Chapter 7: Cannabis and the Risk of Mental Illness

BACK . Book Description

Kelly C Young-Wolff et al. Adolescent Cannabis Use and Risk of Psychotic, Bipolar, Depressive, and Anxiety Disorders JAMA Health Forum . 2026 Feb 20;7(2) PMID: 41719031 , PMCID:12924094 FREE, FREE From JAMA HEALTH FORUM

3-16-26 Major Paper on Marijuana Use in Depression, Anxiety, and PTSD.

Wilson J. et al. Lancet Psychiatry March 16, 2026 Click here for the Open Access copy.

The authors report what has been clear from the research for some time. They state, ” Cannabinoids are increasingly being authorised for the treatment of mental disorders and SUDs, yet our review shows little evidence of efficacy. There is a substantial gap between clinical use and available evidence. It is concerning that the use of these treatments could delay or replace the use of more effective therapies. There is a crucial need for improved study design that includes larger and more representative participant samples.”

Psychosis/Schizophrenia; Paranoia; Depression, Anhedonia, Anxiety, Bipolar Disorder, Click on the topic to go to that section

References are now organized by Disorder/Topic. The references with Bold number were the original references in the book. Then references without bold number are NEWLY added since March 21, 2021, the date of publication of the book. The reference numbers now may not be in order. Some publications may discuss multiple psychiatric disorders and overlap of symptoms..

Click on the link, PMID, or PMCID to go directly to the page, abstract or scientific paper. Use your browser FIND function (Ctrl F) to search for keywords.

419. Suplita RL, 2nd, Eisenstein SA, Neely MH, Moise AM, Hohmann AG. Cross-sensitization and cross-tolerance between exogenous cannabinoid antinociception and endocannabinoid-mediated stress-induced analgesia. Neuropharmacology. 2008;54(1):161-71.PubMed PMID: 17714742; PubMed Central PMCID: 2771679. FREE

420. Mayer TA, Matar MA, Kaplan Z, Zohar J, Cohen H. Blunting of the HPA-axis underlies the lack of preventive efficacy of early post-stressor single-dose Delta-9-tetrahydrocannabinol (THC). Pharmacol Biochem Behav. 2014;122:307-18. PubMed PMID: 24814135

Psychosis/Schizophrenia Back to Top

350. Gage SH, Hickman M, Zammit S. Association Between Cannabis and Psychosis: Epidemiologic Evidence. Biol Psychiatry. 2016;79(7):549-56. PubMed PMID: 26386480.

351. Moore TH, Zammit S, Lingford-Hughes A, Barnes TR, Jones PB, Burke M, et al. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet. 2007;370(9584):319-28. PubMed PMID: 17662880.

352. Sideli L, Quigley H, La Cascia C, Murray RM. Cannabis Use and the Risk of Psychosis and Affective Disorders. J Dual Diagn. 2019:1-21. PubMed PMID: 31647377.

353. Hall W, Degenhardt L. Cannabis use and the risk of developing a psychotic disorder. World Psychiatry. 2008;7(2):68-71. PubMed PMID: 18560513; PubMed Central PMCID: 2424288. FREE

354. Psychosis NIMH. Available from: https://www.nimh.nih.gov/health/topics/schizophrenia/raise/raise-questions-and-answers.shtml#1.

355. Psychosis Wikipedia. Available from: https://en.wikipedia.org/wiki/Psychosis.

356. Thomas H. Psychiatric symptoms in cannabis users. Br J Psychiatry. 1993;163:141-9. PubMed PMID: 8075903.

357. Shah D, Chand P, Bandawar M, Benegal V, Murthy P. Cannabis induced psychosis and subsequent psychiatric disorders. Asian J Psychiatr. 2017;30:180-4. PubMed PMID: 29096386.

358. Johns A. Psychiatric effects of cannabis. Br J Psychiatry. 2001;178:116-22. PubMed PMID: 11157424.

359. Ruby S. Grewal MD TPG, MD. Cannabis-Induced Psychosis: A Review Psychiatric times2017. Available from: https://www.psychiatrictimes.com/substance-use-disorder/cannabis-induced-psychosis-review.

360. Tunving K. Psychiatric effects of cannabis use. Acta Psychiatr Scand. 1985;72(3):209-17. PubMed PMID: 3000137.

361. Di Forti M, Quattrone D, Freeman TP, Tripoli G, Gayer-Anderson C, Quigley H, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. Lancet Psychiatry. 2019;6(5):427-36. PubMed PMID: 30902669.

362. Gerlach J, Koret B, Geres N, Matic K, Prskalo-Cule D, Zadravec Vrbanc T, et al. Clinical Challenges in Patients with First Episode Psychosis and Cannabis Use: Mini-Review and a Case Study. Psychiatr Danub. 2019;31(Suppl 2):162-70. PubMed PMID: 31158117.

363. Arendt M, Rosenberg R, Foldager L, Perto G, Munk-Jorgensen P. Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders: follow-up study of 535 incident cases. Br J Psychiatry. 2005;187:510-5. PubMed PMID: 16319402.

364. Henquet C, Rosa A, Delespaul P, Papiol S, Fananas L, van Os J, et al. COMT ValMet moderation of cannabis-induced psychosis: a momentary assessment study of ‘switching on’ hallucinations in the flow of daily life. Acta Psychiatr Scand. 2009;119(2):156-60. PubMed PMID: 18808401.

365. Vaessen TSJ, de Jong L, Schafer AT, Damen T, Uittenboogaard A, Krolinski P, et al. The interaction between cannabis use and the Val158Met polymorphism of the COMT gene in psychosis: A transdiagnostic meta – analysis. PLoS One. 2018;13(2):e0192658. PubMed PMID: 29444152; PubMed Central PMCID: 5812637. FREE

367. Mane A, Berge D, Penzol MJ, Parellada M, Bioque M, Lobo A, et al. Cannabis use, COMT, BDNF and age at first-episode psychosis. Psychiatry Res. 2017;250:38-43. PubMed PMID: 28142064.

368. Murrie B, Lappin J, Large M, Sara G. Transition of Substance-Induced, Brief, and Atypical Psychoses to Schizophrenia: A Systematic Review and Meta-analysis. Schizophr Bull. 2019. PubMed PMID: 31618428.

373. Schizophrenia-Wikipedia [9/1/2020]. Available from: https://en.wikipedia.org/wiki/Schizophrenia.

374. Kendler KS, Ohlsson H, Sundquist J, Sundquist K. Prediction of Onset of Substance-Induced Psychotic Disorder and Its Progression to Schizophrenia in a Swedish National Sample. Am J Psychiatry. 2019;176(9):711-9. PubMed PMID: 31055966; PubMed CentralPMCID: 6718312. FREE

375. Owen MJ, Sawa A, Mortensen PB. Schizophrenia. Lancet. 2016;388(10039):86-97. PubMed PMID: 26777917; PubMed Central PMCID: 4940219. FREE

376. Boksa P. Abnormal synaptic pruning in schizophrenia: Urban myth or reality? J Psychiatry Neurosci. 2012;37(2):75-7. PubMed PMID: 22339991; PubMed Central PMCID: 3297065. FREE

377. Blest-Hopley G, Colizzi M, Giampietro V, Bhattacharyya S. Is the Adolescent Brain at Greater Vulnerability to the Effects of Cannabis? A Narrative Review of the Evidence. Front Psychiatry. 2020;11:859. PubMed PMID: 33005157; PubMed Central PMCID: 7479242. FREE

378. Evensen S., Wisløff T., Lystad J.U. , Bull H., Ueland T., and Falkum E. Prevalence, Employment Rate, and Cost of Schizophrenia in a High-Income Welfare Society: A Population-Based Study Using Comprehensive Health and Welfare Registers. Schizophr Bull. 2016 Mar; 42(2): 476–483.PubMed PMID: 26433216 PubMed Central PMCID: 4753607 FREE

379. Andreasson S, Allebeck P, Engstrom A, Rydberg U. Cannabis and schizophrenia. A longitudinal study of Swedish conscripts. Lancet. 1987;2(8574):1483-6. PubMed PMID: 2892048.

380. Hjorthoj C, Albert N, Nordentoft M. Association of Substance Use Disorders With Conversion From Schizotypal Disorder to Schizophrenia. JAMA Psychiatry. 2018;75(7):733-9. PubMed PMID: 29710317; PubMed Central PMCID: 6145672. FREE

381. Khantzian EJ. The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harv Rev Psychiatry. 1997;4(5):231-44. PubMed PMID: 9385000.

382 Kolliakou A, Joseph C, Ismail K, Atakan Z, Murray RM. Why do patients with psychosis use cannabis and are they ready to change their use? Int J Dev Neurosci. 2011;29(3):335-46. PubMed PMID: 21172414.

383. Hall W. Cannabis use and psychosis. Drug Alcohol Rev. 1998;17(4):433-44. PubMed PMID: 16203510.

384. Griffith-Lendering MF, Wigman JT, Prince van Leeuwen A, Huijbregts SC, Huizink AC, Ormel J, et al. Cannabis use and vulnerability for psychosis in early adolescence–a TRAILS study. Addiction. 2013;108(4):733-40. PubMed PMID: 23216690.

385. Arseneault L, Cannon M, Poulton R, Murray R, Caspi A, Moffitt TE. Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. BMJ. 2002;325(7374):1212-3. PubMed PMID: 12446537; PubMed Central PMCID: 135493. FREE

386. Kuepper R, van Os J, Lieb R, Wittchen HU, Hofler M, Henquet C. Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. BMJ. 2011;342:d738. PubMed PMID: 21363868; PubMed Central PMCID: 3047001. FREE

387. Bourque J, Afzali MH, Conrod PJ. Association of Cannabis Use With Adolescent Psychotic Symptoms. JAMA Psychiatry. 2018;75(8):864-6. PubMed PMID: 29874357; PubMed Central PMCID: 6584279. FREE

388. Compton MT, Kelley ME, Ramsay CE, Pringle M, Goulding SM, Esterberg ML, et al. Association of pre-onset cannabis, alcohol, and tobacco use with age at onset of prodrome and age at onset of psychosis in first-episode patients. Am J Psychiatry. 2009;166(11):1251-7. PubMed PMID: 19797432; PubMed Central PMCID: 3662470. FREE

389. Neill E, Tan EJ, Toh WL, Selvendra A, Morgan VA, Rossell SL, et al. Examining which factors influence age of onset in males and females with schizophrenia. Schizophr Res. 2020. PubMed PMID: 32883558.

390. Gage SH, Jones HJ, Burgess S, Bowden J, Davey Smith G, Zammit S, et al. Assessing causality in associations between cannabis use and schizophrenia risk: a two-sample Mendelian randomization study. Psychol Med. 2017;47(5):971-80. PubMed PMID: 27928975; PubMed Central PMCID: 5341491. FREE

391. Clausen L, Hjorthoj CR, Thorup A, Jeppesen P, Petersen L, Bertelsen M, et al. Change in cannabis use, clinical symptoms and social functioning among patients with first-episode psychosis: a 5-year follow-up study of patients in the OPUS trial. Psychol Med. 2014;44(1):117-26. PubMed PMID: 23590927.

392. Schoeler T, Petros N, Di Forti M, Pingault JB, Klamerus E, Foglia E, et al. Association Between Continued Cannabis Use and Risk of Relapse in First-Episode Psychosis: A Quasi-Experimental Investigation Within an Observational Study. JAMA Psychiatry. 2016;73(11):1173-9. PubMed PMID: 27680429.

New Publications on Psychosis/Schizophrenia

1. Linda Levi, et. al. Cannabis Use and Symptomatic Relapse in First Episode Schizophrenia: Trigger or Consequence? Data From the OPTIMISE Study. Schizophr Bull 2023 Jul 4;49(4):903-913 PMID: 36999551 PMCID: 10318873 (available on 2024-03-31) ” In patients in remission from their first episode of schizophrenia, schizophreniform, or schizoaffective disorder, cannabis use increases the rate of relapse ..”

2. Fact Sheet: Cannabis and Psychosis Yale School of Medicine

3. Lucía Inchausti, et al. The transition to Schizophrenia spectrum disorder from a first psychotic episode that did or did not appear to be induced by substance use. Psychiatry Res. 2023 Oct:328:115475. PMID: 37713923 ” …use of cannabis (compared to use of another substance or polysubstance use) was associated with a higher risk to conversion… to Schizophrenia or Schizophrenia Spectrum Disorders (SSD).”

4. Nora Penzel, et. al. Association between age of cannabis initiation and gray matter covariance networks in recent onset psychosis. Neuropsychopharmacology. 2021 Jul;46(8):1484-1493. PMID: 33658653 PCMID 8209059 “These findings are in line with previous investigations in healthy cannabis users, and suggest that early initiation of cannabis perturbs the developmental trajectory of certain structural brain networks in a manner imparting risk for psychosis later in life.”

5. Shera Hosseini and Mark Oremus. The Effect of Age of Initiation of Cannabis Use on Psychosis, Depression, and Anxiety among Youth under 25 Years Can J Psychiatry. 2019 May;64(5):304-312. PMID: 30373388 PMCID: PMC6591882 “With psychosis as the outcome, all except one study found that earlier cannabis use was generally associated with higher risks. With depression/anxiety as the outcome, 6 of the 11 included studies reported findings indicating that earlier use of cannabis was linked to higher symptom levels.”

6. Tessa Robinson, et.al.Risk-thresholds for the association between frequency of cannabis use and the development of psychosis: a systematic review and meta-analysis. Psychol Med. 2023 Jul;53(9):3858-3868. PMID: 35321777 PMCID: PMC10317818 “Individuals using cannabis frequently are at increased risk of psychosis, with no significant risk associated with less frequent use” The more you use, the greater the risk.

7. Peter Allebeck, et al. Does a history of cannabis use influence onset and course of schizophrenia? Acta Psychiatr Scand. 2023 Jun;147(6):614-622. PMID: 37094811  Free link ” Our findings indicate that the disease burden of schizophrenia is greater in individuals who use cannabis during adolescence. “

8. Emma C Johnson, et. al. Associations Between Cannabis Use, Polygenic Liability for Schizophrenia, and Cannabis-related Experiences in a Sample of Cannabis Users. Schizophr Bull. 2023 May 3;49(3):778-787. PMID: 36545904 PMCID: PMC10154717 “Among individuals who regularly use cannabis, genetic liability for schizophrenia-even in those without clinical features-may increase the likelihood of reporting unusual experiences related to cannabis use. “

9. P N Suresh, et. al. Psychopathology and Pattern of Remission of Cannabis-Induced Psychotic Disorder. Prim Care Companion CNS Disord. 2023 Apr 18;25(2):22m03350. PMID: 37115153 “Cannabis-induced psychosis in the Indian setting presents with predominant positive symptoms and minimal affective symptoms. The steady improvement noted with complete cessation of cannabis indicates a possible contributory role for cannabis in precipitating psychosis. “

10. Johanna Manja Groening, et. al. A systematic evidence map of the association between cannabis use and psychosis-related outcomes across the psychosis continuum: An umbrella review of systematic reviews and meta-analyses. Psychiatry Res. 2024 Jan:331:115626. PMID: 38096722 Free Article ” Based on a synthesis of current evidence, cannabis use is associated with subclinical psychosis states (psychotic-like experiences) and traits (schizotypal personality) in the healthy population, as well as earlier onset and development of psychosis.”

11. Carsten Hjorthøj, et. al. Association between cannabis use disorder and schizophrenia stronger in young males than in females. Psychol Med. 2023 Nov;53(15):7322-7328. PMID: 37140715 PMC10719679 “Young males might be particularly susceptible to the effects of cannabis on schizophrenia.”

12. Jorandby LE The Cannabis Schizophrenia Link Grows Stronger Psychology Today, March 14, 2024 Free Link

13. Jaisingh Rajput et. al. The Relationship Between Cannabis Use and Schizophrenia As a Risk Factor or For Its Therapeutic Potential: A Systematic Review of Evidence Cureus 2025 Sep 20 PMCID:12539040 FREE

Paranoia Back to Top

369. Paranoia– Wikipedia [9/1/2020]. Available from: https://en.wikipedia.org/wiki/Paranoia.

370. Freeman D, McManus S, Brugha T, Meltzer H, Jenkins R, Bebbington P. Concomitants of paranoia in the general population. Psychol Med. 2011;41(5):923-36. PubMed PMID: 20735884.

371. Freeman D, Morrison PD, Murray RM, Evans N, Lister R, Dunn G. Persecutory ideation and a history of cannabis use. Schizophr Res. 2013;148(1-3):122-5. PubMed PMID: 23806582.

372. Coid JW, Ullrich S, Bebbington P, Fazel S, Keers R. Paranoid Ideation and Violence: Meta-analysis of Individual Subject Data of 7 Population Surveys. Schizophr Bull. 2016;42(4):907-15.. PubMed PMID: 26884548; PubMed Central PMCID: 4903063. FREE

New publications for Paranoia

  1. Molly Carlyle, et. al. Cannabis-induced dysphoria/paranoia mediates the link between childhood trauma and psychotic-like experiences in young cannabis users. Schizophr Res. 2021 Dec:238:178-184. PMID: 34717186 https://pubmed.ncbi.nlm.nih.gov/34717186/ “This suggests childhood trauma is associated with greater PLEs in young people who use cannabis, which may be linked with an increased susceptibility to the dysphoric/paranoid subjective effects when using the drug.”
  2. Pravesh Sharma, et. al. Do the Transmissible Liability Index (TLI) and Adolescent Cannabis Use Predict Paranoid and Schizotypal Symptoms at Young Adulthood Subst Use Misuse. 2021;56(13):2026-2034? PMID: 34402373 https://pubmed.ncbi.nlm.nih.gov/34402373/ ” These findings indicate that adolescent cannabis use and family history of SUD differentially contribute to the development of paranoid and schizotypal personality …”
  3. Daniel Freeman, et.al. How cannabis causes paranoia: using the intravenous administration of ∆9-tetrahydrocannabinol (THC) to identify key cognitive mechanisms leading to paranoia. Schizophr Bull. 2015 Mar;41(2):391-9. PMID: 25031222 https://pubmed.ncbi.nlm.nih.gov/25031222/ PMCID: PMC4332941 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4332941/pdf/sbu098.pdf “THC significantly increased paranoia, nega-tive affect (anxiety, worry, depression, negative thoughtsabout the self), and a range of anomalous experiences, and reduced working memory capacity.”
  4. Clare J Mackie, et.al. A latent class analysis of cannabis use products in a general population sample of adolescents and their association with paranoia, hallucinations, cognitive disorganisation and grandiosity. Addict Behav. 2021 Jun:117:106837. PMID: 33545621 https://pubmed.ncbi.nlm.nih.gov/33545621/ ” Relative to non-users, skunk only use was associated with a 2-fold increase in paranoia (OR = 2.45, 95% CI = 1.29-4.63), along with, sleep disturbance and anxiety. “

Depression Back to Top

394. Gobbi G, Atkin T, Zytynski T, Wang S, Askari S, Boruff J, et al. Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2019;76(4):426-34. PubMed PMID: 30758486; PubMed Central PMCID: 6450286. FREE

395. Esmaeelzadeh S, Moraros J, Thorpe L, Bird Y. The association between depression, anxiety and substance use among Canadian post-secondary students. Neuropsychiatr Dis Treat. 2018;14:3241-51. PubMed PMID: 30538482; PubMed Central PMCID: 6260190. FREE

396. Horwood LJ, Fergusson DM, Coffey C, Patton GC, Tait R, Smart D, et al. Cannabis and depression: an integrative data analysis of four Australasian cohorts. Drug Alcohol Depend. 2012;126(3):369-78. PubMed PMID: 22749560.

397. Lev-Ran S, Roerecke M, Le Foll B, George TP, McKenzie K, Rehm J. The association between cannabis use and depression: a systematic review and meta-analysis of longitudinal studies. Psychol Med. 2014;44(4):797-810. PubMed PMID: 23795762.

398. Gukasyan N, Strain EC. Relationship between cannabis use frequency and major depressive disorder in adolescents: Findings from the National Survey on Drug Use and Health 2012-2017. Drug Alcohol Depend. 2020;208:107867. PubMed PMID: 31958677; PubMed Central PMCID: 7039755. FREE

417. Smaga I, Bystrowska B, Gawlinski D, Przegalinski E, Filip M. The endocannabinoid/endovanilloid system and depression. Curr Neuropharmacol. 2014;12(5):462-74. PubMed PMID: 25426013; PubMed Central PMCID: 4243035. FREE

421. Beyer CE, Dwyer JM, Piesla MJ, Platt BJ, Shen R, Rahman Z, et al. Depression-like phenotype following chronic CB1 receptor antagonism. Neurobiol Dis. 2010;39(2):148-55. PubMed PMID: 20381618.

New publications on Depression

  1. Chantelle T White, et al. Cannabis Use and the Development of Depression in Adolescents: Is There an Established Linear Relationship Between the Two? Cureus. 2022 Jul 28;14(7):e27394. PMID: 36046299 PMCID: PMC9418628 “The studies reviewed provide considerable evidence of a
    strong relationship between cannabis use and depression in adolescents.”
  2. Roya Vaziri-Harami, et. al. Prevalence of anxiety and depression among engineering students consuming cannabis. Ann Med Surg (Lond). 2022 Jul 19:80:104144.
    PMID: 36045802 PMCID: PMC9422071 “Due to the higher frequency of anxiety and depression disorders in cannabis users in this study compared to the general population, cannabis use is likely to be associated with anxiety and depression”
  3. Prathma Anandbhai Dave, et. al. Should Marijuana Be Legalized: A Scoping Review of Associations of Marijuana and Depression.Cureus. 2023 Aug 2;15(8):e42835.PMID: 37664373 PMCID: PMC10474443 “Consuming marijuana was linked to the development of depression in the majority of individuals. “
  4. Jesse D Hinckley, et. al. Cannabis Use Is Associated With Depression Severity and Suicidality in the National Comorbidity Survey-Adolescent Supplement. JAACAP Open. 2023 Jun;1(1):24-35. PMID: 37538853 PMCID: PMC10400070 “”Cannabis use is associated with higher odds of depression and depression severity in adolescence. Furthermore, depression and cannabis use are independently associated with higher odds of suicide attempt.
  5. Shulu Hu, et al. Association of cannabis use with depression among cancer patients.Prev Med Rep. 2023 Jun 29:35:102304. PMID: 37455758 PMCID: PMC10339049 ” In conclusion, the use of cannabis by cancer patients has an associated risk of depression and the cancer patients who currently use cannabis are more likely to have depression.”
  6. Qian Liya Leng, et. al. The association between preconception cannabis use and depression and anxiety during pregnancy. Gen Hosp Psychiatry. 2023 Jul-Aug:83:148-155. PMID: 37196406 PMCID: PMC10428863 (available on 2024-07-01) “Daily cannabis use, compared to rare/never use, was associated with increases in …Depression scores.”
  7. Vivian N Onaemo, et. al. Comorbid Cannabis Use Disorder with Major Depression and Generalized Anxiety Disorder: A Systematic Review with Meta-analysis of Nationally Representative Epidemiological Surveys. J Affect Disord. 2021 Feb 15:281:467-475. PMID: 33360749 ” This review confirms the evidence of high prevalence and a 3-fold comorbid association between Cannabis Use Disorder with Major Depression and Cannabis Use Disorder with Generalized Anxiety Disorder.”
  8. Jodi M Gilman, et. al. Effect of Medical Marijuana Card Ownership on Pain, Insomnia, and Affective Disorder Symptoms in Adults: A Randomized Clinical Trial. JAMA Netw Open. 2022 Mar 1;5(3):e222106. PMID: 35302633 PMCID: PMC8933735” This randomized clinical trial found that immediate acquisition of a medical marijuana card led to a higher incidence and severity of CUD; resulted in no significant improvement in pain, anxiety, or depressive symptoms; and improved self-rating of insomnia symptoms.”
  9. Atheer M Mohammed, et. al. Anxiety, depression-like behaviors and biochemistry disorders induced by cannabis extract in female mice. Saudi J Biol Sci. 2021 Nov;28(11):6097-6111. PMID: 34764743 PMCID: PMC8570964 “The results indicated that the anxiety and depression were increased in treated females (mice) significantly compared to control.”
  10. Sajed Mangoo, et. al. Assessment of clinical outcomes of medicinal cannabis therapy for depression: analysis from the UK Medical Cannabis Registry. Expert Rev Neurother. 2022 Nov-Dec;22(11-12):995-1008. PMID: 36573268 Free Article “Improvement in Depressive symptoms with CBD
  11. Sorkhou M, Dent EL, George TP. Cannabis use and mood disorders: a systematic review. Front Public Health. 2024 Apr 9;12:1346207. PMID: 38655516 PMCID: PMC11035759 “We found that cannabis use is linked to increased depressive and manic symptoms in the general population, and an elevated risk ofdeveloping Malor Depressive Disorder and Bipolar Disorder.“

Anhedonia – the lack of interest, enjoyment or pleasure from life’s experiences. Back to Top

393. Hatzigiakoumis DS, Martinotti G, Giannantonio MD, Janiri L. Anhedonia and substance dependence: clinical correlates and treatment options. Front Psychiatry. 2011;2:10. PubMed PMID: 21556280; PubMed Central PMCID: 3089992. FREE

418. Hirvonen J, Goodwin RS, Li CT, Terry GE, Zoghbi SS, Morse C, et al. Reversible and regionally selective downregulation of brain cannabinoid CB1 receptors in chronic daily cannabis smokers. Mol Psychiatry. 2012;17(6):642-9. PubMed PMID: 21747398; PubMed Central PMCID: 3223558. FREENew

New publications on Anhedonia

  1. Daniele Stavros Hatzigiakoumis, et. al. Anhedonia and substance dependence: clinical correlates and treatment options. Front Psychiatry. 2011 Mar 17:2:10. PMID: 21556280 PMCID: PMC3089992 “In particular, anhedonia has been found to be a frequent feature in alcoholics and addicted patients during acute and chronic withdrawal as well as in cocaine, stimulant, and cannabis abusers.”
  2. Ahmed Hasbi, et. al. Daily Δ9-Tetrahydrocannabinol and Withdrawal Increase Dopamine D1-D2 Receptor Heteromer to Mediate Anhedonia– and Anxiogenic-like Behavior Through a Dynorphin and Kappa Opioid Receptor Mechanism. Biol Psychiatry Glob Open Sci. 2022 Jul 30;3(3):550-566. PMID: 37519471 PMCID: PMC10382712 “These changes plausibly reduce dopamine release to trigger anxiogenic- and anhedonic-like behaviors after daily THC administration that persist for at least 7 days after drug cessation. “
  3. Kenneth Blum, et.al. Psychoactive Drugs Like Cannabis -Induce Hypodopaminergic Anhedonia and Neuropsychological Dysfunction in Humans: Putative Induction of Dopamine Homeostasis via Coupling of Genetic Addiction Risk Severity (GARS) testing and Precision Pro-dopamine Regulation (KB220). Neurology (ECronicon). 2021 Apr;13(4):86-92. PMID: 34085060 PMCID: PMC8171216 ” high THC content in its various forms (wax, smoke or vapor) resulting in brain reward dysfunction induces an imbalance of neurotransmission and subsequent hypodopaminergia and lead to aberrant substance and non-substance (behavioral) addictions.”
  4. Martine Skumlien, et. al. Apathy and Anhedonia in Adult and Adolescent Cannabis Users and Controls Before and During the COVID-19 Pandemic Lockdown. Int J Neuropsychopharmacol. 2021 Nov 12;24(11):859-866. PMID: 34077523 PMCID: PMC8244616 ” Our results suggest that adolescents and adults have differential associations between cannabis use as well as apathy and anhedonia. Within users, dependence may be associated with higher levels of apathy and anhedonia regardless of age…
  5. Martine Skumlien, et. al. Anhedonia, Apathy, Pleasure, and Effort-Based Decision-Making in Adult and Adolescent Cannabis Users and Controls. Int J Neuropsychopharmacol. 2023 Jan 19;26(1):9-19. PMID: 35999024 PMCID: PMC9850660 “Cannabis users had lower anhedonia than controls, albeit at a small effect size. These findings are not consistent with the hypothesis that non-acute cannabis use is associated with amotivation. “
  6. Kenneth Blum, et al. Cannabis-Induced Hypodopaminergic Anhedonia and Cognitive Decline in Humans: Embracing Putative Induction of Dopamine Homeostasis. Front Psychiatry. 2021 Mar 30:12:623403. PMID: 33868044 PMCID: PMC8044913 “Research shows that exposure to cannabis is associated with hypodopaminergic anhedonia (depression), cognitive decline, poor memory, inattention, impaired learning performance, reduced dopamine brain response-associated emotionality, and increased addiction severity in young adults.”

bAnxiety Back to Top

392. Van Ameringen M, Zhang J, Patterson B, Turna J. The role of cannabis in treating anxiety: an update. Curr Opin Psychiatry. 2020;33(1):1-7. PubMed PMID: 31688192.

400. Volkow ND, Hampson AJ, Baler RD. Don’t Worry, Be Happy: Endocannabinoids and Cannabis at the Intersection of Stress and Reward. Annu Rev Pharmacol Toxicol. 2017;57:285-308. PubMed PMID: 27618739.

401. Anxiety Anxiety.org [9/11/2020]. Available from: https://www.anxiety.org/what-is-anxiety.

402. NAMI Anxiety Disorders [9/11/2020]. Available from: https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Anxiety-Disorders.

403. Anxiety disorders Mayo Clinic [9/11/2020]. Available from: https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961.

404 Turna J, Patterson B, Van Ameringen M. Is cannabis treatment for anxiety, mood, and related disorders ready for prime time? Depress Anxiety. 2017;34(11):1006-17. PubMed PMID: 28636769.

405. Bonini SA, Premoli M, Tambaro S, Kumar A, Maccarinelli G, Memo M, et al. Cannabis sativa: A comprehensive ethnopharmacological review of a medicinal plant with a long history. J Ethnopharmacol. 2018;227:300-15. PubMed PMID: 30205181.

406. Ramikie TS, Patel S. Endocannabinoid signaling in the amygdala: anatomy, synaptic signaling, behavior, and adaptations to stress. Neuroscience. 2012;204:38-52. . PubMed PMID: 21884761; PubMed Central PMCID: 3236282. FREE

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408. Lim K, See YM, Lee J. A Systematic Review of the Effectiveness of Medical Cannabis for Psychiatric, Movement and Neurodegenerative Disorders. Clin Psychopharmacol Neurosci. 2017;15(4):301-12. PubMed PMID: 29073741; PubMed Central PMCID: 5678490. FREE

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410. Bossong MG, Jansma JM, van Hell HH, Jager G, Kahn RS, Ramsey NF. Default mode network in the effects of Delta9-Tetrahydrocannabinol (THC) on human executive function. PLoS One. 2013;8(7):e70074. PubMed PMID: 23936144; PubMed Central PMCID: 3729458. FREE

411. Fusar-Poli P, Allen P, Bhattacharyya S, Crippa JA, Mechelli A, Borgwardt S, et al. Modulation of effective connectivity during emotional processing by Delta 9-tetrahydrocannabinol and cannabidiol. Int J Neuropsychopharmacol. 2010;13(4):421-32. PubMed PMID: 19775500.

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New publications on Anxiety

  1. Colleen Stiles-Shields, et. al. A Scoping Review of Associations Between Cannabis Use and Anxiety in Adolescents and Young Adults. Child Psychiatry Hum Dev. 2023 Jun;54(3):639-658. PMID:34724134 Free Article “Twenty-three studies found a positive association that greater anxiety among AYA was associated with greater cannabis use. In contrast, seven studies found a negative association that greater anxiety was related to less cannabis use.”
  2. Jordan P Davis, et.al. Directional associations between cannabis use and anxiety symptoms from late adolescence through young adulthood.Drug Alcohol Depend. 2022 Dec 1:241:109704. PMID: 36434880 PMCID: PMC9810069 ” greater cannabis use predicted greater subsequent increases in anxiety; however, greater anxiety symptoms were associated with decreasing cannabis use.” “… this study support a dynamic interplay between anxiety symptoms and cannabis use…”
  3. Stoner SA. Effects of Marijuana on Mental Health: Anxiety Disorders. Alcohol & Drug Abuse Institute, University of Washington, June 2017. Free paper
  4. Nhung Nguyen, et al. Associations between tobacco and cannabis use and anxiety and depression among adults in the United States: Findings from the COVID-19 citizen science study. PLoS One. 2023 Sep 13;18(9) PMID: 37703257 PMCID: PMC10499225 “Proportions of reporting
    anxiety and depression were highest for the co-use group and lowest for the non-use group.”
  5. Alanna Single, et. al. Cannabis use and social anxiety disorder in emerging adulthood: Results from a nationally representative sample. J Anxiety Disord. 2024 Jan:101:102808.PMID: 38061325 ” Significant associations also emerged between major depressive disorder, bipolar I disorder, generalized anxiety disorder, specific phobia, agoraphobia, and panic disorder and co-occurring cannabis use + SAD”
  6. Sarah D Lichenstein THC, CBD, and Anxiety: A review of recent findings on the anxiolytic and anxiogenic effects of cannabis’ primary cannabinoids. Curr Addict Rep. 2022 Dec;9(4):473-485. PMID: 38106452 PMCID: PMC10722902 “Recent literature supports anxiogenic effects of THC administration, which may be attenuated among regular cannabis users. Data regarding anxiolytic effects of CBD administration are mixed”
  7. Bárbara Dos Anjos Rosário, et. al. Subjective, behavioral and neurobiological effects of cannabis and cannabinoids in social anxiety. Rev Neurosci. 2023 Oct 11. PMID: 37812748 ” Results showed that CBD decreases social anxiety, producing an inverted U-shaped curve, with anxiety measurements being reduced at intermediate doses administered orally (300-600 mg), but not at lower or higher doses. THC either reduces (lower doses, 6-7.5 mg) or increases (higher doses) social anxiety measurements.”
  8. Nobuo Masataka Anxiolytic Effects of Repeated Cannabidiol Treatment in Teenagers With Social Anxiety Disorders. Front Psychol 2019 Nov 8:10:2466. PMID: 31787910 PMCID: PMC6856203 “CBD
    significantly decreased anxiety measured by both scales.”
  9. Julia Dabravolskaj, et. al. The impact of 12 modifiable lifestyle behaviours on depressive and anxiety symptoms in middle adolescence: prospective analyses of the Canadian longitudinal COMPASS study. Int J Behav Nutr Phys Act. 2023 Apr 17;20(1):45. PMID: 37069643 PMCID: PMC10107579 “… no cannabis use, was prospectively associated with less severe depressive and anxiety symptoms in middle adolescents.”
  10. Nelemans SA, et.a;. Longitudinal associations between social anxiety symptoms and cannabis use throughout adolescence: the role of peer involvement. Eur Child Adolesc Psychiatry. 2016 May;25(5):483-92. PMID: 26254219 PMCID:4854944
  11. Hayatbakhsh MR, et.al. Cannabis and anxiety and depression in young adults: a large prospective study. Am Acad Child Adolesc Psychiatry. 2007 Mar;46(3):408-417. PMID: 17314727
  12. Halladay JE, et.al. J Addict Nurs. 2020 Apr/Jun;31(2):92-101. PMID: 32487935 Cannabis Use as a Risk Factor for Depression, Anxiety, and Suicidality: Epidemiological Associations and Implications for Nurses.

Bipolar-Disorder Back to Top

428. Bipolar Disorder-Mayo Clinic [8/21/2020]. Available from: https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955.

429. Gibbs M, Winsper C, Marwaha S, Gilbert E, Broome M, Singh SP. Cannabis use and mania symptoms: a systematic review and meta-analysis. J Affect Disord. 2015;171:39-47. PubMed PMID: 25285897.

New Publications on Bipolar Disorder

  1. Rafaela Torres Portugal Leite, et.al. The Use of Cannabis as a Predictor of Early Onset of Bipolar Disorder and Suicide Attempts Neural Plast. 2015:2015:434127. PMID: 26097750 PMCID: PMC4444580 “Cannabis use is a risk factor for early age at onset of BD. Substance use disorder is associated with a worse course of BD”
  2. Jairo Vinícius Pinto, et.al. The prevalence and clinical correlates of cannabis use and cannabis use disorder among patients with bipolar disorder: A systematic review with meta-analysis and meta-regression. Neurosci Biobehav Rev. 2019 Jun:101:78-84. PMID: 30974123 ” In conclusion, cannabis use present in almost one-quarter of patients with BD and is associated with factors that are highly relevant for both clinical practice and public health. “
  3. Glenn E Hunt, et. al. Comorbidity of bipolar and substance use disorders in national surveys of general populations, 1990-2015: Systematic review and meta-analysis. J Affect Disord. 2016 Dec:206:321-330. PMID: 27426694 “This systematic review and meta-analysis found strong associations between co-occurring SUDs and BD. Of the illicit substances, cannabis had the highest mean prevalence (17%) …”
  4. Smadar V Tourjman, et. al. Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Report: A Systematic Review and Recommendations of Cannabis use in Bipolar Disorder and Major Depressive Disorder. Can J Psychiatry. 2023 May;68(5):299-311. PMID: 35711159 PMCID: PMC10192829 “The data indicate that cannabis use is associated with worsened course and functioning of bipolar disorder and major depressive disorder. “
  5. Rikinkumar S Patel, et. al. Cannabis Use is an Independent Risk Factor for Manic Episode: A Report from 380,265 Bipolar Inpatients. Subst Use Misuse. 2022;57(3):344-349. PMID: 34895014 “Cannabis Use Disorder increases the odds for hospitalization for BP manic episode by 53%.”
  6. Oskar Hougaard Jefsen, et. al. Cannabis Use Disorder and Subsequent Risk of Psychotic and Nonpsychotic Unipolar Depression and Bipolar Disorder. JAMA Psychiatry. 2023 Aug 1;80(8):803-810. PMID: 37223912 PMCID: PMC10209828 (available on 2024-05-24) ” This population-based cohort study found that CUD was associated with an increased risk of psychotic and nonpsychotic bipolar disorder and unipolar depression.”
  7. Weiqiu Cheng, et.al. The relationship between cannabis use, schizophrenia, and bipolar disorder: a genetically informed study. Lancet Psychiatry. 2023 Jun;10(6):441-451. PMID: 37208114 PMCID: PMC10311008 (available on 2024-06-01) …” lifetime cannabis use had a causal effect on bipolar disorder.”
  8. Courtney R Quick, et. al. Comorbidity and Coaggregation of Major Depressive Disorder and Bipolar Disorder and Cannabis Use Disorder in a Controlled Family Study. JAMA Psychiatry. 2022 Jul 1;79(7):727-735. PMID: 35648395 PMCID: PMC9161121 ” Further, rates of Cannabis Use Disorder were highest in relatives with both a familial and individual history of Bipolar-II.”
  9. Gaurav Maggu, et. al. Cannabis use and its relationship with bipolar disorder: A systematic review and meta-analysis. Ind Psychiatry J. 2023 Jul-Dec;32(2):202-214. PMID: 38161465 PMCID: PMC10756590 ” Our findings propose that cannabis use may precipitate or worsen bipolar disorder.”
  10. Alejandra Delgado-Sequera, et. al. A Systematic Review of the Molecular and Cellular Alterations Induced by Cannabis that may serve as Risk Factors for Bipolar Disorder. Int J Neuropsychopharmacol. 2024 Jan 4:pyae002. PMID: 38175142 Free Article ” As cannabis use can trigger the onset of Bipolar Disorder, further studies would be of interest to determine whether they are involved in the early development of the disorder, prompting early treatment.”

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