Posters
Presentation Type
Poster
Discipline Track
Clinical Science
Abstract Type
Research/Clinical
Abstract
Background: Cannabis is the most frequently used federally illegal drug among the population and those receiving psychiatric treatment, including patients with major depression or alcohol use disorder. There is limited information on the impact of chronic cannabis use on treatment response. The aim of this study was to examine the rate of depression remission among patients with MDD and comorbid alcoholism who reported chronic cannabis abuse.
Methods: Sixty-four subjects with comorbid major depressive disorder and alcohol dependence (PRISM/DSM-IV), and a chronic (=>10 years) history of cannabis use (n=26) were compared to those who reported occasional or no cannabis use (n=38) on remission (defined as a score of 7 or below on the Hamilton Rating Scales of Depression (HRSD)) from major depression. Subject completed a 24-week randomized, placebo-controlled, double-blind study receiving fluoxetine (dose range 20-60mg/day) and either naltrexone hydrochloride (dose 50 mg/day) or placebo to decrease alcohol use. Subjects were longitudinally assessed 12 times over a 24-week period. We used mixed model analyses to examine whether chronic cannabis abuse predicted MDD remission and clinicians’ rating of very much improved on the Clinical Global Improvement Scale.
Results: The chronic cannabis use group (n=26) had significantly lower proportion of patients remitted (very much improved on the CGI with a mean HRSD of 5.7 (SD 2.7)) compared to the occasional or no use group (n=38) (5.8% vs. 14.7% respectively, p=0.002) and they had very low likelihood of remission (Odds Ratio= 0.358 (p =0.0018)). The two groups were similar on age, ethnicity, and marital status. There were more males in the chronic use group (65.4% vs. 39.5%, p=0.04). The two groups were similar on baseline alcohol dependency scale score, functioning (GAF mean score), anxiety (HARS mean score), and hours of sleep (PSQI mean score), but differed on baseline depression (HRSD-25 mean score 19.6 (sd 4.4) vs. 22.4 (sd 5.9) respectively, P=0.045), psychiatric severity index (ASI mean score 0.56 (sd. 0.15) vs. 0.48 (SD 0.09) respectively, p=0.014)), and on lifetime years of cannabis abuse (mean years 20.35 (SD 6.7) vs. 0.92 (SD 1.67) respectively, p=<0.001). The chronic cannabis abuse group also reported higher proportion of drug use days during the study (mean weakly days 0.9 (SD 1.8) vs. 0.05 (0.2) respectively, p=0.025). The two groups did not significantly differ on average weekly alcohol drink (10.83 (SD 16.31) vs.16.48 (19.19) respectively) or on average dose of fluoxetine (mean dose 31.69 (SD 14.63) vs. 30.10 (SD 14.15) respectively).
Conclusions: The results indicate that only about one-third of those with chronic cannabis use are as likely to remit as compared to occasional or non-users, despite receiving similar dose of fluoxetine. While this is a secondary analysis in a relatively small sample of patients with MDD and alcohol dependence, to our knowledge, this is the first rigorously controlled study focusing on the potential impact of chronic cannabis use on treatment remission of major depression. Future studies are warranted to further elucidate the role of cannabis use as a predictor of treatment response and remission of major depressive disorder.
Recommended Citation
Salloum, Ihsan, "Chronic Cannabis Use is Associated with Decreased Treatment Response in Major Depression" (2024). Research Symposium. 82.
https://scholarworks.utrgv.edu/somrs/2023/posters/82
Included in
Chronic Cannabis Use is Associated with Decreased Treatment Response in Major Depression
Background: Cannabis is the most frequently used federally illegal drug among the population and those receiving psychiatric treatment, including patients with major depression or alcohol use disorder. There is limited information on the impact of chronic cannabis use on treatment response. The aim of this study was to examine the rate of depression remission among patients with MDD and comorbid alcoholism who reported chronic cannabis abuse.
Methods: Sixty-four subjects with comorbid major depressive disorder and alcohol dependence (PRISM/DSM-IV), and a chronic (=>10 years) history of cannabis use (n=26) were compared to those who reported occasional or no cannabis use (n=38) on remission (defined as a score of 7 or below on the Hamilton Rating Scales of Depression (HRSD)) from major depression. Subject completed a 24-week randomized, placebo-controlled, double-blind study receiving fluoxetine (dose range 20-60mg/day) and either naltrexone hydrochloride (dose 50 mg/day) or placebo to decrease alcohol use. Subjects were longitudinally assessed 12 times over a 24-week period. We used mixed model analyses to examine whether chronic cannabis abuse predicted MDD remission and clinicians’ rating of very much improved on the Clinical Global Improvement Scale.
Results: The chronic cannabis use group (n=26) had significantly lower proportion of patients remitted (very much improved on the CGI with a mean HRSD of 5.7 (SD 2.7)) compared to the occasional or no use group (n=38) (5.8% vs. 14.7% respectively, p=0.002) and they had very low likelihood of remission (Odds Ratio= 0.358 (p =0.0018)). The two groups were similar on age, ethnicity, and marital status. There were more males in the chronic use group (65.4% vs. 39.5%, p=0.04). The two groups were similar on baseline alcohol dependency scale score, functioning (GAF mean score), anxiety (HARS mean score), and hours of sleep (PSQI mean score), but differed on baseline depression (HRSD-25 mean score 19.6 (sd 4.4) vs. 22.4 (sd 5.9) respectively, P=0.045), psychiatric severity index (ASI mean score 0.56 (sd. 0.15) vs. 0.48 (SD 0.09) respectively, p=0.014)), and on lifetime years of cannabis abuse (mean years 20.35 (SD 6.7) vs. 0.92 (SD 1.67) respectively, p=<0.001). The chronic cannabis abuse group also reported higher proportion of drug use days during the study (mean weakly days 0.9 (SD 1.8) vs. 0.05 (0.2) respectively, p=0.025). The two groups did not significantly differ on average weekly alcohol drink (10.83 (SD 16.31) vs.16.48 (19.19) respectively) or on average dose of fluoxetine (mean dose 31.69 (SD 14.63) vs. 30.10 (SD 14.15) respectively).
Conclusions: The results indicate that only about one-third of those with chronic cannabis use are as likely to remit as compared to occasional or non-users, despite receiving similar dose of fluoxetine. While this is a secondary analysis in a relatively small sample of patients with MDD and alcohol dependence, to our knowledge, this is the first rigorously controlled study focusing on the potential impact of chronic cannabis use on treatment remission of major depression. Future studies are warranted to further elucidate the role of cannabis use as a predictor of treatment response and remission of major depressive disorder.