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CC BY-NC-ND 4.0 · Pharmacopsychiatry 2024; 57(03): 104-114
DOI: 10.1055/a-2256-0098
Review

Cannabinoids in the Treatment of Selected Mental Illnesses: Practical Approach and Overview of the Literature

Kirsten R. Müller-Vahl
1   Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Abstract

Although an increasing number of patients suffering from mental illnesses self-medicate with cannabis, current knowledge about the efficacy and safety of cannabis-based medicine in psychiatry is still extremely limited. So far, no cannabis-based finished product has been approved for the treatment of a mental illness. There is increasing evidence that cannabinoids may improve symptoms in autism spectrum disorder (ASD), Tourette syndrome (TS), anxiety disorders, and post-traumatic stress disorder (PTSD). According to surveys, patients often use cannabinoids to improve mood, sleep, and symptoms of attention deficit/hyperactivity disorder (ADHD). There is evidence suggesting that tetrahydrocannabinol (THC) and THC-containing cannabis extracts, such as nabiximols, can be used as substitutes in patients with cannabis use disorder.

Preliminary evidence also suggests an involvement of the endocannabinoid system (ECS) in the pathophysiology of TS, ADHD, and PTSD. Since the ECS is the most important neuromodulatory system in the brain, it possibly induces beneficial effects of cannabinoids by alterations in other neurotransmitter systems. Finally, the ECS is an important stress management system. Thus, cannabinoids may improve symptoms in patients with mental illnesses by reducing stress.

Practically, cannabis-based treatment in patients with psychiatric disorders does not differ from other indications. The starting dose of THC-containing products should be low (1–2.5 mg THC/day), and the dose should be up-titrated slowly (by 1–2.5 mg every 3–5 days). The average daily dose is 10–20 mg THC. In contrast, cannabidiol (CBD) is mainly used in high doses>400 mg/day.

Keywords

cannabis-based medicine - cannabinoids - psychiatry - THC - CBD


Publication History

Received: 17 September 2023

Accepted: 17 January 2024

Article published online:
01 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Ärzteblatt DÄG Redaktion Deutsches. Begleiterhebung zu medizinischem Cannabis: Bedingt aussagekräftig. Deutsches Ärzteblatt 2022 https://www.aerzteblatt.de/archiv/226212/Begleiterhebung-zu-medizinischem-Cannabis-Bedingt-aussagekraeftig Stand: 26.05.2023
    PubMed
  • 2 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
    CrossrefPubMedSearch in Google Scholar
  • 3 Sarris J, Sinclair J, Karamacoska D. et al. Medicinal cannabis for psychiatric disorders: A clinically-focused systematic review. BMC Psychiatry 2020; 20: 24
    CrossrefPubMedSearch in Google Scholar
  • 4 McKee KA, Hmidan A, Crocker CE. et al. Potential therapeutic benefits of cannabinoid products in adult psychiatric disorders: A systematic review and meta-analysis of randomised controlled trials. J Psychiatr Res 2021; 140: 267-281
    CrossrefPubMedSearch in Google Scholar
  • 5 Lim K, See YM, Lee J. A systematic review of the effectiveness of medical cannabis for psychiatric, movement and neurodegenerative disorders. Clin Psychopharmacol Neurosci 2017; 15: 301-312
    CrossrefPubMedSearch in Google Scholar
  • 6 Hazekamp A, Ware MA, Muller-Vahl KR. et al. The medicinal use of cannabis and cannabinoids--an international cross-sectional survey on administration forms. J Psychoactive Drugs 2013; 45: 199-210
    CrossrefPubMedSearch in Google Scholar
  • 7 Lintzeris N, Mills L, Abelev SV. et al. Medical cannabis use in Australia: Consumer experiences from the online cannabis as medicine survey 2020 (CAMS-20). Harm Reduction Journal 2022; 19: 88
    CrossrefPubMedSearch in Google Scholar
  • 8 Kimless D, Caloura M, Markos V. et al. An observational cross-sectional survey exploring the indications for and responses to medical marijuana use in certified patients in Pennsylvania. J Prim Care Community Health 2022; 13 21501319221129734
    CrossrefPubMedSearch in Google Scholar
  • 9 Lintzeris N, Driels J, Elias N. et al. Medicinal cannabis in Australia, 2016: the Cannabis as Medicine Survey (CAMS-16). Med J Aust 2018; 209: 211-216
    CrossrefPubMedSearch in Google Scholar
  • 10 Kayser RR, Raskin M, Snorrason I. et al. Cannabinoid augmentation of exposure-based psychotherapy for obsessive-compulsive disorder. J Clin Psychopharmacol 2020; 40: 207-210
    CrossrefPubMedSearch in Google Scholar
  • 11 Morena M, Berardi A, Colucci P. et al. Enhancing endocannabinoid neurotransmission augments the efficacy of extinction training and ameliorates traumatic stress-induced behavioral alterations in rats. Neuropsychopharmacology 2018; 43: 1284-1296
    CrossrefPubMedSearch in Google Scholar
  • 12 Radwan MM, Chandra S, Gul S. et al. Cannabinoids, phenolics, terpenes and alkaloids of cannabis. Molecules 2021; 26: 2774
    CrossrefPubMedSearch in Google Scholar
  • 13 Wolfe TJ, Kruse NA, Radwan MM. et al. A study of major cannabinoids via Raman spectroscopy and density functional theory. Spectrochim Acta A Mol Biomol Spectrosc 2023; 303: 123133
    CrossrefPubMedSearch in Google Scholar
  • 14 Walsh KB, McKinney AE, Holmes AE. Minor cannabinoids: Biosynthesis, molecular pharmacology and potential therapeutic uses. Front Pharmacol 2021; 12: 777804
    CrossrefPubMedSearch in Google Scholar
  • 15 Ben-Shabat S, Fride E, Sheskin T. et al. An entourage effect: Inactive endogenous fatty acid glycerol esters enhance 2-arachidonoyl-glycerol cannabinoid activity. Eur J Pharmacol 1998; 353: 23-31
    CrossrefPubMedSearch in Google Scholar
  • 16 Piomelli D, Russo EB. The Cannabis sativa versus Cannabis indica debate: An interview with Ethan Russo, MD. Cannabis Cannabinoid Res 2016; 1: 44-46
    CrossrefPubMedSearch in Google Scholar
  • 17 Kanabus J, Bryła M, Roszko M. et al. Cannabinoids—characteristics and potential for use in food production. Molecules 2021; 26: 6723
    CrossrefPubMedSearch in Google Scholar
  • 18 de Almeida DL, Devi LA. Diversity of molecular targets and signaling pathways for CBD. Pharmacol Res Perspect 2020; 8: e00682
    CrossrefPubMedSearch in Google Scholar
  • 19 An D, Peigneur S, Hendrickx LA. et al. Targeting cannabinoid receptors: Current status and prospects of natural products. Int J Mol Sci 2020; 21: 5064
    CrossrefPubMedSearch in Google Scholar
  • 20 Russo E, Guy GW. A tale of two cannabinoids: The therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. Med Hypotheses 2006; 66: 234-246
    CrossrefPubMedSearch in Google Scholar
  • 21 Christensen C, Rose M, Cornett C. et al. Decoding the postulated entourage effect of medicinal cannabis: What it is and what it isn’t. Biomedicines 2023; 11: 2323
    CrossrefPubMedSearch in Google Scholar
  • 22 BfArM – Startseite – Abschlussbericht Begleiterhebung https://www.bfarm.de/SharedDocs/Downloads/DE/Bundesopiumstelle/Cannabis/Abschlussbericht_Begleiterhebung.html Stand: 26.05.2023
    PubMed
  • 23 MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med 2018; 49: 12-19
    CrossrefPubMedSearch in Google Scholar
  • 24 MacCallum CA, Lo LA, Boivin M. "Is medical cannabis safe for my patients?“ A practical review of cannabis safety considerations. Eur J Intern Med 2021; 89: 10-18
    CrossrefPubMedSearch in Google Scholar
  • 25 Gottschling S, Ayonrinde O, Bhaskar A. et al. Safety considerations in cannabinoid-based medicine. Int J Gen Med 2020; 13: 1317-1333
    CrossrefPubMedSearch in Google Scholar
  • 26 Iffland K, Grotenhermen F. An update on safety and side effects of cannabidiol: A review of clinical data and relevant animal studies. Cannabis Cannabinoid Res 2017; 2: 139-154
    CrossrefPubMedSearch in Google Scholar
  • 27 Antoniou T, Bodkin J, Ho JM-W. Drug interactions with cannabinoids. CMAJ 2020; 192: E206
    CrossrefPubMedSearch in Google Scholar
  • 28 Arnold JC, McCartney D, Suraev A. et al. The safety and efficacy of low oral doses of cannabidiol: An evaluation of the evidence. Clin Transl Sci 2022; 16: 10-30
    CrossrefPubMedSearch in Google Scholar
  • 29 deRoon-Cassini TA, Stollenwerk TM, Beatka M. et al. Meet your stress management professionals: The endocannabinoids. Trends Mol Med 2020; 26: 953-968
    CrossrefPubMedSearch in Google Scholar
  • 30 Cohen K, Weizman A, Weinstein A. Modulatory effects of cannabinoids on brain neurotransmission. Eur J Neurosci 2019; 50: 2322-2345
    CrossrefPubMedSearch in Google Scholar
  • 31 Müller-Vahl KR, Bindila L, Lutz B. et al. Cerebrospinal fluid endocannabinoid levels in Gilles de la Tourette syndrome. Neuropsychopharmacology 2020; 5: 1323-1329
    CrossrefPubMedSearch in Google Scholar
  • 32 Russo EB. Clinical endocannabinoid deficiency reconsidered: Current research supports the theory in migraine, fibromyalgia, irritable bowel, and other treatment-resistant syndromes. Cannabis Cannabinoid Res 2016; 1: 154-165
    CrossrefPubMedSearch in Google Scholar
  • 33 Linares IM, Zuardi AW, Pereira LC. et al. Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test. Braz J Psychiatry 2019; 41: 9-14
    CrossrefPubMedSearch in Google Scholar
  • 34 Zuardi AW, Rodrigues NP, Silva AL. et al. Inverted U-shaped dose-response curve of the anxiolytic effect of cannabidiol during public speaking in real life. Front Pharmacol 2017; 8: 259
    CrossrefPubMedSearch in Google Scholar
  • 35 Skelley JW, Deas CM, Curren Z. et al. Use of cannabidiol in anxiety and anxiety-related disorders. J Am Pharm Assoc (2003) 2020; 60: 253-261
    CrossrefPubMedSearch in Google Scholar
  • 36 Blessing EM, Steenkamp MM, Manzanares J. et al. Cannabidiol as a potential treatment for anxiety disorders. Neurotherapeutics 2015; 12: 825-836
    CrossrefPubMedSearch in Google Scholar
  • 37 Cairns EA, Benson MJ, Bedoya-Pérez MA. et al. Medicinal cannabis for psychiatry-related conditions: An overview of current Australian prescribing. Front Pharmacol 2023; 14: 1142680
    CrossrefPubMedSearch in Google Scholar
  • 38 Buckner JD, Schmidt NB, Lang AR. et al. Specificity of social anxiety disorder as a risk factor for alcohol and cannabis dependence. J Psychiatr Res 2008; 42: 230-239
    CrossrefPubMedSearch in Google Scholar
  • 39 Salazar CA, Tomko RL, Akbar SA. et al. Medical cannabis use among adults in the Southeastern United States. Cannabis 2019; 2: 53-65
    CrossrefPubMedSearch in Google Scholar
  • 40 Turna J, Simpson W, Patterson B. et al. Cannabis use behaviors and prevalence of anxiety and depressive symptoms in a cohort of Canadian medicinal cannabis users. J Psychiatr Res 2019; 111: 134-139
    CrossrefPubMedSearch in Google Scholar
  • 41 Bergamaschi MM, Queiroz RHC, Chagas MHN. et al. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients. Neuropsychopharmacology 2011; 36: 1219-1226
    CrossrefPubMedSearch in Google Scholar
  • 42 Masataka N. Anxiolytic effects of repeated cannabidiol treatment in teenagers with social anxiety disorders. Front Psychol 2019; 10: 2466
    CrossrefPubMedSearch in Google Scholar
  • 43 Crippa JAS, Derenusson GN, Ferrari TB. et al. Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: A preliminary report. J Psychopharmacol (Oxford) 2011; 25: 121-130
    CrossrefPubMedSearch in Google Scholar
  • 44 Kwee CM, Baas JM, van der Flier FE. et al. Cannabidiol enhancement of exposure therapy in treatment refractory patients with social anxiety disorder and panic disorder with agoraphobia: A randomised controlled trial. Eur Neuropsychopharmacol 2022; 59: 58-67
    CrossrefPubMedSearch in Google Scholar
  • 45 Kwee CMB, Leen NA, Van der Kamp RC. et al. Anxiolytic effects of endocannabinoid enhancing compounds: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2023; 72: 79-94
    CrossrefPubMedSearch in Google Scholar
  • 46 Schmidt ME, Liebowitz MR, Stein MB. et al. The effects of inhibition of fatty acid amide hydrolase (FAAH) by JNJ-42165279 in social anxiety disorder: A double-blind, randomized, placebo-controlled proof-of-concept study. Neuropsychopharmacol 2021; 46: 1004-1010
    CrossrefPubMedSearch in Google Scholar
  • 47 Mitchell JT, Sweitzer MM, Tunno AM. et al. "I Use weed for my ADHD“: A qualitative analysis of online forum discussions on cannabis use and ADHD. PLoS ONE 2016; 11: e0156614
    CrossrefPubMedSearch in Google Scholar
  • 48 Loflin M, Earleywine M, De Leo J. et al. Subtypes of attention deficit-hyperactivity disorder (ADHD) and cannabis use. Subst Use Misuse 2014; 49: 427-434
    CrossrefPubMedSearch in Google Scholar
  • 49 Grotenhermen F, Müller-Vahl K. Cannabis und cannabinoide in der medizin: Fakten und ausblick. Suchttherapie 2016; 17: 71-76
    Thieme ConnectPubMedSearch in Google Scholar
  • 50 Szejko N, Becher E, Heimann F. et al. Medicinal use of different cannabis strains: Results from a large prospective survey in Germany. Pharmacopsychiatry (in revision).
    PubMed
  • 51 Strohbeck-Kühner P, Skopp G, Mattern R. Fitness to drive in spite (because) of THC. Arch Kriminol 2007; 220: 11-19
    PubMedSearch in Google Scholar
  • 52 Mansell H, Quinn D, Kelly LE. et al. Cannabis for the treatment of attention deficit hyperactivity disorder: A report of 3 cases. Med Cannabis Cannabinoids 2022; 5: 1-6
    CrossrefPubMedSearch in Google Scholar
  • 53 Milz E, Grotenhermen F. Successful therapy of treatment resistant adult ADHD with cannabis: Experience from a medical practice with 30 patients. In: Poster. Sestri Levante, Italy: 2015
    Search in Google Scholar
  • 54 Cooper RE, Williams E, Seegobin S. et al. Cannabinoids in attention-deficit/hyperactivity disorder: A randomised-controlled trial. Eur Neuropsychopharmacol 2017; 27: 795-808
    CrossrefPubMedSearch in Google Scholar
  • 55 Centonze D, Bari M, Di Michele B. et al. Altered anandamide degradation in attention-deficit/hyperactivity disorder. Neurology 2009; 72: 1526-1527
    CrossrefPubMedSearch in Google Scholar
  • 56 Ahmadalipour A, Mehdizadeh Fanid L, Zeinalzadeh N. et al. The first evidence of an association between a polymorphism in the endocannabinoid-degrading enzyme FAAH (FAAH rs2295633) with attention deficit hyperactivity disorder. Genomics 2020; 112: 1330-1334
    CrossrefPubMedSearch in Google Scholar
  • 57 Bilge S, Ekici B. CBD-enriched cannabis for autism spectrum disorder: An experience of a single center in Turkey and reviews of the literature. J Cannabis Res 2021; 3: 53
    CrossrefPubMedSearch in Google Scholar
  • 58 Bertolino B, Crupi R, Impellizzeri D. et al. Beneficial effects of co-ultramicronized palmitoylethanolamide/luteolin in a mouse model of autism and in a case report of autism. CNS Neurosci Ther 2017; 23: 87-98
    CrossrefPubMedSearch in Google Scholar
  • 59 Aran A, Cassuto H, Lubotzky A. et al. Brief report: Cannabidiol-rich cannabis in children with autism spectrum disorder and severe behavioral problems-A retrospective feasibility study. J Autism Dev Disord 2019; 49: 1284-1288
    CrossrefPubMedSearch in Google Scholar
  • 60 Barchel D, Stolar O, De-Haan T. et al. Oral cannabidiol use in children with autism spectrum disorder to treat related symptoms and co-morbidities. Front Pharmacol 2018; 9: 1521
    CrossrefPubMedSearch in Google Scholar
  • 61 Hacohen M, Stolar OE, Berkovitch M. et al. Children and adolescents with ASD treated with CBD-rich cannabis exhibit significant improvements particularly in social symptoms: An open label study. Transl Psychiatry 2022; 12: 375
    CrossrefPubMedSearch in Google Scholar
  • 62 Aran A, Harel M, Cassuto H. et al. Cannabinoid treatment for autism: A proof-of-concept randomized trial. Mol Autism 2021; 12: 6
    CrossrefPubMedSearch in Google Scholar
  • 63 da Silva EA, Medeiros WMB, Santos JPMD. et al. Evaluation of the efficacy and safety of cannabidiol-rich cannabis extract in children with autism spectrum disorder: Randomized, double-blind and controlled placebo clinical trial. Trends Psychiatry Psychother 2022; 26: 44
    CrossrefPubMedSearch in Google Scholar
  • 64 Levin FR, Mariani JJ, Brooks DJ. et al. Dronabinol for the treatment of cannabis dependence: A randomized, double-blind, placebo-controlled trial. Drug Alcohol Depend 2011; 116: 142-150
    CrossrefPubMedSearch in Google Scholar
  • 65 Allsop DJ, Copeland J, Lintzeris N. et al. Nabiximols as an agonist replacement therapy during cannabis withdrawal: A randomized clinical trial. JAMA Psychiatry 2014; 71: 281-291
    CrossrefPubMedSearch in Google Scholar
  • 66 Trigo JM, Soliman A, Quilty LC. et al. Nabiximols combined with motivational enhancement/cognitive behavioral therapy for the treatment of cannabis dependence: A pilot randomized clinical trial. PLoS One 2018; 13: e0190768
    CrossrefPubMedSearch in Google Scholar
  • 67 Lintzeris N, Bhardwaj A, Mills L. et al. Nabiximols for the treatment of cannabis dependence: A randomized clinical trial. JAMA Intern Med 2019; 179: 1242-1253
    CrossrefPubMedSearch in Google Scholar
  • 68 Freeman TP, Hindocha C, Baio G. et al. Cannabidiol for the treatment of cannabis use disorder: A phase 2a, double-blind, placebo-controlled, randomised, adaptive Bayesian trial. Lancet Psychiatry 2020; 7: 865-874
    CrossrefPubMedSearch in Google Scholar
  • 69 D’Souza DC, Cortes-Briones J, Creatura G. et al. Efficacy and safety of a fatty acid amide hydrolase inhibitor (PF-04457845) in the treatment of cannabis withdrawal and dependence in men: A double-blind, placebo-controlled, parallel group, phase 2a single-site randomised controlled trial. Lancet Psychiatry 2019; 6: 35-45
    CrossrefPubMedSearch in Google Scholar
  • 70 Lofwall MR, Babalonis S, Nuzzo PA. et al. Opioid withdrawal suppression efficacy of oral dronabinol in opioid dependent humans. Drug Alcohol Depend 2016; 164: 143-150
    CrossrefPubMedSearch in Google Scholar
  • 71 Bisaga A, Sullivan MA, Glass A. et al. The effects of dronabinol during detoxification and the initiation of treatment with extended release naltrexone. Drug Alcohol Depend 2015; 154: 38-45
    CrossrefPubMedSearch in Google Scholar
  • 72 Hurd YL, Spriggs S, Alishayev J. et al. Cannabidiol for the reduction of cue-induced craving and anxiety in drug-abstinent individuals with heroin use disorder: A double-blind randomized placebo-controlled trial. Am J Psychiatry 2019; 176: 911-922
    CrossrefPubMedSearch in Google Scholar
  • 73 Kvamme SL, Pedersen MM, Rømer Thomsen K. et al. Exploring the use of cannabis as a substitute for prescription drugs in a convenience sample. Harm Reduct J 2021; 18: 72
    CrossrefPubMedSearch in Google Scholar
  • 74 Mongeau-Pérusse V, Brissette S, Bruneau J. et al. Cannabidiol as a treatment for craving and relapse in individuals with cocaine use disorder: A randomized placebo-controlled trial. Addiction 2021; 116: 2431-2442
    CrossrefPubMedSearch in Google Scholar
  • 75 Morissette F, Mongeau-Pérusse V, Rizkallah E. et al. Exploring cannabidiol effects on inflammatory markers in individuals with cocaine use disorder: A randomized controlled trial. Neuropsychopharmacology 2021; 46: 2101-2111
    CrossrefPubMedSearch in Google Scholar
  • 76 Fernandes JAB, Filev R, Fidalgo TM. Cannabinoids for substance use disorder treatment: What does the current evidence say?. Cannabis Cannabinoid Res 2023; 8: 703-715
    CrossrefPubMedSearch in Google Scholar
  • 77 Cannabinoid Conference 2022. Med Cannabis Cannabinoids. 2022; 5: 159-198
    CrossrefPubMedSearch in Google Scholar
  • 78 Botsford SL, Yang S, George TP. Cannabis and cannabinoids in mood and anxiety disorders: Impact on illness onset and course, and assessment of therapeutic potential. Am J Addict 2020; 29: 9-26
    CrossrefPubMedSearch in Google Scholar
  • 79 Sexton M, Cuttler C, Finnell JS. et al. A cross-sectional survey of medical cannabis users: Patterns of use and perceived efficacy. Cannabis Cannabinoid Res 2016; 1: 131-138
    CrossrefPubMedSearch in Google Scholar
  • 80 Li X, Diviant JP, Stith SS. et al. The effectiveness of cannabis flower for immediate relief from symptoms of depression. Yale J Biol Med 2020; 93: 251-264
    PubMedSearch in Google Scholar
  • 81 Ware MA, Wang T, Shapiro S. et al. Smoked cannabis for chronic neuropathic pain: A randomized controlled trial. CMAJ 2010; 182: E694-E701
    CrossrefPubMedSearch in Google Scholar
  • 82 Emons B, Arning L, Makulla V-E. et al. Endocannabinergic modulation of central serotonergic activity in healthy human volunteers. Ann Gen Psychiatry 2023; 22: 11
    CrossrefPubMedSearch in Google Scholar
  • 83 Szejko N, Fremer C, Müller-Vahl KR. Cannabis improves obsessive-compulsive disorder-case report and review of the literature. Front Psychiatry 2020; 11: 681
    CrossrefPubMedSearch in Google Scholar
  • 84 Kayser RR, Senter MS, Tobet R. et al. Patterns of cannabis use among individuals with obsessive-compulsive disorder: Results from an internet survey. J Obsessive Compuls Relat Disord 2021; 30: 100664
    CrossrefPubMedSearch in Google Scholar
  • 85 Schindler F, Anghelescu I, Regen F. et al. Improvement in refractory obsessive compulsive disorder with dronabinol. Am J Psychiatry 2008; 165: 536-537
    CrossrefPubMedSearch in Google Scholar
  • 86 Cooper JJ, Grant J. Refractory OCD due to thalamic infarct with response to dronabinol. J Neuropsychiatry Clin Neurosci 2017; 29: 77-78
    CrossrefPubMedSearch in Google Scholar
  • 87 Kayser RR, Haney M, Raskin M. et al. Acute effects of cannabinoids on symptoms of obsessive-compulsive disorder: A human laboratory study. Depress Anxiety 2020; 37: 801-811
    CrossrefPubMedSearch in Google Scholar
  • 88 Grant JE, Odlaug BL, Chamberlain SR. et al. Dronabinol, a cannabinoid agonist, reduces hair pulling in trichotillomania: A pilot study. Psychopharmacology (Berl) 2011; 218: 493-502
    CrossrefPubMedSearch in Google Scholar
  • 89 Grant JE, Valle S, Chesivoir E. et al. Tetrahydrocannabinol fails to reduce hair pulling or skin picking: Results of a double-blind, placebo-controlled study of dronabinol. Int Clin Psychopharmacol 2022; 37: 14-20
    CrossrefPubMedSearch in Google Scholar
  • 90 Abizaid A, Merali Z, Anisman H. Cannabis: A potential efficacious intervention for PTSD or simply snake oil?. J Psychiatry Neurosci 2019; 44: 75-78
    CrossrefPubMedSearch in Google Scholar
  • 91 Wilkinson ST, Stefanovics E, Rosenheck RA. Marijuana use is associated with worse outcomes in symptom severity and violent behavior in patients with posttraumatic stress disorder. J Clin Psychiatry 2015; 76: 1174-1180
    CrossrefPubMedSearch in Google Scholar
  • 92 Metrik J, Stevens AK, Gunn RL. et al. Cannabis use and posttraumatic stress disorder: Prospective evidence from a longitudinal study of veterans. Psychol Med 2022; 52: 446-456
    CrossrefPubMedSearch in Google Scholar
  • 93 Allan NP, Ashrafioun L, Kolnogorova K. et al. Interactive effects of PTSD and substance use on suicidal ideation and behavior in military personnel: Increased risk from marijuana use. Depress Anxiety 2019; 36: 1072-1079
    CrossrefPubMedSearch in Google Scholar
  • 94 LaFrance EM, Glodosky NC, Bonn-Miller M. et al. Short and long-term effects of cannabis on symptoms of post-traumatic stress disorder. J Affect Disord 2020; 274: 298-304
    CrossrefPubMedSearch in Google Scholar
  • 95 Lake S, Kerr T, Buxton J. et al. Does cannabis use modify the effect of post-traumatic stress disorder on severe depression and suicidal ideation? Evidence from a population-based cross-sectional study of Canadians. J Psychopharmacol 2020; 34: 181-188
    CrossrefPubMedSearch in Google Scholar
  • 96 Passie T, Emrich HM, Karst M. et al. Mitigation of post-traumatic stress symptoms by Cannabis resin: A review of the clinical and neurobiological evidence. Drug Test Anal 2012; 4: 649-659
    CrossrefPubMedSearch in Google Scholar
  • 97 Greer GR, Grob CS, Halberstadt AL. PTSD symptom reports of patients evaluated for the New Mexico Medical Cannabis Program. J Psychoactive Drugs 2014; 46: 73-77
    CrossrefPubMedSearch in Google Scholar
  • 98 Nacasch N, Avni C, Toren P. Medical cannabis for treatment-resistant combat PTSD. Front Psychiatry 2022; 13: 1014630
    CrossrefPubMedSearch in Google Scholar
  • 99 Cameron C, Watson D, Robinson J. Use of a synthetic cannabinoid in a correctional population for posttraumatic stress disorder-related insomnia and nightmares, chronic pain, harm reduction, and other indications: A retrospective evaluation. J Clin Psychopharmacol 2014; 34: 559-564
    CrossrefPubMedSearch in Google Scholar
  • 100 Fraser GA. The use of a synthetic cannabinoid in the management of treatment-resistant nightmares in posttraumatic stress disorder (PTSD). CNS Neurosci Ther 2009; 15: 84-88
    CrossrefPubMedSearch in Google Scholar
  • 101 Roitman P, Mechoulam R, Cooper-Kazaz R. et al. Preliminary, open-label, pilot study of add-on oral Δ9-tetrahydrocannabinol in chronic post-traumatic stress disorder. Clin Drug Investig 2014; 34: 587-591
    CrossrefPubMedSearch in Google Scholar
  • 102 Shannon S, Opila-Lehman J. Effectiveness of cannabidiol oil for pediatric anxiety and insomnia as part of posttraumatic stress disorder: A case report. Perm J 2016; 20: 16-005
    CrossrefPubMedSearch in Google Scholar
  • 103 Elms L, Shannon S, Hughes S. et al. Cannabidiol in the treatment of post-traumatic stress disorder: A case series. J Altern Complement Med 2019; 25: 392-397
    CrossrefPubMedSearch in Google Scholar
  • 104 Jetly R, Heber A, Fraser G. et al. The efficacy of nabilone, a synthetic cannabinoid, in the treatment of PTSD-associated nightmares: A preliminary randomized, double-blind, placebo-controlled cross-over design study. Psychoneuroendocrinology 2015; 51: 585-588
    CrossrefPubMedSearch in Google Scholar
  • 105 Bolsoni LM, Crippa JAS, Hallak JEC. et al. The anxiolytic effect of cannabidiol depends on the nature of the trauma when patients with post-traumatic stress disorder recall their trigger event. Braz J Psychiatry 44: 298-307
    CrossrefPubMed
  • 106 Bolsoni LM, Crippa JAS, Hallak JEC. et al. Effects of cannabidiol on symptoms induced by the recall of traumatic events in patients with posttraumatic stress disorder. Psychopharmacology 2022; 239: 1499-1507
    CrossrefPubMedSearch in Google Scholar
  • 107 Bonn-Miller MO, Sisley S, Riggs P. et al. The short-term impact of 3 smoked cannabis preparations versus placebo on PTSD symptoms: A randomized cross-over clinical trial. PLoS One 2021; 16: e0246990
    CrossrefPubMedSearch in Google Scholar
  • 108 Neumeister A, Normandin MD, Pietrzak RH. et al. Elevated brain cannabinoid CB1 receptor availability in posttraumatic stress disorder: A positron emission tomography study. Mol Psychiatry 2013; 18: 1034-1040
    CrossrefPubMedSearch in Google Scholar
  • 109 Piper BJ. Mother of cerries, ACDC, or chocolope: Examination of the strains used by medical cannabis patients in New England. J Psychoactive Drugs 2018; 50: 95-104
    CrossrefPubMedSearch in Google Scholar
  • 110 Kuhathasan N, Dufort A, MacKillop J. et al. The use of cannabinoids for sleep: A critical review on clinical trials. Exp Clin Psychopharmacol 2019; 27: 383-401
    CrossrefPubMedSearch in Google Scholar
  • 111 Peball M, Seppi K, Krismer F. et al. Effects of nabilone on sleep outcomes in patients with Parkinson’s disease: A post-hoc analysis of NMS-Nab study. Mov Disord Clin Pract 2022; 9: 751-758
    CrossrefPubMedSearch in Google Scholar
  • 112 Maddison KJ, Kosky C, Walsh JH. Is there a place for medicinal cannabis in treating patients with sleep disorders?. What we know so far. Nat Sci Sleep 2022; 14: 957-968
    CrossrefPubMedSearch in Google Scholar
  • 113 Walsh JH, Maddison KJ, Rankin T. et al. Treating insomnia symptoms with medicinal cannabis: A randomized, crossover trial of the efficacy of a cannabinoid medicine compared with placebo. Sleep 2021; 44: zsab149
    CrossrefPubMedSearch in Google Scholar
  • 114 Ried K, Tamanna T, Matthews S. et al. Medicinal cannabis improves sleep in adults with insomnia: A randomised double-blind placebo-controlled crossover study. J Sleep Res 2023; 32: e13793
    CrossrefPubMedSearch in Google Scholar
  • 115 Sandyk R, Awerbuch G. Marijuana and Tourette’s syndrome. J Clin Psychopharmacol 1988; 8: 444-445
    CrossrefPubMedSearch in Google Scholar
  • 116 Hemming M, Yellowlees PM. Effective treatment of Tourette’s syndrome with marijuana. J Psychopharmacol (Oxford) 1993; 7: 389-391
    CrossrefPubMedSearch in Google Scholar
  • 117 Müller-Vahl KR, Kolbe H, Schneider U. et al. Cannabinoids: Possible role in patho-physiology and therapy of Gilles de la Tourette syndrome. Acta Psychiatr Scand 1998; 98: 502-506
    CrossrefPubMedSearch in Google Scholar
  • 118 Abi-Jaoude E, Chen L, Cheung P. et al. Preliminary evidence on cannabis effectiveness and tolerability for adults with Tourette syndrome. J Neuropsychiatry Clin Neurosci 2017; 29: 391-400
    CrossrefPubMedSearch in Google Scholar
  • 119 Thaler A, Arad S, Schleider LB-L. et al. Single center experience with medical cannabis in Gilles de la Tourette syndrome. Parkinsonism & Related Disorders 2019; 61: 211-213
    CrossrefPubMedSearch in Google Scholar
  • 120 Jakubovski E, Müller-Vahl K. Speechlessness in Gilles de la Tourette syndrome: Cannabis-based medicines improve severe vocal blocking tics in two patients. Int J Mol Sci 2017; 18: 1739
    CrossrefPubMedSearch in Google Scholar
  • 121 Müller-Vahl KR, Schneider U, Kolbe H. et al. Treatment of Tourette’s syndrome with delta-9-tetrahydrocannabinol. Am J Psychiatry 1999; 156: 495
    CrossrefPubMedSearch in Google Scholar
  • 122 Müller-Vahl K, Schneider U, Emrich H. Combined treatment of Tourette-syndrome with delts-9-THC and dopamine receptor antagonists. J Cannabis Therap 2002; 2: 145-154
    CrossrefPubMedSearch in Google Scholar
  • 123 Brunnauer A, Segmiller FM, Volkamer T. et al. Cannabinoids improve driving ability in a Tourette’s patient. Psychiatry Res 2011; 190: 382
    CrossrefPubMedSearch in Google Scholar
  • 124 Pichler E-M, Kawohl W, Seifritz E. et al. Pure delta-9-tetrahydrocannabinol and its combination with cannabidiol in treatment-resistant Tourette syndrome: A case report. Int J Psychiatry Med 2019; 54: 150-156
    CrossrefPubMedSearch in Google Scholar
  • 125 Trainor D, Evans L, Bird R. Severe motor and vocal tics controlled with Sativex®. Australas Psychiatry 2016; 24: 541-544
    CrossrefPubMedSearch in Google Scholar
  • 126 Kanaan AS, Jakubovski E, Müller-Vahl K. Significant tic reduction in an otherwise treatment-resistant patient with Gilles de la Tourette syndrome following treatment with nabiximols. Brain Sci 2017; 7: 47
    CrossrefPubMedSearch in Google Scholar
  • 127 Bloch MH, Landeros-Weisenberger A, Johnson JA. et al. A phase-2 pilot study of a therapeutic combination of Δ9-tetrahydracannabinol and palmitoylethanolamide for adults with Tourette’s syndrome. J Neuropsychiatry Clin Neurosci 2021; 33: 328-336
    CrossrefPubMedSearch in Google Scholar
  • 128 Milosev LM, Psathakis N, Szejko N. et al. Treatment of Gilles de la Tourette syndrome with cannabis-based medicine: Results from a retrospective analysis and online survey. Cannabis Cannabinoid Res 2019; 4: 265-274
    CrossrefPubMedSearch in Google Scholar
  • 129 Szejko N, Jakubovski E, Fremer C. et al. Delta-9-tetrahydrocannabinol for the treatment of a child with Tourette syndrome—case report. EJMCR 2018; 2: 43-46
    CrossrefPubMedSearch in Google Scholar
  • 130 Szejko N, Jakubovski E, Fremer C. et al. Vaporized cannabis is effective and well-tolerated in an adolescent with Tourette syndrome. MCA 2019; 2: 60-64
    CrossrefPubMedSearch in Google Scholar
  • 131 Hasan A, Rothenberger A, Münchau A. et al. Oral delta 9-tetrahydrocannabinol improved refractory Gilles de la Tourette syndrome in an adolescent by increasing intracortical inhibition: A case report. J Clin Psychopharmacol 2010; 30: 190-192
    CrossrefPubMedSearch in Google Scholar
  • 132 Müller-Vahl KR, Schneider U, Koblenz A. et al. Treatment of Tourette’s syndrome with delta 9-tetrahydrocannabinol (THC): A randomized crossover trial. Pharmacopsychiatry 2002; 35: 57-61
    Thieme ConnectPubMedSearch in Google Scholar
  • 133 Müller-Vahl KR, Schneider U, Prevedel H. et al. Delta 9-tetrahydrocannabinol (THC) is effective in the treatment of tics in Tourette syndrome: A 6-week randomized trial. J Clin Psychiatry 2003; 64: 459-465
    CrossrefPubMedSearch in Google Scholar
  • 134 Müller-Vahl KR, Koblenz A, Jöbges M. et al. Influence of treatment of Tourette syndrome with delta9-tetrahydrocannabinol (delta9-THC) on neuropsychological performance. Pharmacopsychiatry 2001; 34: 19-24
    Thieme ConnectPubMedSearch in Google Scholar
  • 135 Müller-Vahl KR, Prevedel H, Theloe K. et al. Treatment of Tourette syndrome with delta-9-tetrahydrocannabinol (delta 9-THC): No influence on neuropsychological performance. Neuropsychopharmacology 2003; 28: 384-388
    CrossrefPubMedSearch in Google Scholar
  • 136 Abi-Jaoude E, Bhikram T, Parveen F. et al. A double-blind, randomized, controlled crossover trial of cannabis in adults with Tourette syndrome. Cannabis Cannabinoid Res 2023; 8: 835-845
    CrossrefPubMedSearch in Google Scholar
  • 137 Jakubovski E, Pisarenko A, Fremer C. et al. The CANNA-TICS Study Protocol: A randomized multi-center double-blind placebo controlled trial to demonstrate the efficacy and safety of nabiximols in the treatment of adults with chronic tic disorders. Front Psychiatry 2020; 11: 575826
    CrossrefPubMedSearch in Google Scholar
  • 138 Müller-Vahl KR, Pisarenko A, Szejko N. et al. CANNA-TICS: Efficacy and safety of oral treatment with nabiximols in adults with chronic tic disorders – Results of a prospective, multicenter, randomized, double-blind, placebo controlled, phase IIIb superiority study. Psychiatry Res 2023; 323: 115135
    CrossrefPubMedSearch in Google Scholar
  • 139 Müller-Vahl KR, Fremer C, Beals C. et al. Endocannabinoid modulation using monoacylglycerol lipase inhibition in Tourette syndrome: A phase 1 randomized, placebo-controlled study. Pharmacopsychiatry 2022; 55: 148-156
    Thieme ConnectPubMedSearch in Google Scholar
  • 140 Müller-Vahl KR, Fremer C, Beals C. et al. Monoacylglycerol Lipase Inhibition in Tourette syndrome: A 12-week, randomized, controlled study. Mov Disord 2021; 36: 2413-2418
    CrossrefPubMedSearch in Google Scholar
  • 141 Gadzicki D, Müller-Vahl KR, Heller D. et al. Tourette syndrome is not caused by mutations in the central cannabinoid receptor (CNR1) gene. Am J Med Genet B Neuropsychiatr Genet 2004; 127B: 97-103
    CrossrefPubMedSearch in Google Scholar
  • 142 Szejko N, Fichna JP, Safranow K. et al. Association of a variant of CNR1 gene encoding cannabinoid receptor 1 with Gilles de la Tourette syndrome. Front Genet 2020; 11: 125
    CrossrefPubMedSearch in Google Scholar