March 24, 2005

Marijuana as anti-antipsychotic?

Cannabis as an “anti-antipsychotic”

The subject of marijuana (cannabis) and psychosis is one that is currently drawing a large amount of research effort. It is controversial the extent to which marijuana (or the active ingredient THC) has towards the onset of psychosis. Some argue that it has a causal effect in particular patients while others maintain that while it may hurt, certainly does not help, it does not have a profound causal relationship with schizophrenia or psychosis.

This article attempts to take a more thorough look at the role of cannabis in patients who are admitted to a psychiatric intensive care unit (PICU.) A PICU is a unit for patients who are severely disturbed and acutely are unable to be placed on a regular inpatient unit. The authors report a previous study in which 90% of PICU patients were found to have substance abuse histories and nearly 50% of patients had used cannabis in a prior hospitalization. Despite this, there are no guidelines for how to treat cannabis induced psychosis. Part of this goes to the debate as to the precise role of cannabis in inducing psychosis, but nevertheless, it is an area in which physicians must choose treatments based on experience and on similarities in presentation with other psychotic episodes though the etiology may be slightly different. Most medication trials restrict the subjects from having a substance abuse history which makes studied subjects therefore different from the general population. To test the effect of antipsychotic medication on people with active cannabis use, the authors did a naturalistic, open-label study (meaning that they observed what people were already doing and did not intervene to isolate variables) in patients on their PICU. They wanted to see if antipsychotics worked differently or had different effectiveness in people who used marijuana.

Looking at 115 patients, the authors found that 71% of them had abused cannabis in the past. To qualify for abuse of a drug, a person must have used it in the face of persistent problems that stemmed from use of the drug. Merely use of an illicit substance does not qualify as “abuse.” 60% of the subjects tested positive for cannabis on admission to the hospital and on repeat drug testing it was found that 25% of patients used marijuana while in the hospital. Those 25% were found to have nearly 2x as long a hospital stay, put on more weight, and had a history of earlier and more frequent hospitalizations.

What conclusions can we draw from this data? The authors believe that the rise in drug, namely marijuana use, in Britain is part of an explanation of why there has been a rise in mental health usage over the last several years in the National Health Service. It is apparent from these data that time to recovery is lengthened sharply by people who continue to use cannabis while treatment is being in initiated in the hospital. Does that apply to community settings where patients are not as acutely ill as they are on a PICU? This study looks at the subset of patients with the most debilitating symptoms and may not necessarily be applicable to the general psychiatric population or even other inpatient, less acute settings though it is reasonable to imagine that marijuana has a negative impact on treatment in any setting. Lastly, the authors issue a strong advisory for all patients treated with antipsychotic medication to refrain completely from marijuana or other THC containing drugs.

human psychopharmacology
Maria Isaac*, Michael Isaac and Frank Holloway. Is cannabis an anti-antipsychotic? The experience in psychiatric intensive care. Hum Psychopharmacol Clin Exp (in press).

Click here for article on PubMed


well, I'm a schizo, and have been for over 10 yrs;yet I have never been hospitalized and I haven't taken much in the way of anti-psych meds either-I am also a pot head, aka a cannabis user, and rather than exacerbate my "condition" I feel it helps me immensely, and I'm sure that without a good smoke I'd probly be a fat weebil like my dosed-up comrades...I feel cannabis works, for me, partly becuase I can attribute any feelings of paranoia to the drug- it also makes me happy, unlike anti-psych meds, and as a result I am "high functioning", even though I was initially told I would have a poor prognosis... however- it can make symptoms worse, for some ppl..

Posted by: sam at August 4, 2005 06:32 AM

I'm schizophrenic, Been having symptoms since age 13.
I was taken to the hospital a few times and given Diazepam, Then given appointments I could never attend because of paranoia.

Aged 15 I started smoking dope, It saved me from depression, And probably alcoholism. (Its given me bad lungs, I'm planning on purchasing a vapourizer though.)

As long as I dont do a lot of cannabis, And am compliant with my Seroquel I'm alright. (I've also been on Risperdal and Largactil but stopped cause of side effects.)

Posted by: john. at November 27, 2005 06:31 PM

i just started seraquel and im wondering if smoking weed affects or hurts you while the chemicals are in your system,i heard 16

Posted by: zach allen at August 28, 2006 08:04 PM

I have been working with schizophrenics for 25 years. many of these are also drug users, mainly Marijuana. Much of the behavior that is problematic with Marijuana use and anti psychotics , stems from the actual combination of prescribed drugs. Very rarely is someone ONLY on an antipsychotic with a diagnosis of Schizophrenia. Alot of folks self-medicate so they are really not good candidates to study the effects that THC has on an actual regiment of prescribed dugs. It is baffling and frustrating because of the "fixed" mindset many drug users have in regards to the actual harm involved with so called "minimal" drug use.There is much more proof of "harm" than "help" when using recreational drugs and prescribed medicines.

Posted by: suzanne at July 2, 2007 08:23 AM

I'm a
Paranoid schizophrenic who medicates with pot, and have been ever since my last psychotic episode over 2 years ago. Previously I had an episode at least twice a year for three years. since I was diagnosed nothing has calmed me more or made me feel more like a normal human than Regular Marijuana use.

Posted by: Kezd at February 12, 2008 09:58 AM

I suffered severe side effects from Geodon and Seroquel, namely extrapyramidal reactions like severe muscle spasms and full-body cramping, which pot seemed to make worse. Even when I was only on ONE drug (I'm bipolar so was being given the medications as "mood stabilizers"--haha). As a matter of fact, the last time i took seroquel and had a reaction i smoked a couple days later and some of the symptoms (jaw-twitching) came back. Very peculiar sensation--it felt like the psych meds and the weed were both competing for the same parts of my brain. However, even when I abstained from weed I still had reactions to the drugs, though I'm not sure if they react with residual cannabis from years of heavy use. At any rate, I would say that I feel more HUMAN on weed, although people tell me I was more "normal" on psych meds. I think "normal" is just easy to deal with--calm, vegetating, and passively compliant.

Posted by: bobble at May 3, 2008 01:02 AM

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