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Review
. 2019 Feb;269(1):107-120.
doi: 10.1007/s00406-018-0970-7. Epub 2018 Dec 19.

Cannabis and mental illness: a review

Darby J E Lowe  1   2 , Julia D Sasiadek  1 , Alexandria S Coles  1 , Tony P George  3   4
Affiliations
Review

Cannabis and mental illness: a review

Darby J E Lowe et al. Eur Arch Psychiatry Clin Neurosci. 2019 Feb.

Abstract

With the increasing push to legalize cannabis in Western nations, there is a need to gage the potential impact of this policy change on vulnerable populations, such as those with mental illness, including schizophrenia, mood, and anxiety disorders. This is particularly important as there are strong motives in these individuals to seek short-term reward (e.g., "getting high"). Nonetheless, data to support the beneficial effects of cannabis use in psychiatric populations are limited, and potential harms in patients with psychotic and mood disorders have been increasingly documented. This article reviews the effects of cannabis in people with mental illness. Then, we provide a reconciliation of the addiction vulnerability and allostatic hypotheses to explain co-morbidity addiction in mentally ill cannabis users, as well as to further aid in developing a rational framework for the assessment and treatment of problematic cannabis use in these patients.

Keywords: Addiction; Anxiety disorders; Cannabis; Harms; Legalization; Mood disorders; Post-traumatic stress disorder; Schizophrenia; Therapeutics.

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Figures

Figure 1.
Figure 1.. Addiction Vulnerability and Allostasis Models Conceptualized for Cannabis Users with Mental Illness
Individuals without mental illness (MI) (A) who use cannabis transition to an allostatic state, leading to neurobiological changes that induce a continuous reduction in positive affect that is associated with further use in attempts to regain original homeostatic levels. Individuals with MI (B) already have a lowered set point for positive and negative hedonic homeostasis, promoting addiction vulnerability, as substances are used in attempts to normalize an already altered (reduced) set point. Addiction in psychiatric patients is associated with a similar transition to an allostatic state but with an even lower homeostatic baseline (see dashed line in Panel B), with cannabis use continuing in attempts to regain the original positive affect experienced prior to substance use.
See this image and copyright information in PMC

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