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.
Highlights
Major depression disorder (MDD) is the prominent cause of disability-adjusted life years lost in 10–19-year-olds, with a global prevalence of 4–25% [1,2,3]
The rate of cannabis use while on antidepressant medication (AD) medication is an important issue that became more relevant in the last decades due to the sharp increases in both AD prescription [53]
There is relatively scarce information about the pharmacological interactions between these two groups of drugs and the clinical efficacy of AD when prescribed to a cannabisusing patient is unknown
Summary
Major depression disorder (MDD) is the prominent cause of disability-adjusted life years lost in 10–19-year-olds, with a global prevalence of 4–25% [1,2,3]. Whereas MDD manifests as an episodic but often recurrent illness with a mean duration of 16 weeks, often comorbid with other mental disorders, anxiety [9], the clinical presentation of MDD in adolescents is quite different from the adult one. A core problem is that use amongst depressed teens has increased more rapidly over the past 15 years compared to their peers [45], yet, almost all clinical studies of ADs examined ‘clean’ patients; with no concomitant use of psychoactive substances. This does not represent the course of therapy in cannabis users. We hypothesized that due to some similarities between the mechanisms of action of antidepressants and cannabis, the outcomes of AD treatment are limited
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