doi: 10.1055/a-2256-0098.
- PMID: 38428836
- DOI: 10.1055/a-2256-0098
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.
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Conflict of interest statement
Kirsten Müller-Vahl has received financial or material research support from DFG: GZ MU 1527/3–1 and GZ MU 1527/3–2 and Almirall Hermal GmbH. She has received consultant’s and other honoraria from Canymed, Emalex, Eurox Group, Sanity Group, Stadapharm GmbH, Swiss alpinapharm, Synendos Therapeutics AG, Tetrapharm, and Triaspharm. She is an advisory/scientific board member for Branchenverband Cannabiswirtschaft e.V. (BvCW), Sanity Group, Synendos Therapeutics AG, Syqe Medical Ltd., and Therapix Biosciences Ltd.. She has received speaker’s fees from Almirall, Bundesverband der pharmazeutischen Cannabinoidunternehmen (BPC), Cogitando GmbH, Emalex, Grow, Medizinischer Dienst Westfalen Lippe, Noema, streamedup! GmbH, and Vidal. She has received royalties from Elsevier, Medizinisch Wissenschaftliche Verlagsgesellschaft Berlin, and Kohlhammer. She is an associate editor for “Cannabis and Cannabinoid Research” and an Editorial Board Member of “Medical Cannabis and Cannabinoids” und “MDPI-Reports” and a Scientific board member for “Zeitschrift für Allgemeinmedizin.”
