RSS-Feed abonnieren
DOI: 10.1055/a-2215-6114
Effectiveness of Medical Cannabis for the Treatment of Depression: A Naturalistic Outpatient Study
Abstract
Background There is a lack of studies on the course and effectiveness of medical cannabis in the treatment of major depressive disorder (MDD).
Methods Retrospective longitudinal (18 weeks) study of n=59 outpatients with MDD, treated with medical cannabis via a telemedical platform. Previous treatment with antidepressant medication was required for inclusion into the study. Standardized data collection was carried out at entry and during monthly consultations. Severity of depression was measured on a 0–10 point rating scale. Side-effects were assessed by a checklist.
Results Patients were 20–54 years old; 72.9% were male; one third reported times of regular cannabis consumption within the previous five years. Drop-out rate was 22% after 18 weeks. Mean severity of depression decreased from 6.9 points (SD 1.5) at entry to 3.8 points (2.7) at week 18 (baseline observation carried forward; 95% CI for the mean difference: 2.4 to 3.8; p<0.001). A treatment response (>50% reduction of the initial score) was seen in 50.8% at week 18. One third of patients complained about side effects, none was considered as severe. Concomitant antidepressant medication (31% of patients) was not associated with outcome.
Conclusions Medical cannabis was well tolerated and dropout rate was comparable to those in clinical trials of antidepressant medication. Patients reported a clinically significant reduction of depression severity. Further research on the effectiveness of medical cannabis for MDD seems warranted. Risks of this medication, such as sustaining or inducing a cannabis use disorder, or side effects such as poor concentration, must be taken into consideration.
Publikationsverlauf
Eingereicht: 31. Mai 2023
Angenommen: 09. November 2023
Artikel online veröffentlicht:
11. Januar 2024
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 World Health Organization. Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization; 2017
- 2 Fava M, Davidson KG. Definition and epidemiology of treatment-resistant depression. Psychiatr Clin North Am 1996; 19: 179-200
- 3 Gartlehner G, Hansen RA, Morgan LC. et al. Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: An updated meta-analysis. Ann Intern Med 2011; 155: 772-785
- 4 Carvalho AF, Berk M, Hyphantis TN. et al. The integrative management of treatment-resistant depression: a comprehensive review and perspectives. Psychother Psychosom 2014; 83: 70-88
- 5 Gourion D, Galinowski A, Baraille L. et al. Changer d'antidépresseur: quand, comment, pourquoi? [Switch antidepressants: when? How? Why?]. Encephale 2011; 37: S50-S57
- 6 Turna J, Patterson B, Van Ameringen M. Is cannabis treatment for anxiety, mood, and related disorders ready for prime time?. Depress Anxiety 2017; 34: 1006-1017
- 7 Witkin JM, Tzavara ET, Davis RJ. et al. A therapeutic role for cannabinoid CB 1 receptor antagonists in major depressive disorders. Trends Pharmacol Sci 2005; 26: 609-617
- 8 Hill MN, Hillard CJ, Bambico FR. et al. The therapeutic potential of the endocannabinoid system for the development of a novel class of antidepressants. Trends Pharmacol Sci 2009; 30: 484-493
- 9 Katzman MA, Furtado M, Anand L. Targeting the endocannabinoid system in psychiatric illness. J Clin Psychopharmacol 2016; 36: 691-703
- 10 Garani R, Watts JJ, Mizrahi R. Endocannabinoid system in psychotic and mood disorders, a review of human studies. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106: 110096
- 11 Orsolini L, Chiappini S, Volpe U. et al. Use of medicinal cannabis and synthetic cannabinoids in post-traumatic stress disorder (PTSD): A systematic review. Medicina (Kaunas) 2019; 55: 525
- 12 Hoch E, Niemann D, von Keller R. et al. How effective and safe is medical cannabis as a treatment of mental disorders? A systematic review. Eur Arch Psychiatry Clin Neurosci 2019; 269: 87-105
- 13 Black N, Stockings E, Campbell G. et al. Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: A systematic review and meta-analysis. Lancet Psychiatry 2019; 6: 995-1010
- 14 Kendzor DE, Ehlke SJ, Kharazi Boozary L. et al. Characteristics of adults with a medical cannabis license, reasons for use, and perceptions of benefit following medical cannabis legalization in Oklahoma. Prev Med Rep 2022; 27: 101777
- 15 Kosiba JD, Maisto SA, Ditre JW. Patient-reported use of medical cannabis for pain, anxiety, and depression symptoms: Systematic review and meta-analysis. Soc Sci Med 2019; 233: 181-192
- 16 Cremer-Schaeffer P, Knöss W. Cannabis zu medizinischen Zwecken – Das Gesetz vom März 2017 und seine Vorgeschichte [Cannabis for medical purposes-the law of March 2017 and its history]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62: 801-805
- 17 Reuter W. Cannabis-Verordnungen und Kostenübernahme von gesetzlicher und privater Krankenversicherung. [Cannabis prescriptions and reimbursement in statutory and private health insurance in Germany]. Nervenheilkunde 2023; 42: 209-213
- 18 Gaebel W, Kowitz S, Zielasek J. The DGPPN research project on mental healthcare utilization in Germany: Inpatient and outpatient treatment of persons with depression by different disciplines. Eur Arch Psychiatry Clin Neurosci 2012; 262: S51-S55
- 19 Atakan Z. Cannabis, a complex plant: Different compounds and different effects on individuals. Ther Adv Psychopharmacol 2017; 2: 241-254
- 20 Müller-Vahl K, Grotenhermen F. Medizinisches Cannabis: Die wichtigsten Änderungen [Medical cannabis: The most important changes]. Dtsch Arztebl 2017; 114 A-352 / B-306 / C-300
- 21 Knodt M. Zu teuer? Medizinische cannabis-extrakte warten weiter auf den Durchbruch [Too expensive? Medical cannabis extracts are still waiting for their breakthrough]. Krautinvest. 2021 June 23 https://krautinvest.de/zu-teuer-medizinische-cannabis-extrakte-warten-weiter-auf-den-durchbruch/
- 22 European Medicines Agency (EMA). Guideline on clinical investigation of medicinal products in the treatment of depression. Revision 2. EMA/CHMP/185423/2010 Rev. 2. 2013 https://www.ema.europa.eu/en/documents/scientific-guideline/guideline-clinical-investigation-medicinal-products-treatment-depression-revision-2_en.pdf
- 23 Zimmerman M, Ruggero CJ, Chelminski I. et al. Developing brief scales for use in clinical practice: The reliability and validity of single-item self-report measures of depression symptom severity, psychosocial impairment due to depression, and quality of life. J Clin Psychiatry 2006; 67: 1536-1541
- 24 McKenzie N, Marks I. Quick rating of depressed mood in patients with anxiety disorders. Br J Psychiatry 1999; 174: 266-269
- 25 Palmer GA, Palmer DG, McMillen TN. Single-item depression screening with the Neuro-behavioral Symptom Inventory (NSI): Do scores assist clinicians with predicting need for mental health interventions?. Psychol Serv 2023; 20: 690–696
- 26 Heller GZ, Manuguerra M, Chow R. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance. Scand J Pain 2016; 13: 67-75
- 27 Jackson WC, Papakostas GI, Rafeyan R. et al. Recognizing Inadequate Response in Patients With Major Depressive Disorder. J Clin Psychiatry 2020; 81: OT19037BR2
- 28 Lydersen S. Last observation carried forward. Tidsskr Nor Laegeforen. 2019 139.
- 29 Cohen J. Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum; 1988
- 30 IBM. SPSS statistics for Windows. Version 29.0. Armonk, NY: IBM,; 2022
- 31 Mangoo S, Erridge S, Holvey C. et al. Assessment of clinical outcomes of medicinal cannabis therapy for depression: Analysis from the UK Medical Cannabis Registry. Expert Rev Neurother 2022; 22: 995-1008
- 32 Undurraga J, Baldessarini RJ. Randomized, placebo-controlled trials of antidepressants for acute major depression: thirty-year meta-analytic review. Neuropsychopharmacology 2012; 37: 851-864
- 33 Rutherford BR, Sneed JR, Roose SP. Does differential drop-out explain the influence of study design on antidepressant response? A meta-analysis. J Affect Disord 2012; 140: 57-65
- 34 Furukawa TA, Cipriani A, Atkinson LZ. Placebo response rates in antidepressant trials: A systematic review of published and unpublished double-blind randomised controlled studies. Lancet Psychiatry 2016; 3: 1059-1066
- 35 Davies P, Ijaz S, Williams CJ. et al. Pharmacological interventions for treatment-resistant depression in adults. Cochrane Database Syst Rev 2019; 12: CD010557
- 36 Trivedi MH, Rush AJ, Wisniewski SR. et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: Implications for clinical practice. Am J Psychiatry 2006; 163: 28-40
- 37 Sharma T, Guski LS, Freund N. et al. Drop-out rates in placebo-controlled trials of antidepressant drugs: A systematic review and meta-analysis based on clinical study reports. Int J Risk Saf Med 2019; 30: 217-232
- 38 Warden D, Rush AJ, Wisniewski SR. et al. What predicts attrition in second step medication treatments for depression?: a STAR*D Report. Int J Neuropsychopharmacol 2009; 12: 459-473
- 39 Busch MA, Maske UE, Ryl L. et al. Prevalence of depressive symptoms and diagnosed depression among adults in Germany: Results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsbl – Gesundheitsforsch - Gesundheitsschutz 2013; 56: 733-739
- 40 Möller-Leimkühler AM, Schwarz R, Burtscheidt W. et al. Alcohol dependence and gender-role orientation. Eur Psychiatry 2002; 17: 1-8
- 41 Swendsen J, Merikangas KR. The comorbidity of depression and substance use disorders. Clin Psychol Rev 2000; 20: 173-189
- 42 Möller-Leimkühler AM. Männer und Depression: Geschlechtsspezifisches Hilfesuchverhalten.[Men and Depression: Gender-Related Help-Seeking Behaviour]. Fortschr Neurol Psychiatr 2000; 68: 489-495
- 43 Seidler ZE, Dawes AJ, Rice SM. et al. The role of masculinity in men’s help-seeking for depression: A systematic review. Clin Psychol Rev 2016; 49: 106-118
- 44 Gough B, Novikova I. Mental health, men and culture: How do sociocultural constructions of masculinities relate to men's mental health help-seeking behaviour in the WHO European Region? WHO Health Evidence Network Synthesis Reports. Copenhagen: WHO Regional Office for Europe; 2020
- 45 Joshi M, Joshi A, Bartter T. Marijuana and the Lung: Evolving Understandings. Med Clin North Am 2022; 106: 1093-1107
- 46 Jett J, Stone E, Warren G. et al. Cannabis use, lung cancer, and related issues. J Thorac Oncol 2018; 13: 480-487
- 47 Abelia XA, Lesmana R, Goenawan H. et al. Comparison impact of cigarettes and e-cigs as lung cancer risk inductor: A narrative review. Eur Rev Med Pharmacol Sci 2023; 27: 6301-6318
- 48 Oldenmenger WH, de Raaf PJ, de Klerk C. et al. Cut points on 0-10 numeric rating scales for symptoms included in the Edmonton Symptom Assessment Scale in cancer patients: A systematic review. J Pain Symptom Manage 2003; 45: 1083-1093
- 49 Cuijpers P, Karyotaki E, Eckshtain D. et al. Psychotherapy for depression across different age groups: A systematic review and meta-analysis. JAMA Psychiatry 2020; 77: 694-702
- 50 Bonnet U, Preuss UW. The cannabis withdrawal syndrome: Current insights. Subst Abuse Rehabil 2017; 8: 9-37
- 51 Gießelmann K. Cannabisarzneimittel: Schmerz steht an erster Stelle [Cannabis medication: Pain in the first place]. Dtsch Arztebl 2019; 116 A-1054 / B-867 / C-855
- 52 Cooke ME, Potter KW, Jashinski J. et al. Development of cannabis use disorder in medical cannabis users: A 9-month follow-up of a randomized clinical trial testing effects of medical cannabis card ownership. Front Psychiatry 2023; 14: 1083334
- 53 Mammen G, Rueda S, Roerecke M. et al. Association of cannabis with long-term clinical symptoms in anxiety and mood disorders: A systematic review of prospective studies. J Clin Psychiatry 2018; 79: 17r11839
- 54 World Health Organization. The health and social effects of nonmedical cannabis use. Geneva: World Health Organization; 2016