Prospects for the Use of Cannabinoids in Psychiatric Disorders

Abstract

Increasing evidence suggests an essential role of the endocannabinoid system in modulating cognitive abilities, mood, stress, and sleep. The psychoactive effects of cannabis are described as euphoric, calming, anxiolytic, and sleep-inducing and positively affect the mood, but can also adversely affect therapy. The responses to cannabinoid medications depend on the patient's endocannabinoid system activity, the proportion of phytocannabinoids, the terpenoid composition, and the dose used. There is some evidence for a therapeutic use of phytocannabinoids in psychiatric conditions. THC and CBD may have opposing effects on anxiety. Current guidelines recommend caution in using THC in patients with anxiety or mood disorders. In a small number of clinical trials, cannabinoids used to treat cancer, HIV, multiple sclerosis, hepatitis C, Crohn's disease, and chronic neuropathic pain report decreases in anxiety or depression symptoms and presented sedative and anxiolytic effects. Several studies have investigated the influence of potential genetic factors on psychosis and schizophrenia development after cannabis use. THC may increase the risk of psychosis, especially in young patients with an immature central nervous system. There is limited evidence from clinical trials that cannabinoids are effective therapy for sleep disorders associated with concomitant conditions. There is evidence for a possible role of cannabis as a substitute for alcohol and drugs, also in the context of the risks of opioid use (e.g., opioid-related mortality). In this narrative review of the recent evidence, we discuss the prospects of using the psychoactive effects of cannabinoids in treating mental and psychiatric disorders. However, this evidence is weak for some clinical conditions and well-designed randomized controlled trials are currently lacking. Furthermore, some disorders may be worsened by cannabis use.

The Effects of Cannabinoids on Sleep

“… 63 , 64 Cannabis products have potential analgesic properties for those with a chronic pain manifestation of their RLS symptoms; additional mechanisms may relate to the anxiolytic and/or sedative hypnotic effects of these products but are generally unknown at this time. 65 , 66 There is a lack of objective efficacy measures with the use of cannabis for RLS in the literature. Therefore, caution is recommended with use of cannabis products in RLS, given the limited evidence base and potential for abuse and psychoactive effects.…”

Anti-Microbial Activity of Phytocannabinoids and Endocannabinoids in the Light of Their Physiological and Pathophysiological Roles

“…Based on its immunomodulatory activities, CBD has been implicated in the treatment of various autoimmune diseases [14,21], and its anti-nociceptive activity was found to be beneficial in relieving chronic pain [192]. In addition, CBD has potential uses in psychiatry due to its neuromodulatory activities in the brain that control recognition, emotional and behavioral responses [111,193,194]. CBD has especially been reported to have therapeutic effect for psychopathological conditions, such as substance use disorders, chronic psychosis, and anxiety [193].…”

Potential Role of Curcumin for the Treatment of Major Depressive Disorder

“…The ECS also influences anxiety, feeding behaviour, emotional responses, HPA-axis activity, and neurogenesis [ 176 , 177 ]. Alterations in the ECS have been identified in depression and present as a therapeutic target of intervention [ 177 , 178 ]. In animal trials, curcumin administration has influenced the ECS by increasing cannabinoid receptor type 1 (CB1)-mediated endocannabinoid signalling and increasing levels of CB1 mRNA [ 42 , 179 ].…”