The Endocannabinoid System: A New Treatment Target for Obsessive Compulsive Disorder?

Abstract

Introduction: Obsessive-compulsive disorder (OCD) is a disabling illness that is associated with significant functional impairment. Although evidence-based pharmacotherapies exist, currently available medications are ineffective in some patients and may cause intolerable side effects in others. There is an urgent need for new treatments. Discussion: A growing body of basic and clinical research has showed that the endocannabinoid system (ECS) plays a role in anxiety, fear, and repetitive behaviors. At the same time, some patients with OCD who smoke cannabis anecdotally report that it relieves their symptoms and mitigates anxiety, and several case reports describe patients whose OCD symptoms improved after they were treated with cannabinoids. Taken together, these findings suggest that the ECS could be a potential target for novel medications for OCD. In this study, we review evidence from both animal and human studies that suggests that the ECS may play a role in OCD and related disorders. We also describe findings from studies in which cannabinoid drugs were shown to impact symptoms of these conditions. Conclusions: An emerging body of evidence suggests that the ECS plays a role in OCD symptoms and may be a target for the development of novel medications. Further exploration of this topic through well-designed human trials is warranted.

Cannabis Improves Obsessive-Compulsive Disorder—Case Report and Review of the Literature

“…The presented case report adds evidence to the hypothesis that modulation of the ECS by activating central CB1 receptors may improve OCD. Although in general our findings are in line with previous case reports ( 39 – 42 ), there are also some relevant differences: (i) while in all previous studies pure THC (dronabinol) or the synthetic analogue of THC, nabilone, have been used, our patient was treated with medicinal cannabis including more than 100 different cannabinoids; (ii) in previous case studies, preexisting treatment was augmented with CBM, while we used medicinal cannabis as monotherapy; and (iii) while all previously described patients were treatment resistant, in this case, the patient refused treatment with psychotherapy and had stopped medication with an (S)SRI due to adverse events after only one week. Thus, currently it is not only unclear whether CBM in general might be effective in the treatment of OCD, but also which cannabinoid or combinations of cannabinoids—and in particular the ratio of THC to CBD—is most effective and whether treatment with CBM should be used in monotherapy or in combination with (S)SRI or behavioral therapy.…”

“…Until today, only two case studies and one small controlled trial have been published reporting effects of CBM in a total of 14 patients with OCD (39)(40)(41)(42). In 2008, Schindler et al (41) described two patients with otherwise treatment-resistant OCD, who improved after adding dronabinol to preexisting treatments.…”

Psychiatric emergency care during Coronavirus 2019 (COVID 19) pandemic lockdown: results from a Department of Mental Health and Addiction of northern Italy

“…Occasional users resulted to have stopped consumption or at least have reduced their use during the lockdown, while strong users appeared to have increased the consumption of cannabis seen as a relief for anxiety and boredom ( EMCDDA, 2020 ). Although the cannabidiol, a cannabinoid compound, seem to have anxiolytic properties ( Kayser et al., 2019 ), a number of articles reported that the use of cannabis as a whole exacerbates many psychiatric disorders like schizophrenia, mood, personality and anxiety disorders, leading to an increased number of visits at the emergency rooms ( Hall et al., 2018 ).…”

“…However, according to our results, we cannot entirely rule out that cannabis may act as a confounder. Different studies reported that both delta-9-tetrahydrocannabinol and cannabidiol might have some anxiolytic, anti-obsessional and anticompulsive properties ( Kaiser et al., 2019 ). Nevertheless, some studies reported that many individuals with OCD use cannabis to control their symptoms although other research reported a worsening of symptoms induced by cannabinoids ( Spradlin et al., 2017 ).…”

Role of Cannabinoid Receptors in Psychological Disorder

“…hippocampus, and hypothalamus of the brain (Zou & Kumar, 2018). The present literature review examines the role that the endocannabinoid system may play in these disorders and the potential value of targeting this system to search for novel and improved medications (Patel et al, 2017;Kayser et al, 2019).…”