The impact of depressed mood and coping motives on cannabis use quantity across the menstrual cycle in those with and without pre‐menstrual dysphoric disorder

Abstract

Background and Aims Reported rates of cannabis use among Canadian females are increasing. Female cannabis users progress to cannabis use disorder more rapidly than males (telescoping) and have higher rates of emotional disorder comorbidity. Addictive behaviors may change, along with mood and motivations, across the menstrual cycle (MC), particularly for females with pre‐menstrual dysphoric disorder (PMDD). This study aimed to determine whether increases in depressed mood and coping motives would predict increased cannabis use pre‐menstrually/menstrually, particularly among females with PMDD. We also assessed positive mood and enhancement motive ratings to establish specificity of predicted depressed mood and coping motive results. Design Observational study using data collected across 32 days using electronic daily diary methods. Setting Nova Scotia, Canada. Participants Sixty‐nine naturally cycling female cannabis users (Mean (M) age = 29.25, Standard Deviation (SD) = 5.66) with and without retrospectively identified PMDD (via structured clinical interview) and prospectively identified PMDD (via elevated pre‐menstrual depressed mood). Self‐reported MC phase was validated using salivary progesterone concentrations. Measurements Depressed/positive mood, coping‐/enhancement‐motivated cannabis use, and cannabis use quantity. Findings Coping motives explained heightened cannabis use pre‐menstrually/menstrually in those with retrospectively identified PMDD. Depressed mood explained increased cannabis use menstrually in those with retrospectively/prospectively identified PMDD. Moreover, prospectively identified PMDD significantly moderated the relationship between depressed mood and cannabis use quantity menstrually. In those with prospectively identified PMDD, positive mood and enhancement motives were associated with decreased cannabis use during the follicular/ovulatory phases. Females with versus without retrospectively identified PMDD also displayed greater overall cannabis use quantity (M [SD] = 3.44[2.84] standard joint equivalents versus 1.85[1.82], respectively; U = 277.50, P = 0.008). Conclusions Depressed mood may explain heightened cannabis use menstrually in females with pre‐menstrual dysphoric disorder. Coping motives may explain heightened cannabis use pre‐menstrually/menstrually in females with retrospectively identified with pre‐menstrual dysphoric disorder.

Reactivity to Daily Self-Monitoring of Cannabis Use in Biological Females

“…Session one included telephone eligibility screening. Once deemed eligible, participants were scheduled for session 2 which occurred during specific menstrual cycle days (Joyce, 2019;Joyce et al, 2021); this ensured reactivity effects would not be confounded by menstrual cycle phase. During session 2, informed consent was provided, a demographics questionnaire was completed, and participants were taught how to use their smartphone to answer surveys.…”

“…Every day at 10:30 am, participants were asked the total quantity of cannabis used the prior day. Participants completed two daily questions on their cannabis use quantity: one at 10:30am and another at 2pm (Joyce, 2019). Further, a daily reminder to complete the 2pm survey was sent at 6:30pm.…”

“…Measures for the current study were chosen from among a broader set used in the original study (Joyce, 2019;Joyce et al, 2021) to focus solely on cannabis use reactivity effects over the self-monitoring period.…”

“…Eighty-eight female 1 cannabis users (Mage=28.86 years, SD=6.11, Range=19-45) were originally recruited via advertisement for a study on cannabis use across the menstrual cycle (Joyce, 2019;Joyce et al, 2021). Eligibility criteria included: aged 19-45 years, access to a smart phone with a data/texting plan (daily diary surveys were sent to participants via text message and accessed through the internet), using cannabis >4 times/past month, and not attempting to abstain from cannabis or receiving cannabis treatment.…”

Impact of Acute and Chronic Cannabis Use on Stress Response Regulation: Challenging the Belief That Cannabis Is an Effective Method for Coping

“…For example, preclinical research indicates that female rats with intact ovaries had heightened selfadministration, cue-induced reinstatement behavior, and druginduced reinstatement behavior in response to WIN 55,212-2 (a drug used instead of THC for intravenious animal studies) as compared to female rats who were ovarectomized and male rats (Fattore et al, 2007(Fattore et al, , 2010; suggesting that estradiol may reinforce the effects of cannabis (Brents, 2016). In clinical literature, depressed mood increased the use of cannabis in women with premenstrual dysphoric disorder (PMDD) differentially across the menstrual cycle; suggesting both ovarian hormones and adverse moods may influence cannabis use in those in a chronically stressed state (Joyce et al, 2021). Indeed, research has begun to explore progesterone as a treatment for cannabis use disorder (Sherman et al, 2019).…”