Q&A

Cannabis and Mental Health

Can cannabis cause or be used to treat mental illness? Hear from Deepak D'Souza, a world-renowned expert in cannabis and psychosis.

Dr. Deepak Cyril D'Souza is the Vikram Sodhi Professor of Psychiatry at Yale School of Medicine and inaugural director of the Yale Center for the Science of Cannabis and Cannabinoids. He earned his medical degree at St. John's Medical College in Bangalore, India, completed his psychiatry residency at SUNY Health Science Center at Brooklyn, and trained as a postdoctoral fellow at Yale. Alongside his Yale roles, he is a staff psychiatrist at VA Connecticut Healthcare System.

His best-known work uses carefully controlled doses of THC, the main psychoactive compound in cannabis, to study psychosis. In a 2004 study, intravenous THC produced brief schizophrenia-like symptoms and memory problems in healthy volunteers.

In this Q&A, Dr. D'Souza explains whether cannabis can trigger psychosis, who is most vulnerable, how today's high-potency products change the picture, and what the evidence says about cannabis and CBD as treatments

Does cannabis use increase the risk of psychosis? If so, what are the factors that determine the outcome?

Yes. The dose of exposure (amount, potency, frequency, duration) is one factor. Those who have other risks factors for psychosis (e.g., a family history of psychosis) may be more vulnerable.

What are the effects of cannabis on higher cognitive functioning? How do we create awareness about this in the context of legalising cannabis?

Cannabis and some of its constituents produce acute impairments in memory, attention, executive function, impulsivity and risk-taking behaviour, and psychomotor coordination. Some of these cognitive processes are critical for driving a car.

Chronic exposure to cannabis has also been associated with impairments in memory, attention, executive function, motivation and IQ.

We need to educate young people as early as possible with the media platforms that they most subscribe to.

An Evidenced Based Review of Acute and Long-Term Effects of Cannabis Use On Executive Cognitive Functions.

Is it true that CBD has anxiolytic and antipsychotic properties?

CBD may have anxiolytic effects. Whether it has antipsychotic effects remains an open question with some studies showing such effects but others not showing such effect. We still need more convincing data. But, importantly the CBD present in cannabis is not enough to produce antipsychotic effects.

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Gone to Pot

Is there data to suggest that cannabis (THC and/or CBC) is useful in treating mood and anxiety disorders and trauma? Why do you think that, anecdotally, people report relief from symptoms by using these products?

No, several studies have concluded that there is no convincing evidence. Recently Black et al., 2019 conducted a metaanalysis of all studies between 1980 and 2018 and concluded that there remains “insufficient evidence” for using cannabinoids to treat depressive disorders and symptoms, anxiety disorders and symptoms, ADHD, post-traumatic stress disorder, Tourette syndrome, or psychosis. What individuals may be reporting is a transient disconnection from their problems, which doesn’t last long, but with repeated use will lead to tolerance and dependence.

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The Psychotomimetic Effects

Does long-term use of THC and CBD lead to tolerance, dependence and withdrawal syndromes?

Using cannabis and its principal active constituent THC does lead to tolerance, dependence and withdrawal. This may not be the case with CBD.

study gauges impact heavy chronic cannabis use cognition and psychosis related phenomena

Does the use of THC and CBD stimulate the brain's reward system and the release of dopamine like known substances of abuse?

THC but not CBD does increase dopamine in the reward system but to a lesser extent than other drugs like heroin, cocaine and nicotine.

What is the best approach to treat cannabis addiction in a patient with history of cannabinoid hyperemesis syndrome?

To quit!!

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Cannabinoid Hyperemesis Syndrome

If cannabis can both cause mental illness and be helpful in treatment of mental illness, how do you know when it is helpful or unhelpful?

The current state of the evidence is that cannabis and THC is generally harmful to people with psychiatric conditions.

I've seen research implicating abnormal levels of endogenous cannabinoids in depressive disorders, eating disorders and schizophrenia. What might this mean for clinical practice?

It may mean that altering endocannabinoid levels (not with cannabis) may offer an approach to treat some of these conditions/symptoms.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6949116/

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