Examining the Use of Antidepressants for Adolescents with Depression/Anxiety Who Regularly Use Cannabis: A Narrative Review

Abstract

Depression and anxiety disorders are two of the most common and growing mental health concerns in adolescents. Consequently, antidepressant medication (AD) use has increased widely during the last decades. Several classes of antidepressants are used mainly to treat depression, anxiety, and obsessive-compulsive disorders by targeting relevant brain neurochemical pathways. Almost all randomized clinical trials of antidepressants examined patients with no concomitant medications or drugs. This does not address the expected course of therapy and outcome in cannabis users. Cannabis is the most commonly used illicit substance globally. Substantial changes in its regulation are recently taking place. Many countries and US states are becoming more permissive towards its medical and recreational use. The psychological and physiological effects of cannabis (mainly of its major components, tetrahydrocannabinol (THC) and cannabidiol (CBD)) have been extensively characterized. Cannabis use can be a risk factor for depressive and anxiety symptoms, but some constituents or mixtures may have antidepressant and/or anxiolytic potential. The aim of this literature review is to explore whether simultaneous use of AD and cannabis in adolescence can affect AD treatment outcomes. Based on the current literature, it is reasonable to assume that antidepressants are less effective for adolescents with depression/anxiety who frequently use cannabis. The mechanisms of action of antidepressants and cannabis point to several similarities and conjunctions that merit future investigation regarding the potential effectiveness of antidepressants among adolescents who consume cannabis regularly.

Canabidiol (CBD) e seus efeitos terapêuticos para a ansiedade no ser humano

“…Em testes realizados pelo estudo experimental laboratorial com adultos saudáveis realizado na Escócia, onde foi realizado o Teste de Estresse Agudo de Maastricht (MAST), com o fito de induzir estado de ansiedade nos pacientes; esse teste possui duas fases sendo uma onde o procedimento é explicado durante 5 minutos e a outra leva cerca de 10 minutos induzindo o estresse agudo (Shoval et al, 2022).…”

Endocannabinoid System: Chemical Characteristics and Biological Activity

“…Many advances have been made in mood disorder treatment over the past decades. Approximately 30% of the population does not respond to current therapies, and the search for novel pharmacological approaches continues [ 178 , 179 ].…”

“…However, symptoms such as paranoia, irritation, dysphoria, depression, depersonalization, and demotivation may appear in some individuals with such adverse effects [ 51 , 180 ]. The reactions depend on the patient’s endocannabinoid activity, the dose used (normally stimulating action at a low dose and inhibitory action at a high dose), the proportion of phytocannabinoids, and the terpenoid composition [ 179 , 181 ]. Evidence is increasing regarding the role of eCB in mood regulation.…”

“…Patients experiencing a mood disorder may not be objective in assessing their condition and cannot decide on their own to modify the treatment. Thus, professional care and control are essential [ 177 , 179 , 191 , 192 , 193 , 194 ].…”

A systematic review of evidence on integrated management of psychiatric disorders in youth who use cannabis

“…Cannabis use is also associated with poor treatment outcomes among youth with comorbid mental health disorders. For example, a recent narrative review found that adolescents with depression and anxiety who used cannabis frequently showed a loss of effectiveness of antidepressants ( Hen-Shoval et al., 2022 ).…”