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Chapter 32 - Cannabinoids as Medicines
- from Part VIII - Special Topics
- Edited by Deepak Cyril D'Souza, Staff Psychiatrist, VA Connecticut Healthcare System; Professor of Psychiatry, Yale University School of Medicine, David Castle, University of Tasmania, Australia, Sir Robin Murray, Honorary Consultant Psychiatrist, Psychosis Service at the South London and Maudsley NHS Trust; Professor of Psychiatric Research at the Institute of Psychiatry
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- Book:
- Marijuana and Madness
- Published online:
- 12 May 2023
- Print publication:
- 01 June 2023, pp 346-356
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- Chapter
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Summary
Cannabis and cannabinoids are widely used, both as recreational substances with potential for addiction, and as treatments for a number of disorders. A large body of literature has investigated the harmful and/or beneficial effects of cannabis and/or cannabinoids employing observational and interventional methodologies. These individual studies have been pooled in many meta-analyses. Further, Mendelian Randomization (MR) studies have reported on a causal association between cannabis use and certain outcomes. This chapter reviews existing meta-analyses that pooled observational and interventional studies, and MR studies reporting on health outcomes after exposure to cannabis and/or cannabinoids in the general population, and selected clinical populations. We show that evidence from observational, interventional, and MR studies point towards an association between cannabis and psychosis. Several additional detrimental effects of cannabis emerged, including other psychiatric symptoms, cognitive impairment, and risk of motor vehicle accident (MVA). In terms of therapeutic benefits, cannabidiol seems to be effective for certain types of epilepsy, notably in children. Also, cannabis-based medicines can be effective in improving muscle spasticity in multiple sclerosis, ameliorating chronic pain syndromes, and reducing nausea/vomiting in palliative care settings. Risk–benefit ratios should be discussed with individual patients.
Maternal depression and inflammation during pregnancy
- Marius Lahti-Pulkkinen, Polina Girchenko, Rachel Robinson, Soili M. Lehto, Elena Toffol, Kati Heinonen, Rebecca M. Reynolds, Eero Kajantie, Hannele Laivuori, Pia M. Villa, Esa Hämäläinen, Jari Lahti, Katri Räikkönen
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- Journal:
- Psychological Medicine / Volume 50 / Issue 11 / August 2020
- Published online by Cambridge University Press:
- 23 August 2019, pp. 1839-1851
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- Article
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Background
Maternal depression during pregnancy increases the risk for adverse developmental outcomes in children. However, the underpinning biological mechanisms remain unknown. We tested whether depression was associated with levels of and change in the inflammatory state during pregnancy, if early pregnancy overweight/obesity or diabetes/hypertensive pregnancy disorders accounted for/mediated these effects, and if depression added to the inflammation that typically accompanies these conditions.
MethodsWe analyzed plasma high-sensitivity C-reactive protein (hsCRP) and glycoprotein acetyls at three consecutive stages during pregnancy, derived history of depression diagnoses before pregnancy from Care Register for Healthcare (HILMO) (N = 375) and self-reports (N = 347) and depressive symptoms during pregnancy using the Center for Epidemiological Studies Depression Scale completed concurrently to blood samplings (N = 295). Data on early pregnancy body mass index (BMI) and diabetes/hypertensive pregnancy disorders came from medical records.
ResultsHigher overall hsCRP levels, but not change, during pregnancy were predicted by history of depression diagnosis before pregnancy [HILMO: mean difference (MD) = 0.69 standard deviation (s.d.) units; 95% confidence interval (CI) 0.26–1.11, self-report: MD = 0.56 s.d.; 95% CI 0.17–0.94] and higher depressive symptoms during pregnancy (0.06 s.d. per s.d. increase; 95% CI 0.00–0.13). History of depression diagnosis before pregnancy also predicted higher overall glycoprotein acetyls (HILMO: MD = 0.52 s.d.; 95% CI 0.12–0.93). These associations were not explained by diabetes/hypertensive disorders, but were accounted for and mediated by early pregnancy BMI. Furthermore, in obese women, overall hsCRP levels increased as depressive symptoms during pregnancy increased (p = 0.006 for interaction).
ConclusionsDepression is associated with a proinflammatory state during pregnancy. These associations are mediated by early pregnancy BMI, and depressive symptoms during pregnancy aggravate the inflammation related to obesity.