The Obsessive-compulsive disorder (OCD) is a mental disorder marked by anxiety or distress, characterized by the presence of persistent thoughts (better known as obsessions). These recurrent thoughts are suppressed by new ones or actions, known as compulsions (acts performed in response to the obsession). The compulsions aim at preventing the anxiety or distress[1]
The word “refractory” is applied to diseases that do not respond to treatment. Around 60% of patients with Obsessive-Compulsive Disorder do not respond to first-line treatment. Options in these cases include an increase of dosages or switching to another drug. In this sense, new evidence reported patients with treatment-resistant OCD who could respond better to an increase dosage of medications combined with medical cannabis.
Improvement in Refractory Obsessive Compulsive Disorder
In 2008, researchers published an article in the American Journal of Psychiatry. In this article, the researchers presented the experiences of two refractory OCD patients, a man and a woman, after synthetic THC administration.
For the female subject, doctors had prescribed during 8 months an antidepressant (selective serotonin reuptake inhibitor) and psychological therapy to treat her OCD and major depression, but without success. Switching to a new antidepressant (tricyclic antidepressant) resulted only in partial response after 12 weeks. Interestingly, the woman reported that when she smoked cannabis, her symptoms were relieved. Based on this personal experience, it was decided to supplement her current treatment with synthetic THC. In just 10 days, her OCD symptoms were reduced, and her severity disease score improved by 50%.
Regarding the male subject, doctors prescribed different antipsychotics, both in monotherapy and in combination with an antidepressant (selective serotonin reuptake inhibitor), without success either. Partial response on his psychotic and refractory obsessive compulsive disorder symptoms was only possible with an atypical antipsychotic medication (clozapine) in combination with an antidepressant (selective serotonin reuptake inhibitor). Later, the patient tried switching to another antidepressant (tricyclic antidepressant) and additional electroconvulsive therapy, but he did not improve. In his case, after the addition of the synthetic THC to the ongoing medication, his refractory obsessive compulsive disorder symptoms were reduced within 2 weeks, and his severity disease score improved by 35%. No side effects were reported in these patients.
Based on these two cases, the researchers therefore hypothesized that cannabinoids are definitely useful in treating the symptoms of people with refractory OCD[2]
In 2010, a clinical study was subsequently published in the Journal Behavioural Pharmacology, describing the observation of CBD effects on rodents (subjected to an animal model proposed to reflect compulsive behaviour). In this study, the researchers found that Cannabidiol (CBD), a component of cannabis that has been shown to have anxiolytic effects, both in animals and humans, could significantly reduce symptoms associated with stimulated compulsive animal behaviour for a significant duration, since the effects of CBD were still present 7 days after its administration. A similar decrease was found using the benzodiazepine diazepam and the serotonin selective reuptake inhibitor paroxetine. However, the effect of diazepam was no longer present after 7 days. The results suggest a potential role of cannabinoids on the cannabinoid system in controlling compulsive behaviour[3].
In general, these studies demonstrated a therapeutic potential of cannabinoids to reduce Refractory Obsessive Compulsive Disorders, however, new studies are needed to definitively validate its utility or not.
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[1] Hirschtritt, M. E., Bloch, M. H., & Mathews, C. A. (2017). Obsessive-Compulsive Disorder. JAMA, 317(13), 1358. doi:10.1001/jama.2017.2200
[2] Schindler, F., Anghelescu, I., Regen, F., & Jockers-Scherubl, m. (2008). Improvement in Refractory Obsessive Compulsive Disorder With Dronabinol. American Journal of Psychiatry, 165(4), 536–537.doi:10.1176/appi.ajp.2007.07061016
[3] Casarotto PC, Gomes FV, Resstel LB, Guimaraes FS. Cannabidiol inhibitory effect on marble-burying behaviour: involvement of CB1 receptors. Behav Pharmacol 2010;21:353-358.