Trazodone Prolonged-Release Monotherapy in Cannabis Dependent Patients during Lockdown Due to COVID-19 Pandemic: A Case Series

Emerging strategies and clinical recommendations for the management of novel depression subtypes

INTRODUCTION

The phenomenology of depression is characterized by a wide array of emotional, cognitive, and physical symptoms that significantly disrupt an individual's life. Societal changes, driven by technological advancements, economic pressures, environmental concerns including climate change, and shifting cultural norms, have influenced how depression manifests and is understood. These developments have led to the identification of new depression subtypes, highlighting the need for personalized treatment approaches based on individual symptoms and underlying causes.

AREAS COVERED

The authors provide a comprehensive narrative review of the literature on managing novel depression subtypes, focusing on both pharmacological and non-pharmacological treatments. Specifically, scenarios recorded were related to i) depression in adolescents and young adults; ii) depression and social disconnection; iii) depression and alcohol/substance use disorder; iv) depression and gender dysphoria; v) depression, stressful events, and other environmental factors.

EXPERT OPINION

In the novel depression subtypes discussed, individualized treatment approaches tailored to the individual's specific circumstances are necessary. While selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) remain the cornerstone of treatment for many forms of depression, atypical antidepressants such as trazodone, and emerging therapies like ketamine, neuromodulation techniques, and personalized psychotherapy offer hope for those with complex or treatment-resistant presentations.

Green rush and red warnings: Retrospective chart review of adverse events of interactions between cannabinoids and psychotropic drugs

Aim

Our objective was to systematically assess the prevalence and clinical features of adverse events related to interactions between cannabinoids and psychotropic drugs through a retrospective chart review.

Methodology

1586 adverse event reports were assessed. Cases included in the analysis showed a high probability of a causal relationships between cannabinoid-psychotropic drug interactions and adverse events. Data extracted included age, sex, psychotropic drug, cannabinoid products, other medications, and the clinical outcomes and mechanisms of these interactions.

Results

Cannabinoids were involved in 8% of adverse events associated with the concomitant use of psychotropic drugs and other preparations. We identified 20 reports in which side effects presented a causal relationship with the use of psychotropic drugs and cannabinoids. Preparations containing 18% or more tetrahydrocannabinol (THC), presented significant side effects with the following antidepressants: mianserine (restless legs syndrome, urogenital pain, ventricular tachycardia), mirtazapine (pancreatitis, hyperhidrosis, arthralgia), quetiapine (myocarditis, renal failure, bradycardia, sialorrhea), haloperidol (ventricular arrhythmia, prolonged QTc), aripiprazole (prolonged QTc), ventricular tachycardia) and cariprazine (stomach pain, hepatotoxicity), sertraline (ataxia, hyperactivity, coma, hallucinations, anxiety, agitation, tachycardia, panic attacks, disorientation, headache, dizziness, blurry vision, severe emesis, xerostomia, dry eyes), trazodone (disorientation, memory impairment, sedation), fluvoxamine (tachycardia, tachypnoea, dysarthria, auditory hallucinations). Two out of 20 reports (10%) analyzed in our study was related with the simultaneous use of cannabidiol (CBD) oil and sertraline. Concomitant use of those substances was associated with the adverse events in form of diarrhea, emesis, fever and severe fatigue.

Conclusion

Clinicians need to closely monitor adverse events resulting from the combined use of cannabinoids and psychotropic medications. The accumulation of side effects and pharmacokinetic interactions (including CYP and p-glycoprotein inhibition) between these drugs can lead to clinically significant adverse outcomes.