Abstract
Individuals with mood/anxiety disorders may use cannabis for “self-medication,” i.e., to induce positive mood or attenuate aversive mood states. However, little neurobiological evidence supports such use. The goal of this investigation was to test the hypothesis that cannabis use attenuates striatal response to reward in those with mood/anxiety disorders. Reward-related processing was measured using a monetary incentive delay task under functional MRI. Individuals with any lifetime mood/anxiety disorder diagnoses and problematic cannabis use (“Mood/Anxiety+CB”; n = 41) were compared with a propensity score-matched group of similar subjects without cannabis use (“Mood/Anxiety−CB”; n = 41), and a cannabis-naïve healthy control group (n = 35). Activations during win- and loss-anticipations were extracted from bilateral nucleus accumbens, dorsal caudate, and dorsolateral putamen. Mixed models were estimated for each region separately for win- and loss-anticipations, with a test for the main effect of group, condition (e.g., high-win, low-win, neutral), and their interaction. A significant main effect of group for win- and loss-anticipation was observed for each striatal region. Specifically, the Mood/Anxiety+CB group exhibited the lowest striatal activations across condition levels relative to both the Mood/Anxiety-CB and healthy group. A significant group-by-condition interaction was only observed for the dorsolateral putamen and indicated divergent activation modulation as a function of win and loss-magnitude for Mood/Anxiety+CB subjects. Finally, individuals with heavier recent cannabis use showed greater attenuation of gain-related activation in all three striatal regions. There was no such relationship for other illicit drugs. These data support the hypothesis that cannabis use in individuals with mood/anxiety disorders is associated with attenuated brain processing of reward magnitude, which may contribute to persistent affective symptoms.
Highlights
Many individuals with mood or anxiety disorders believe that cannabis use might be a viable treatment option to alleviate their symptoms[1]
The present study examined whether lower striatal blood-oxygen level dependent (BOLD) signals during monetary incentive delay (MID) win/loss anticipation would be observed in individuals with mood/anxiety disorders and cannabis use, compared with (1) a propensity scorematched group of cannabis-naïve individuals with similar internalizing symptoms, alcohol/nicotine dependence, and other sociodemographic variables; and (2) healthy controls without a history of mood/anxiety disorders or cannabis use
We focused on MID anticipation given prior work with substance use/internalizing disorder samples that showed striatal impairments were observed during anticipation[21,22,23]
Summary
Many individuals with mood or anxiety disorders believe that cannabis use might be a viable treatment option to alleviate their symptoms[1]. Individuals with these disorders may “self-medicate” with cannabis to achieve both the positive reinforcing (euphoric) and negative reinforcing (anxiolytic) effects of the drug[2]. Prevalence estimates from the National Epidemiologic Survey on Alcohol and Related Conditions[3] indicate that 10% of individuals with mood disorders[4] and 7.6% of individuals with anxiety disorders[5] report any past year cannabis use. Epidemiological studies on drug risk perceptions show that perceived risk for regular cannabis use is low for adults and adolescents[6,12], some of whom are likely to become the
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