Tag: CBD

Reading of the Week: Catatonia – the new NEJM Review; CBD for Bipolar and Dr. Samuels on Medical Assistance in Dying

From the Editor

Catatonia has been well described but is poorly understood.

So write Drs. Stephan Heckers and Sebastian Walther (both of Vanderbilt University) in a new review. We could add: catatonia is often striking. I remember a patient who literally sat for hours in his chair with catatonia secondary to schizophrenia. His family, in some denial, had insisted that his poor eating was related to hospital food and that his lack of activity had to do with the boredom of the ward.

Drs. Heckers and Walther’s review, just published in The New England Journal of Medicine, notes: “Catatonia is common in psychiatric emergency rooms and inpatient units,” with an estimated prevalence of 9% to 30%. They describe the diagnosis and treatment. We consider the paper and its implications.

Waxy flexibility (from catatonia) in an undated photo

Interest in CBD has surged in recent years. Can it help with the tough clinical problem of bipolar depression? In the second selection, Dr. Jairo Vinícius Pinto (of the University of São Paulo) and his co-authors attempt to answer that question in a new Canadian Journal of Psychiatry paper. They describe a pilot study, with 35 patients randomized to CBD or placebo, finding: “cannabidiol did not show significantly higher adverse effects than placebo.”

And in the third selection, Dr. Hannah Samuels (of the University of Toronto) discusses medical assistance in dying in a paper for Academic Psychiatry. This resident of psychiatry describes a patient who, dealing with pain, opted for MAiD. Dr. Samuels considers the decision but her ambivalence in part stemming from her training. “I felt sad, confused, and morally conflicted. Mrs. L never faltered in her confidence that this was the right decision for her, but I could not understand it.”


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Reading of the Week: Substances, Substances, Substances – Papers from CJP & JMIR, and Dr. Devine on Our Federal Strategy

From the Editor

Creams, gummies, drinks. Cannabidiol (CBD) is increasingly popular and found in various products. Given its supposed benefits, including as an anxiolytic, could CBD be part of a harm reduction strategy?

In new paper for The Canadian Journal of Psychiatry, Lindsay A. Lo (of the University of Toronto) and her co-authors attempt to answer that question with a rapid review of 27 studies, including 5 randomized trials, covering opioids, cocaine, and polydrug use. “Low-quality evidence suggests that CBD may reduce drug cravings and other addiction-related symptoms and that CBD may have utility as an adjunct harm reduction strategy for people who use drugs.” We discuss the paper and its implications.

In the second selection, Dr. Braden O’Neill (of the University of Toronto) and his co-authors consider cannabis clinic websites. Focusing on Ontario, they find 29 clinic websites. In new paper for Journal of Medical Internet Research, they look at the claims made, and analyze the supporting literature. “The recommendation of cannabis as a general therapeutic for many indications unsupported by high-quality evidence is potentially misleading for medical practitioners and patients.”

And in the third selection, Dr. Jeremy Devine (of McMaster University) writes about federal drug policy in an essay for The Toronto Star. He feels that the current approach to the opioid crisis is flawed, with its focus on “regulation” – and he is particularly critical of safe supply programs. “The core ideological flaw in our drug policy is that it fails to recognize a hard truth: the drug user cannot have both their addiction and a free, safe, and self-determined life.”


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Reading of the Week: Cannabis & Cannabinoids in Psychiatry – the New AJP Paper; Also, Dr. Jillian Horton on Her Burnout & Recovery (QT)

From the Editor

It’s popular – but is it actually helpful?

With legalization, cannabis is readily available. Not surprisingly, our patients are increasingly trying it. But what’s the latest evidence? In the first selection, we consider a new paper that was just published by The American Journal of Psychiatry. Dr. Kevin P. Hill (of Harvard University) and his co-authors review almost 850 papers and comment on everything from the potential therapeutic effects of cannabis to clinician guidance. “There is little data indicating that cannabinoids are helpful in treating psychiatric illness, while there is considerable evidence that there is potential for harm in vulnerable populations such as adolescents and those with psychotic disorders.” We consider the big paper and its clinical implications.


In this week’s second selection, we mull physicians and burnout. Dr. Jillian Horton (of the University of Manitoba) joins me for a Quick Takes podcast interview. We discuss burnout, mindfulness, and recovery. She comments on her own burnout: “I would get home at the end of my long shifts on the wards, and I would have nothing left. Nothing left for myself, nothing left for my spouse, nothing left for my children.”

Please note that there will be no Readings for the next two weeks. We will return in early January with the best of 2021.


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Reading of the Week: Is CBD Useful for Mood Disorders? The New CJP Paper. Also, Peer Support and Online CBT (Psych Services) & the Art of Daniel Regan

From the Editor

This week, we have three selections.

With the legalization of cannabis, many big claims haven been made about the medicinal aspects of this drug – including by industry. Cannabidiol, or CBD, is often touted as being helpful yet non-addictive (in contrast to THC, the more famous cannabis molecule). In the first selection, UBC’s Jairo Vinícius Pinto and his co-authors consider cannabidiol in the treatment of mood disorders, reviewing the existing literature. Does CBD help? “The methodology varied in several aspects and the level of evidence is not enough to support its indication as a treatment for mood disorders.”

In the second selection, the University of Michigan’s Paul N. Pfeiffer and his co-authors try to improve depression treatment outcomes by combining a cutting-edge psychotherapy (CBT, delivered by computer) with a not-so-cutting edge approach (peer support). They conclude that the intervention “should be considered as an initial treatment enhancement to improve effectiveness of primary care treatment of depression.”


And in the third selection, we look at the work of artist Daniel Regan, which is featured on the front cover of February issue of The Lancet Psychiatry. He notes: “I really think if I hadn’t gone on to study photography, I wouldn’t be here.” Featured above is “Abandoned,” part of a series of photos from Victorian-era asylums in the UK.


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Reading of the Week: Cannabis for Mental Illness: Popular and Promoted by Industry – But Evidenced? The New Lancet Psychiatry Paper

From the Editor

“It’s the only thing that helps with my anxiety.”

It’s closing in on midnight, and the ED patient I’m seeing is adamant that cannabis has helped him with his generalized anxiety disorder. My day has been long, but I choose to push a bit. Why cannabis? He notes how challenging it was to access mental health care. When he finally did see a psychiatrist, he feels he was offered a prescription after only a few minutes, and the trial of sertraline left him feeling more anxious. Cannabis, in contrast, helps him sleep and takes an edge off the anxiety.

More and more, our patients are talking up cannabis. Google “medical marijuana,” and there are over 166 million hits. And, yes, industry has noticed. There are a half a dozen cannabis dispensaries within a 10-minute walk from the CAMH ED, where I work. In the spring, a former prime minister joined the board of Acreage Holdings, a marijuana company, explaining that he was excited by the potential of cannabis to treat PTSD.

But is any of this evidence based?

This week, we look at a new paper from The Lancet Psychiatry. University of New South Wales’ Nicola Black and her co-authors do a systematic review and meta-analysis. Considering a variety of psychiatric disorders including depression, they draw on the literature to try to understand the effectiveness and safety of cannabinoids. “There is scarce evidence to suggest that cannabinoids improve depressive disorders and symptoms, anxiety disorders, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder, or psychosis.”


We consider this big paper on the hot topic.

We also discuss the comment paper that accompanies this study. Yale University’s Deepak Cyril D’Souza writes: “The process of drug development in modern medicine is to first demonstrate efficacy and safety in clinical trials before using the drug clinically. With cannabinoids, it seems that the cart (use) is before the horse (evidence).” For the record, I don’t think Acreage Holdings will be distributing either paper to shareholders.

Please note that there will be no Reading next week.


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Reading of the Week: Is Cannabis Helpful? Can We Prevent Depression? What’s It Like to be Depressed & in Medicine?

From the Editor

In most Readings of the Week, a paper or essay is selected and then discussed. This week, we return to an older format, and look at several selections, offering an overview of a few topics.

The selections ask thought-provoking questions:

Is cannabis helpful?

Can we prevent depression?

What’s it like to be depressed – and in medicine?


Cannabis: Hype or Help?



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