
An Overview of Cannabis Use in Individuals With Affective Disorders
This research update underscores the need to be well versed in the data in order to have meaningful conversations with our patients who are cannabis users or contemplate use.
RESEARCH UPDATE
Affective disorders are among the most debilitating psychiatric conditions and afflict 20% of the population while contributing to significant morbidity and mortality.1 The association between cannabis use and unipolar depression has been well documented, as individuals with cannabis dependence are almost three times more likely to suffer from depressive disorders than the general population.2 Those with depressive conditions are in turn twice as likely to use cannabis than the general population.3 In patients with bipolar depression, much of the same is
In one longitudinal study by
According to the National Academy of Sciences, Engineering, and Medicine
The role of the endocannabinoid system has been of interest since the 1990s when it was first discovered. A reduction in serum levels of 2-arachidonoylglycerol, one of the endocannabinoids, has been
The only randomized controlled trials of cannabinoids in humans for affective disorders are rather limited and date back to the 1970s.11,12 Here the investigators attempted to use oral tetrahydrocannabinol (THC) only in the treatment of unipolar and bipolar depressive disorders. Not only was there a complete failure of an antidepressant response, but also poor tolerability was demonstrated in the form of dysphoric, psychotic, and anxiety reactions.
In a study by
In a study by
Clinical bottom line
There is much to be learned about the exact implication of the endocannabinoid system in mental health symptoms and overall clinical conditions. However, the current body of available knowledge certainly suggests involvement. Although the majority of data provide mere association, if one accepts the implied bidirectional relationship, there is significant concern of harm in individuals with affective disorders and cannabis use should be discouraged.
Although a better understanding of the endocannabinoid system may unveil pharmacotherapeutic targets, this is likely years away. To expedite this, pharmaceutical-grade cannabinoids are now available and should be utilized in furthering such research.
At this point, all organizations for mental health have issued warnings discouraging endorsement of cannabis use in general, as well as for attempts at management of any mental health clinical conditions. As clinicians, we need to be well versed with the above data in order to have meaningful conversations with our patients who are cannabis users or contemplate use.
Disclosures:
Dr Stanciu is Assistant Professor of Psychiatry at Dartmouth’s Geisel School of Medicine and Director of Addiction Services at New Hampshire Hospital, Concord, NH. Dr Teja is a PGY-4 General Psychiatry Resident at Dartmouth’s Geisel School of Medicine, Hanover, NH. The authors report no conflicts of interest concerning the subject matter of this article.
References:
1. Whiteford HA, Degenhardt L, Rehm J, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet. 2013;382:1575-1586.
2. Compton WM, Grant BF, Colliver JD, et al.
3. Pacek LR, Weinberger AH, Zhu J, Goodwin RD.
4. Lev-Ran S, Roerecke M, Le Foll B, et al.
5. Henquet C1, Krabbendam L, de Graaf R, et al.
6. Borges G, Bagge CL, Orozco R.
7.
8. Cousijn J, Núñez AE, Filbey FM.
9. Hill MN, Miller GE, Ho WS, et al.
10. Hungund BL, Vinod KY, Kassir SA, et al.
11. Kotin J, Post RM, Goodwin FK.
12. Ablon SL, Goodwin FK.
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