), have been proposed as potential treatments for anxiety disorders, specifically posttraumatic stress disorder (PTSD). Objective: To evaluate quality-of-life outcomes after treatment with various cannabis formulations to determine the effectiveness and associated AEs. Methods: An interim analysis of data collected between September 2018 and June 2021 from the CA Clinics Observational Study. Patient-Reported Outcomes Measurement Information System-29 survey scores of 198 participants with an anxiety disorder were compared at baseline and after treatment with medicinal cannabis. The data of 568 anxiety participants were also analyzed to examine the AEs they experienced by the Medical Dictionary for Regulatory Activities organ system class. Results: The median doses taken were 50.0 mg/day for CBD and 4.4 mg/day for THC. The total participant sample reported significantly improved anxiety, depression, fatigue, and ability to take part in social roles and activities. Those who were diagnosed with PTSD (n = 57) reported significantly improved anxiety, depression, fatigue, and social abilities. The most common AEs reported across the whole participant cohort were dry mouth (32.6%), somnolence (31.3%), and fatigue (18.5%), but incidence varied with different cannabis formulations. The inclusion of THC in a formulation was significantly associated with experiencing gastrointestinal AEs; specifically dry mouth and nausea. Conclusions: Formulations of cannabis significantly improved anxiety, depression, fatigue, and the ability to participate in social activities in participants with anxiety disorders. The AEs experienced by participants are consistent with those in other studies.
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Affiliation(s)
- Sophie K. Stack
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Nial J. Wheate
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | | | | | - Elise A. Schubert
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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14
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Hellwig S, Domschke K. [Anxiety and substance abuse disorders-Focus on alcohol and cannabis]. DER NERVENARZT 2023:10.1007/s00115-023-01502-7. [PMID: 37341771 DOI: 10.1007/s00115-023-01502-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/22/2023]
Abstract
Anxiety disorders are frequent, with a 12-month prevalence of 14%, tend to be chronic, and display a high comorbidity with substance abuse disorders. Anxiety and substance abuse disorders are associated with a pronounced individual as well as socioeconomic burden. This article reviews the epidemiological, etiological, and clinical aspects of the dual diagnosis of anxiety and substance abuse disorders, with a particular focus on alcohol and cannabis. The treatment comprises nonpharmacological strategies, mainly cognitive behavioral therapy combined with elements of motivational interviewing (MI) and pharmacological management with antidepressants; however, the use of selective serotonin reuptake inhibitors (SSRI)/serotonin and noradrenaline reuptake inhibitors (SNRI) is not unreservedly recommended. The use of gabapentinoids requires careful risk-benefit consideration because of their potential for abuse and dependence in substance abuse disorders. Benzodiazepines are reserved exclusively for crisis management. Rapid diagnosis and treatment initiation targeting both disorders are essential for successful treatment of comorbid anxiety and substance abuse disorders.
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Affiliation(s)
- Sabine Hellwig
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hauptstr. 5, 79104, Freiburg, Deutschland.
| | - Katharina Domschke
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hauptstr. 5, 79104, Freiburg, Deutschland
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15
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Hasan KM. Cannabis Unveiled: An Exploration of Marijuana's History, Active Compounds, Effects, Benefits, and Risks on Human Health. Subst Abuse 2023; 17:11782218231182553. [PMID: 37359105 PMCID: PMC10286197 DOI: 10.1177/11782218231182553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Abstract
Marijuana, also known as cannabis, is a psychoactive drug that comes from the Cannabis plant. Marijuana can be smoked, vaporized, or consumed through edibles in a variety of ways. Perception changes, changes in mood, and problems with coordination are all possible side effects. Marijuana is used for both recreational and medical purposes to treat a variety of health conditions. The literature review on the effects of marijuana on the human body has increased in recent years as more states legalize its use. It is important to investigate the benefits and harmful effects of marijuana on individuals due to the widespread use of cannabis-derived substances like marijuana for medical, recreational, and combined purposes. The paper will review different aspects of marijuana in 4 main domains. A thorough discussion of marijuana's definition, history, mechanism of action, pharmacokinetics, and effects on human cells will be given in the first domain. The second domain will concentrate on marijuana's negative effects, while the third domain will look at marijuana's possible positive impacts, such as its usage in controlling multiple sclerosis, treating obesity, lowering social anxiety, and managing pain. The fourth domain will concentrate on marijuana's effects on anxiety, educational attainment, and social consequences. Additionally, this paper also will provide a highlight of the history of marijuana use and governmental legislation, both of which play a significant role in determining how the public views marijuana. In conclusion, this paper provides a comprehensive review of marijuana's effects, which may be of interest to a large readership. This review adds to the continuing discussion about the use of marijuana by analyzing the data that is currently available about the possible advantages and disadvantages of marijuana usage.
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Affiliation(s)
- Khaled M Hasan
- Khaled M Hasan, Physician Assistant Department, School of Pharmacy and Health Professions, University of Maryland Eastern Shore, Hazel Hall, Suite 1042, Princess Anne, MD 21853, USA.
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Cairns EA, Benson MJ, Bedoya-Pérez MA, Macphail SL, Mohan A, Cohen R, Sachdev PS, McGregor IS. Medicinal cannabis for psychiatry-related conditions: an overview of current Australian prescribing. Front Pharmacol 2023; 14:1142680. [PMID: 37346297 PMCID: PMC10279775 DOI: 10.3389/fphar.2023.1142680] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
Objective: Evidence is accumulating that components of the Cannabis sativa plant may have therapeutic potential in treating psychiatric disorders. Medicinal cannabis (MC) products are legally available for prescription in Australia, primarily through the Therapeutic Goods Administration (TGA) Special Access Scheme B (SAS-B). Here we investigated recent prescribing practices for psychiatric indications under SAS-B by Australian doctors. Methods: The dataset, obtained from the TGA, included information on MC applications made by doctors through the SAS-B process between 1st November 2016 and 30th September 2022 inclusive. Details included the primary conditions treated, patient demographics, prescriber location, product type (e.g., oil, flower or capsule) and the general cannabinoid content of products. The conditions treated were categorized according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR). Trends in prescribing for conditions over time were analyzed via polynomial regression, and relationships between categorical variables determined via correspondence analyses. Results: Approximately 300,000 SAS-B approvals to prescribe MC had been issued in the time period under investigation. This included approvals for 38 different DSM-5-TR defined psychiatric conditions (33.9% of total approvals). The majority of approvals were for anxiety disorders (66.7% of psychiatry-related prescribing), sleep-wake disorders (18.2%), trauma- and stressor-related disorders (5.8%), and neurodevelopmental disorders (4.4%). Oil products were most prescribed (53.0%), followed by flower (31.2%) and other inhaled products (12.4%). CBD-dominant products comprised around 20% of total prescribing and were particularly prevalent in the treatment of autism spectrum disorder. The largest proportion of approvals was for patients aged 25-39 years (46.2% of approvals). Recent dramatic increases in prescribing for attention deficit hyperactivity disorder were identified. Conclusion: A significant proportion of MC prescribing in Australia is for psychiatry-related indications. This prescribing often appears somewhat "experimental", given it involves conditions (e.g., ADHD, depression) for which definitive clinical evidence of MC efficacy is lacking. The high prevalence of THC-containing products being prescribed is of possible concern given the psychiatric problems associated with this drug. Evidence-based clinical guidance around the use of MC products in psychiatry is lacking and would clearly be of benefit to prescribers.
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Affiliation(s)
- Elizabeth A. Cairns
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Melissa J. Benson
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Miguel A. Bedoya-Pérez
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Sara L. Macphail
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Adith Mohan
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Neuropsychiatric Institute, The Prince of Wales Hospital, Randwick, NSW, Australia
| | - Rhys Cohen
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Neuropsychiatric Institute, The Prince of Wales Hospital, Randwick, NSW, Australia
| | - Iain S. McGregor
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
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17
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Haycraft AL. Cannabis update: Anxiety disorders and post-traumatic stress disorder. J Am Assoc Nurse Pract 2023; 35:276-280. [PMID: 37000126 DOI: 10.1097/jxx.0000000000000864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/02/2023] [Indexed: 04/01/2023]
Abstract
ABSTRACT The development of anxiety disorders and post-traumatic stress disorder (PTSD) is complex. Both delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are of potential therapeutic use. Evidence suggests that cannabis has a beneficial effect on neural circuitry involved in fear regulation. In the United States, cannabis is considered either medical or recreational and can contain pure THC or CBD or any combination thereof. The numerous cannabis compounds of various administration routes, with variable pharmacokinetics, further affect the cannabis conundrum. Despite being federally unregulated, medical cannabis has received increased attention socially, and at present, 37 states, four territories, and the District of Columbia have legalized medical cannabis for use in specific health conditions. Patients are increasingly inquiring about cannabis, and clinicians must educate themselves with reliable cannabinoid information for patient education. In adults with anxiety disorders and PTSD, evidence supports a relatively safe profile for medical cannabis; however, conclusive scientific evidential support of its therapeutic properties is limited, resulting in a lack of standardization and Food and Drug Administration approval.
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Sultan RS, Zhang AW, Olfson M, Kwizera MH, Levin FR. Nondisordered Cannabis Use Among US Adolescents. JAMA Netw Open 2023; 6:e2311294. [PMID: 37133862 PMCID: PMC10157425 DOI: 10.1001/jamanetworkopen.2023.11294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/20/2023] [Indexed: 05/04/2023] Open
Abstract
Importance Cannabis use is increasingly viewed by adolescents as not harmful. Youths with cannabis use disorder (CUD) are recognized by clinicians as being at risk for adverse outcomes, yet little is known about the associations between subclinical cannabis use (ie, nondisordered cannabis use [NDCU]) and adverse psychosocial events. Objective To describe the prevalence and demographics of NDCU and to compare associations of cannabis use with adverse psychosocial events among adolescents with no cannabis use, NDCU, and CUD. Design, Setting, and Participants This cross-sectional study used a nationally representative sample derived from the 2015 to 2019 National Survey on Drug Use and Health. Participants were adolescents aged 12 to 17 years, separated into 3 distinct groups: nonuse (no recent cannabis use), NDCU (recent cannabis use below diagnostic threshold), and CUD. Analysis was conducted from January to May 2022. Exposures CUD, NDCU, or cannabis nonuse. NDCU was defined as endorsing recent cannabis use but not meeting the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) CUD criteria. CUD was defined using DSM-5 criteria. Main Outcomes and Measures The main outcomes were prevalence of adolescents meeting criteria for NDCU and associations between adverse psychosocial events and NDCU, adjusted for sociodemographic characteristics. Results The 68 263 respondents (mean [SD] age, 14.5 [1.7] years; 34 773 [50.9%] males) included in the analysis represented an estimated yearly mean of 25 million US adolescents during 2015 to 2019. Among respondents, 1675 adolescents (2.5%) had CUD, 6971 adolescents (10.2%) had NDCU, and 59 617 adolescents (87.3%) reported nonuse. Compared with nonusers, individuals with NDCU had approximately 2 to 4 times greater odds of all adverse psychosocial events examined, including major depression (adjusted odds ratio [aOR], 1.86; 95% CI, 1.67-2.08), suicidal ideation (aOR, 2.08; 95% CI, 1.88-2.29), slower thoughts (aOR, 1.76; 95% CI, 1.58-1.96), difficulty concentrating (aOR, 1.81; 95% CI, 1.65-2.00), truancy (aOR, 1.90; 95% CI, 1.67-2.16), low grade point average (aOR, 1.80; 95% CI, 1.62-2.00), arrest (aOR, 4.15; 95% CI, 3.17-5.43), fighting (aOR, 2.04; 95% CI, 1.80-2.31), and aggression (aOR, 2.16; 95% CI, 1.79-2.62). Prevalence of adverse psychosocial events was greatest for adolescents with CUD (range, 12.6% to 41.9%), followed by NDCU (range, 5.2% to 30.4%), then nonuse (range, 0.8% to 17.3%). Conclusions and Relevance In this cross-sectional study of US adolescents, past-year NDCU was approximately 4 times as prevalent as past-year CUD. A stepwise gradient association was observed for odds of adverse psychosocial events between adolescent NDCU and CUD. In the context of US normalization of cannabis use, prospective research into NDCU is necessary.
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Affiliation(s)
- Ryan S. Sultan
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- New York State Psychiatric Institute, New York
- Integrative Psychiatry, New York, New York
| | - Alexander W. Zhang
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- New York State Psychiatric Institute, New York
| | - Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- New York State Psychiatric Institute, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Muhire H. Kwizera
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- New York State Psychiatric Institute, New York
| | - Frances R. Levin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- New York State Psychiatric Institute, New York
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19
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Kuhathasan N, Ballester PL, Minuzzi L, MacKillop J, Frey BN. Predictors of perceived symptom change with acute cannabis use for mental health conditions in a naturalistic sample: A machine learning approach. Compr Psychiatry 2023; 122:152377. [PMID: 36787672 DOI: 10.1016/j.comppsych.2023.152377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Despite limited clinical evidence of its efficacy, cannabis use has been commonly reported for the management of various mental health concerns in naturalistic field studies. The aim of the current study was to use machine learning methods to investigate predictors of perceived symptom change across various mental health symptoms with acute cannabis use in a large naturalistic sample. METHODS Data from 68,819 unique observations of cannabis use from 1307 individuals using cannabis to manage mental health symptoms were analyzed. Data were extracted from Strainprint®, a mobile app that allows users to monitor their cannabis use for therapeutic purposes. Machine learning models were employed to predict self-perceived symptom change after cannabis use, and SHapley Additive exPlanations (SHAP) value plots were used to assess feature importance of individual predictors in the model. Interaction effects of symptom severity pre-scores of anxiety, depression, insomnia, and gender were also examined. RESULTS The factors that were most strongly associated with perceived symptom change following acute cannabis use were pre-symptom severity, age, gender, and the ratio of CBD to THC. Further examination on the impact of baseline severity for the most commonly reported symptoms revealed distinct responses, with cannabis being reported to more likely benefit individuals with lower pre-symptom severity for depression, and higher pre-symptom severity for insomnia. Responses to cannabis use also differed between genders. CONCLUSIONS Findings from this study highlight the importance of several factors in predicting perceived symptom change with acute cannabis use for mental health symptom management. Mental health profiles and baseline symptom severity may play a large role in perceived responses to cannabis. Distinct response patterns were also noted across commonly reported mental health symptoms, emphasizing the need for placebo-controlled cannabis trials for specific user profiles.
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Affiliation(s)
- Nirushi Kuhathasan
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada
| | - Pedro L Ballester
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada
| | - Luciano Minuzzi
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada
| | - James MacKillop
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada; Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada
| | - Benicio N Frey
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada.
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20
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Byrne GJ. Interventions for generalized anxiety disorder. Curr Opin Psychiatry 2023; 36:134-139. [PMID: 36705012 DOI: 10.1097/yco.0000000000000840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of recently published work on anxiety, focusing on generalized anxiety disorder (GAD) and its treatment. RECENT FINDINGS Self-reported anxiety symptoms were highly prevalent during the COVID-19 global pandemic in both the general population and in selected groups. There remains divided opinion about whether internet-based cognitive behavioural therapy (CBT) is noninferior to face-to-face CBT for GAD. A systematic review of drug treatment for GAD showed efficacy for selective serotonin reuptake inhibitors (SNRIs), agomelatine, and quetiapine. There may be a place for repetitive transcranial magnetic stimulation in the treatment of GAD. There was some evidence of efficacy for complementary therapies, including physical exercise, yoga, acupuncture, and Withania somnifera (ashwagandha). However, a systematic review of cannabidiol and tetrahydrocannabinol found insufficient evidence of efficacy in anxiety disorders. SUMMARY Antidepressants and quetiapine show efficacy in the treatment of GAD. Internet-based psychological interventions have a place in the treatment of GAD when face-to-face treatment is inaccessible. There is increasing evidence for the use of physical exercise in the management of GAD. Some other complementary therapies, including cannabinoids, require further, methodologically sound, research.
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Affiliation(s)
- Gerard J Byrne
- Academy of Psychiatry, School of Medicine, University of Queensland
- Mental Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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21
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Hasbi A, Madras BK, George SR. Endocannabinoid System and Exogenous Cannabinoids in Depression and Anxiety: A Review. Brain Sci 2023; 13:brainsci13020325. [PMID: 36831868 PMCID: PMC9953886 DOI: 10.3390/brainsci13020325] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
Background: There is a growing liberalization of cannabis-based preparations for medical and recreational use. In multiple instances, anxiety and depression are cited as either a primary or a secondary reason for the use of cannabinoids. Aim: The purpose of this review is to explore the association between depression or anxiety and the dysregulation of the endogenous endocannabinoid system (ECS), as well as the use of phytocannabinoids and synthetic cannabinoids in the remediation of depression/anxiety symptoms. After a brief description of the constituents of cannabis, cannabinoid receptors and the endocannabinoid system, the most important evidence is presented for the involvement of cannabinoids in depression and anxiety both in human and from animal models of depression and anxiety. Finally, evidence is presented for the clinical use of cannabinoids to treat depression and anxiety. Conclusions: Although the common belief that cannabinoids, including cannabis, its main studied components-tetrahydrocannabinol (THC) and cannabidiol (CBD)-or other synthetic derivatives have been suggested to have a therapeutic role for certain mental health conditions, all recent systematic reviews that we report have concluded that the evidence that cannabinoids improve depressive and anxiety disorders is weak, of very-low-quality, and offers no guidance on the use of cannabinoids for mental health conditions within a regulatory framework. There is an urgent need for high-quality studies examining the effects of cannabinoids on mental disorders in general and depression/anxiety in particular, as well as the consequences of long-term use of these preparations due to possible risks such as addiction and even reversal of improvement.
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Affiliation(s)
- Ahmed Hasbi
- Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Correspondence: (A.H.); (S.R.G.)
| | - Bertha K. Madras
- McLean Hospital, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Susan R. George
- Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Correspondence: (A.H.); (S.R.G.)
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22
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Faraj M, Dautrich T, Lundahl L, Marusak H. Effects of Two Cannabidiol Oil Products on Self-Reported Stress Relief: A Quasi-Experimental Study. Med Cannabis Cannabinoids 2023; 6:138-147. [PMID: 37942294 PMCID: PMC10629851 DOI: 10.1159/000531886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 06/29/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Estimated rates of past-month cannabidiol (CBD) use in the general public are 13-26% and emerging research examines CBD as a potential adjunct treatment for several medical conditions, including stress-related disorders (e.g., depression, anxiety, and chronic pain). However, little is known about the effects of different CBD products on self-reported stress. The present study compared the effects of two delta-9-tetrahydrocannabinol (THC)-free CBD tincture products - (1) an isolate CBD oil and (2) a broad spectrum CBD oil - on self-ratings of effectiveness of the product and ability to manage stress. Methods This quasi-experimental study reports on a total of 374 participants who completed either a 30- or 60-day regimen. Participants were instructed to use a 1,000 mg CBD isolate product at will, and then switch over to a 1,000 mg broad spectrum product for the remainder of the regimen (i.e., next 15 or 30 days). Self-reported effectiveness of the product and its ability to help manage stress was compared between the isolate and broad spectrum products. We also examined overall impression, quality, taste, and adverse effects of each product. Results Overall, both products were rated to be highly effective and able to assist with stress management. Participants reported that the broad spectrum product's effectiveness (p < 0.001) and ability to reduce stress (p < 0.001) as greater than the isolate product across both regimens. However, participants preferred the taste of the isolate product over that of the broad spectrum across regimens (p < 0.05). For the 30-day regimen, participants reported a more positive overall impression of the isolate as compared to the broad spectrum (p < 0.001); however, overall impression did not differ between the products in the 60-day regimen. There was no difference in adverse effects or quality between the products, across both regimens. Conclusion These results fit with prior studies suggesting anti-stress effects of CBD. Ratings were higher for the broad spectrum as compared to the isolate product, which is consistent with prior data suggesting that cannabinoids can work synergistically to maximize benefits. Nonetheless, more controlled studies are needed to explore these effects in nonclinical and clinical populations.
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Affiliation(s)
- Mohammed Faraj
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Leslie Lundahl
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Hilary Marusak
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Pharmacology, Wayne State University School of Medicine, Detroit, MI, USA
- Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, MI, USA
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23
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Ragnhildstveit A, Kaiyo M, Snyder MB, Jackson LK, Lopez A, Mayo C, Miranda AC, August RJ, Seli P, Robison R, Averill LA. Cannabis-assisted psychotherapy for complex dissociative posttraumatic stress disorder: A case report. Front Psychiatry 2023; 14:1051542. [PMID: 36846226 PMCID: PMC9947284 DOI: 10.3389/fpsyt.2023.1051542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND A dissociative subtype of posttraumatic stress disorder, known as "D-PTSD", has been included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. In addition to meeting criteria for PTSD, patients endorse prominent dissociative symptoms, namely depersonalization and derealization, or detachment from one's self and surroundings. At present, this population is supported by a highly heterogeneous and undeveloped literature. Targeted interventions are therefore lacking, and those indicated for PTSD are limited by poor efficacy, delayed onset of action, and low patient engagement. Here, we introduce cannabis-assisted psychotherapy (CAP) as a novel treatment for D-PTSD, drawing parallels to psychedelic therapy. CASE PRESENTATION A 28-year-old female presented with complex D-PTSD. In a naturalistic setting, she underwent 10 sessions of CAP, scheduled twice monthly over 5 months, coupled with integrative cognitive behavioral therapy. An autonomic and relational approach to CAP was leveraged, specifically psychedelic somatic interactional psychotherapy. Acute effects included oceanic boundlessness, ego dissolution, and emotional breakthrough. From baseline to post-treatment, the patient showed a 98.5% reduction in pathological dissociation, as measured by the Multidimensional Inventory of Dissociation, no longer meeting criteria for D-PTSD. This was accompanied by decreased cognitive distractibility and emotional suffering, as well as increased psychosocial functioning. Anecdotally, the patient has sustained improvements for over 2 years to date. CONCLUSIONS There is urgency to identify treatments for D-PTSD. The present case, while inherently limited, underscores the potential of CAP as a therapeutic option, leading to robust and sustained improvement. Subjective effects were comparable to those produced by classic and non-classic psychedelics, such as psilocybin and ketamine. Further research is warranted to explore, establish, and optimize CAP in D-PTSD, and to characterize its role in the pharmacological landscape.
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Affiliation(s)
- Anya Ragnhildstveit
- Integrated Research Literacy Group, Draper, UT, United States.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.,Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Miriam Kaiyo
- Integrated Research Literacy Group, Draper, UT, United States.,Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, United States
| | | | | | - Alex Lopez
- Integrated Research Literacy Group, Draper, UT, United States
| | - Chasity Mayo
- Integrated Research Literacy Group, Draper, UT, United States
| | - Alyssa Claire Miranda
- Integrated Research Literacy Group, Draper, UT, United States.,Consciousness and Transformative Studies, National University, San Diego, CA, United States
| | - River Jude August
- Integrated Research Literacy Group, Draper, UT, United States.,Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, United States
| | - Paul Seli
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Reid Robison
- Numinus Wellness, Draper, UT, United States.,Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Lynnette Astrid Averill
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.,Department of Veterans Affairs, Clinical Neuroscience Division, National Center for PTSD, West Haven, CT, United States
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24
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Narayan AJ, Downey LA, Manning B, Hayley AC. Cannabinoid treatments for anxiety: A systematic review and consideration of the impact of sleep disturbance. Neurosci Biobehav Rev 2022. [DOI: https:/doi.org.ezproxy.mnsu.edu/10.1016/j.neubiorev.2022.104941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
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25
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Dahlgren MK, Lambros AM, Smith RT, Sagar KA, El-Abboud C, Gruber SA. Clinical and cognitive improvement following full-spectrum, high-cannabidiol treatment for anxiety: open-label data from a two-stage, phase 2 clinical trial. COMMUNICATIONS MEDICINE 2022; 2:139. [PMID: 36352103 PMCID: PMC9628346 DOI: 10.1038/s43856-022-00202-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 10/18/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Evidence suggests cannabidiol (CBD) has anxiolytic properties, indicating potential for novel treatment strategies. However, few clinical trials of CBD-based products have been conducted, and none thus far have examined the impact of these products on cognition. METHODS For the open-label stage of clinical trial NCT02548559, autoregressive linear modeling assessed efficacy and tolerability of four-weeks of 1 mL t.i.d. treatment with a full-spectrum, high-CBD sublingual solution (9.97 mg/mL CBD, 0.23 mg/mL Δ-9-tetrahydrocannabinol) in 14 outpatients with moderate-to-severe anxiety, defined as ≥16 on the Beck Anxiety Inventory (BAI) or ≥11 on the Overall Anxiety Severity and Impairment Scale (OASIS). RESULTS Findings suggest significant improvement on primary outcomes measuring anxiety and secondary outcomes assessing mood, sleep, quality of life, and cognition (specifically executive function) following treatment. Anxiety is significantly reduced at week 4 relative to baseline (BAI: 95% CI = [-21.03, -11.40], p < 0.001, OASIS: 95% CI = [-9.79, -6.07], p < 0.001). Clinically significant treatment response (≥15% symptom reduction) is achieved and maintained as early as week 1 in most patients (BAI = 78.6%, OASIS = 92.7%); cumulative frequency of treatment responders reached 100% by week 3. The study drug is well-tolerated, with high adherence/patient retention and no reported intoxication or serious adverse events. Minor side effects, including sleepiness/fatigue, increased energy, and dry mouth are infrequently endorsed. CONCLUSIONS Results provide preliminary evidence supporting efficacy and tolerability of a full-spectrum, high-CBD product for anxiety. Patients quickly achieve and maintain symptom reduction with few side effects. A definitive assessment of the impact of this novel treatment on clinical symptoms and cognition will be ascertained in the ongoing double-blind, placebo-controlled stage.
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Affiliation(s)
- Mary Kathryn Dahlgren
- grid.240206.20000 0000 8795 072XCognitive and Clinical Neuroimaging Core, McLean Hospital Imaging Center, 115 Mill Street, Belmont, MA 02478 USA ,grid.240206.20000 0000 8795 072XMarijuana Investigations for Neuroscientific Discovery (MIND) Program, McLean Hospital Imaging Center, 115 Mill Street, Belmont, MA 02478 USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Ashley M. Lambros
- grid.240206.20000 0000 8795 072XCognitive and Clinical Neuroimaging Core, McLean Hospital Imaging Center, 115 Mill Street, Belmont, MA 02478 USA ,grid.240206.20000 0000 8795 072XMarijuana Investigations for Neuroscientific Discovery (MIND) Program, McLean Hospital Imaging Center, 115 Mill Street, Belmont, MA 02478 USA
| | - Rosemary T. Smith
- grid.240206.20000 0000 8795 072XCognitive and Clinical Neuroimaging Core, McLean Hospital Imaging Center, 115 Mill Street, Belmont, MA 02478 USA ,grid.240206.20000 0000 8795 072XMarijuana Investigations for Neuroscientific Discovery (MIND) Program, McLean Hospital Imaging Center, 115 Mill Street, Belmont, MA 02478 USA
| | - Kelly A. Sagar
- grid.240206.20000 0000 8795 072XCognitive and Clinical Neuroimaging Core, McLean Hospital Imaging Center, 115 Mill Street, Belmont, MA 02478 USA ,grid.240206.20000 0000 8795 072XMarijuana Investigations for Neuroscientific Discovery (MIND) Program, McLean Hospital Imaging Center, 115 Mill Street, Belmont, MA 02478 USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Celine El-Abboud
- grid.240206.20000 0000 8795 072XCognitive and Clinical Neuroimaging Core, McLean Hospital Imaging Center, 115 Mill Street, Belmont, MA 02478 USA ,grid.240206.20000 0000 8795 072XMarijuana Investigations for Neuroscientific Discovery (MIND) Program, McLean Hospital Imaging Center, 115 Mill Street, Belmont, MA 02478 USA
| | - Staci A. Gruber
- grid.240206.20000 0000 8795 072XCognitive and Clinical Neuroimaging Core, McLean Hospital Imaging Center, 115 Mill Street, Belmont, MA 02478 USA ,grid.240206.20000 0000 8795 072XMarijuana Investigations for Neuroscientific Discovery (MIND) Program, McLean Hospital Imaging Center, 115 Mill Street, Belmont, MA 02478 USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
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Narayan A, Downey LA, Manning B, Hayley AC. Cannabinoid Treatments for Anxiety: A Systematic Review and Consideration of the Impact of Sleep Disturbance. Neurosci Biobehav Rev 2022; 143:104941. [DOI: 10.1016/j.neubiorev.2022.104941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 10/13/2022] [Accepted: 10/30/2022] [Indexed: 11/11/2022]
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Xiao S, Yang Z, Su T, Gong J, Huang L, Wang Y. Functional and structural brain abnormalities in posttraumatic stress disorder: A multimodal meta-analysis of neuroimaging studies. J Psychiatr Res 2022; 155:153-162. [PMID: 36029627 DOI: 10.1016/j.jpsychires.2022.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Numerous resting-state functional and structural studies have revealed that many brain regions are involved in the pathogenesis of posttraumatic stress disorder (PTSD), but their findings have been inconsistent. Moreover, there has no study explored the functional and structural alterations across languages in PTSD. METHODS A meta-analysis of whole-brain on the amplitude of low-frequency fluctuation (ALFF) and voxel-based morphometry (VBM) studies that explored alterations in the spontaneous functional brain activity and grey matter volume (GMV) in PTSD patients across languages by using the Seed-based d Mapping with Permutation of Subject Images (SDM-PSI) software. RESULTS A total of 15 studies (19 datasets) comprising 577 PTSD patients and 499 HCs for ALFF, and 27 studies (31 datasets) comprising 539 PTSD patients and 693 HCs for VBM were included. Overall, PTSD patients across languages displayed decreased ALFF in the in the left amygdala. For VBM meta-analysis, PTSD patients across languages displayed reduced GMV in the bilateral anterior cingulate cortex/medial prefrontal cortex (ACC/mPFC), striatum, insula, superior temporal gyrus, left postcentral gyrus, and occipital gyrus. CONCLUSIONS The multimodal meta-analysis suggest that PTSD patients showed similar pattern of aberrant resting-state functional brain activity and structure mainly in the amygdala, suggesting that structural deficits might underlie alterations in function. In addition, some regions exhibited only structural abnormalities in PTSD, including the ACC/mPFC, striatum, insula, primary visual, auditory and sensorimotor cortices. Moreover, consistent alterations in PTSD patients across languages may draw attention to the disparity in multi-cultural considerations in psychiatric research and further understanding the neurophysiopathology of PTSD.
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Affiliation(s)
- Shu Xiao
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Zibin Yang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Ting Su
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Jiaying Gong
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China; Department of Radiology, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, China
| | - Li Huang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China.
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Hill ML, Loflin M, Nichter B, Na PJ, Herzog S, Norman SB, Pietrzak RH. Cannabis use among U.S. military veterans with subthreshold or threshold posttraumatic stress disorder: Psychiatric comorbidities, functioning, and strategies for coping with posttraumatic stress symptoms. J Trauma Stress 2022; 35:1154-1166. [PMID: 35275431 DOI: 10.1002/jts.22823] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/27/2021] [Accepted: 01/19/2022] [Indexed: 11/07/2022]
Abstract
Cannabis use is common among individuals with posttraumatic stress disorder (PTSD) symptoms, but its impact on psychiatric symptoms and functioning in this population is unclear. To clarify the clinical and functional correlates of cannabis use in individuals with PTSD symptoms, we analyzed data from the 2019-2020 National Health and Resilience in Veterans Study, a nationally representative survey of U.S. military veterans. Participants with current subthreshold or full PTSD (N = 608) reported on their past-6-month cannabis use and current psychiatric symptoms, functioning, treatment utilization, and PTSD symptom management strategies. Veterans with subthreshold/full PTSD who used cannabis more than weekly were more likely to screen positive for co-occurring depression, anxiety, and suicidal ideation than those who did not use cannabis, ORs = 3.4-3.8, or used cannabis less than weekly, ORs = 2.7-3.7. Veterans who used cannabis more than weekly also scored lower in cognitive functioning than veterans with no use, d = 0.25, or infrequent use, d = 0.71, and were substantially more likely to endorse avoidance coping strategies, ORs = 8.2-12.2, including substance use, OR = 4.4, and behavioral disengagement, ORs = 2.7-9.1, to manage PTSD symptoms. Despite more psychiatric and functional problems, veterans with frequent cannabis use were not more likely to engage in mental health treatment, ORs = 0.87-0.99. The results suggest enhanced cannabis use screening, interventions targeting risky use, and strategies promoting treatment engagement may help ameliorate more severe clinical presentations associated with frequent cannabis use among veterans with subthreshold/full PTSD.
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Affiliation(s)
- Melanie L Hill
- Department of Psychiatry, University of California, San Diego, California, USA.,VA San Diego Healthcare System, San Diego, California, USA
| | - Mallory Loflin
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Brandon Nichter
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Sarah Herzog
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, New York, USA.,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California, San Diego, California, USA.,VA San Diego Healthcare System, San Diego, California, USA.,National Center for PTSD, White River Junction, Vermont, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
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Winder GS, Andrews SR, Banerjee AG, Hussain F, Ivkovic A, Kuntz K, Omary L, Shenoy A, Thant T, VandenBerg A, Zimbrean P. Cannabinoids and solid organ transplantation: Psychiatric perspectives and recommendations. Transplant Rev (Orlando) 2022; 36:100715. [PMID: 35853383 DOI: 10.1016/j.trre.2022.100715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/10/2022] [Indexed: 01/01/2023]
Abstract
Cannabinoid use in patients seeking solid organ transplantation (SOT) is an important and unsettled matter which all transplantation clinicians regularly encounter. It is also a multifaceted, interprofessional issue, difficult for any specialty alone to adequately address in a research article or during clinical care. Such uncertainty lends itself to bias for or against cannabinoid use accompanied by inconsistent policies and procedures. Scientific literature in SOT regarding cannabinoids often narrowly examines the issue and exists mostly in liver and kidney transplantation. Published recommendations from professional societies are mosaics of vagueness and specificity mirroring the ongoing dilemma. The cannabinoid information SOT clinicians need for clinical care may require data and perspectives from diverse medical literature which are rarely synthesized. SOT teams may not be adequately staffed or trained to address various neuropsychiatric cannabinoid effects and risks in patients. In this article, authors from US transplantation centers conduct a systematized review of the few existing studies regarding clinician perceptions, use rates, and clinical impact of cannabinoid use in SOT patients; collate representative professional society guidance on the topic; draw from diverse medical literature bases to detail facets of cannabinoid use in psychiatry and addiction pertinent to all transplantation clinicians; provide basic clinical and policy recommendations; and indicate areas of future study.
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Affiliation(s)
| | - Sarah R Andrews
- Johns Hopkins Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland, USA
| | | | - Filza Hussain
- Stanford University Department of Psychiatry and Behavioral Sciences, Palo Alto, California, USA
| | - Ana Ivkovic
- Massachusetts General Hospital Department of Psychiatry, Boston, Massachusetts, USA
| | - Kristin Kuntz
- Ohio State University Department of Psychiatry and Behavioral Health, Columbus, Ohio, USA
| | - Lesley Omary
- Vanderbilt University Department of Psychiatry and Behavioral Sciences, Nashville, Tennessee, USA
| | - Akhil Shenoy
- Columbia University Department of Psychiatry, New York City, New York, USA
| | - Thida Thant
- University of Colorado Department of Psychiatry, Aurora, Colorado, USA
| | - Amy VandenBerg
- University of Michigan Department of Psychiatry, Ann Arbor, Michigan, USA
| | - Paula Zimbrean
- Yale University Department of Psychiatry, New Haven, Connecticut, USA
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Hernández-Hernández E, García-Fuster MJ. Dose-Dependent Antidepressant-Like Effects of Cannabidiol in Aged Rats. Front Pharmacol 2022; 13:891842. [PMID: 35847003 PMCID: PMC9283859 DOI: 10.3389/fphar.2022.891842] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
Aging predisposes to late-life depression and since antidepressants are known to change their efficacy with age, novel treatment options are needed for our increased aged population. In this context, the goal of the present study was to evaluate the potential antidepressant-like effect of cannabidiol in aged rats. For this purpose, 19–21-month-old Sprague–Dawley rats were treated for 7 days with cannabidiol (dose range: 3–30 mg/kg) and scored under the stress of the forced-swim test. Hippocampal cannabinoid receptors and cell proliferation were evaluated as potential molecular markers underlying cannabidiol’s actions. The main results of the present study demonstrated that cannabidiol exerted a dose-dependent antidepressant-like effect in aged rats (U-shaped, effective at the intermediate dose of 10 mg/kg as compared to the other doses tested), without affecting body weight. None of the molecular markers analyzed in the hippocampus were altered by cannabidiol’s treatment. Overall, this study demonstrated a dose-dependent antidepressant-like response for cannabidiol at this age-window (aged rats up to 21 months old) and in line with other studies suggesting a beneficial role for this drug in age-related behavioral deficits.
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Affiliation(s)
- Elena Hernández-Hernández
- IUNICS, University of the Balearic Islands, Palma, Spain
- Health Research Institute of Balearic Islands (IdISBa), Palma, Spain
| | - M. Julia García-Fuster
- IUNICS, University of the Balearic Islands, Palma, Spain
- Health Research Institute of Balearic Islands (IdISBa), Palma, Spain
- *Correspondence: M. Julia García-Fuster,
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Exploring pharmacological options for adolescent depression: a preclinical evaluation with a sex perspective. Transl Psychiatry 2022; 12:220. [PMID: 35650182 PMCID: PMC9160287 DOI: 10.1038/s41398-022-01994-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/19/2022] [Accepted: 05/25/2022] [Indexed: 11/12/2022] Open
Abstract
There is an urgent need for developing novel pharmacological treatment options for adolescent depression, and to ensure an optimal translational outcome to the clinic, sex should be included as a biological variable in preclinical studies. In this context, the present study compared the antidepressant-like potential of ketamine and cannabidiol, with the clinical standard fluoxetine, in adolescent rats exposed to maternal deprivation (as a model of early-life stress), while including a sex perspective. Moreover, changes in drug efficacy over time were evaluated by re-exposing rats to the same dose regimens during adulthood. Antidepressant-like responses were scored through a battery of distinctive tests (forced-swim, novelty-suppressed feeding, and sucrose preference) across time. The main results proved an antidepressant-like potential for ketamine and cannabidiol in adolescent rats, although their efficacy was dependent on sex and prior stress exposure, as well as on treatment length and the behavioral feature analyzed. In general, while all tested antidepressants in male rats improved certain affective-like features, female rats were mainly unresponsive to the treatments performed (except for certain benefits induced by ketamine), demonstrating the need for further characterizing proper treatments for this particular sex. Moreover, when rats were re-exposed in adulthood to the same drug regimens as in adolescence, a drop in efficacy was observed. These findings may have translational ramifications in that ketamine or cannabidiol could be moved forward as antidepressants for the adolescent depressed population, but not before further characterizing their potential long-term safety and/or beneficial vs. harmful effects for both sexes.
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Clary KL, Habbal M, Smith DC, Fratila I. The Green Sheep: Exploring the Perceived Risks and Benefits of Cannabis Among Young Military Members and Veterans. CANNABIS (ALBUQUERQUE, N.M.) 2021; 4:31-46. [PMID: 37287531 PMCID: PMC10212263 DOI: 10.26828/cannabis/2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Medical and recreational cannabis are becoming more accessible and socially accepted across the United States. Emerging adults (EAs; 18 to 29) are the largest group of cannabis users. Studies have found that veterans are more likely to report cannabis use compared to nonveterans. While research exists on the use levels of cannabis, limited knowledge is available on the perceived risks and benefits of using cannabis among EA military and veteran populations. Helping professionals encounter veterans who use cannabis and must consider military cultural factors and attitudes towards cannabis that may influence or exacerbate cannabis use. We conducted a qualitative study with 23 EA veteran and military members with high-risk substance use and asked about their thoughts on the acceptability, risks, and perceived benefits associated with cannabis. Two qualitative coders used NVivo to find themes following the six steps of thematic analysis. Results provide in-depth understanding of EA military members and veterans' perceptions of cannabis. Overall, we found participants were receptive to using cannabis for pain ailments, mental health issues, and as an alternative to benzodiazepines, opioids, and alcohol. However, they acknowledged restrictions are needed to moderate cannabis use and mitigate negative outcomes. Lastly, participants recognized the incongruence of cannabis use with military job responsibilities and expectations. These findings shed light on potential risk and protective factors related to using cannabis for recreational or medical reasons and should be considered when consulting EA military members and veterans.
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Affiliation(s)
| | - Megan Habbal
- Department of Psychology, University of Illinois at Urbana-Champaign
| | - Douglas C. Smith
- School of Social Work, University of Illinois at Urbana-Champaign
| | - Iulia Fratila
- Community Health, University of Illinois at Urbana-Champaign
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Stute P. Cannabis zur Behandlung des klimakterischen Syndroms!? GYNAKOLOGISCHE ENDOKRINOLOGIE 2021. [DOI: 10.1007/s10304-021-00388-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Selling cannabidiol products in Canada: A framing analysis of advertising claims by online retailers. BMC Public Health 2021; 21:1285. [PMID: 34210299 PMCID: PMC8248754 DOI: 10.1186/s12889-021-11282-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/14/2021] [Indexed: 02/03/2023] Open
Abstract
Background In Canada, the legalization of cannabis has enabled cannabidiol (CBD) to become a popular commercial product, increasingly used for medical or therapeutic purposes. There are currently over one thousand CBD products available globally, ranging from oil extracts to CBD-infused beverages. Despite increased usage and availability, the evidence supporting the medical efficacy of CBD is limited. Anecdotal evidence suggests CBD sellers represent their products for medical use through direct medical claims or advice, which in Canada, is not allowed under the Cannabis Act without Health Canada approval. However, it is not clear the extent of sellers making health claims or other strategies used to promote medical usage of CBD. The objective of this study is to determine how CBD sellers advertise their products online to consumers. Methods The product descriptions of 2165 CBD products from 70 websites selling CBD products for human consumption in Canada were collected from January 14th, 2020 to February 2nd, 2020 using an automated website scraper tool. A framing analysis was used to determine how CBD sellers frame their products to prospective customers. The specific medical conditions CBD is represented to treat and product forms were tabulated. Results CBD products are framed to prospective customer through three distinct frames: a specific cure or treatment (n = 1153), a natural health product (n = 872), and a product used in certain ways to achieve particular results (n = 1388). Product descriptions contained medical or therapeutic claims for 171 medical conditions and ailments, with 53.3% of products containing at least one claim. The most prevalent claims found in product descriptions were the ability to treat or manage pain (n = 824), anxiety (n = 609), and inflammation (n = 545). Claims were found for treating or managing serious and-life-threatening illnesses such as multiple sclerosis (n = 210), arthritis (n = 179), cancer (n = 169), Crohn’s disease (n = 78), Parkinson’s disease (n = 59), and human immunodeficiency virus (HIV) (n = 54). CBD most often came in oil/tincture/concentrate form (n = 755), followed by edibles (n = 428), and vaporizer pen/cartridge/liquid products (n = 290). Conclusion The findings suggest CBD is represented as a medical option for numerous conditions and ailments. We recommend Health Canada to conduct a systematic audit of companies selling CBD for regulatory adherence.
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