NAC for cannabis use disorder and depression

Abstract

Case: A 16‐year‐old patient is referred for major depressive disorder and cannabis use disorder (CUD). In the past year, she has been smoking marijuana three to five times per day, every day. Over the same year, her grades have declined and her relationship with her family has been strained in the context of increased cannabis use. Sertraline was started 4 months ago for depression and has been dosed at 200 mg daily for the past month. Her family notes improvement in sleep, concentration and mood with the selective serotonin reuptake inhibitor. The patient describes using marijuana, “because it's the only thing that has worked for my anxiety and made me not care about my depression.” She describes craving marijuana every day, especially when she smells marijuana on her clothes, smells marijuana on someone else, hears a song on the radio that she has enjoyed while high, or sees images of people smoking on TV. She doesn't intend to stop smoking altogether, but she doesn't want to feel like she needs to smoke every day. She has a history of occasional alcohol use (less than once a month) and occasional cigarettes (less than five per week).