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. 2020 Jan 16;20(1):24.
doi: 10.1186/s12888-019-2409-8.

Medicinal Cannabis for Psychiatric Disorders: A Clinically-Focused Systematic Review

Free PMC article

Medicinal Cannabis for Psychiatric Disorders: A Clinically-Focused Systematic Review

Jerome Sarris et al. BMC Psychiatry. .
Free PMC article


Background: Medicinal cannabis has received increased research attention over recent years due to loosening global regulatory changes. Medicinal cannabis has been reported to have potential efficacy in reducing pain, muscle spasticity, chemotherapy-induced nausea and vomiting, and intractable childhood epilepsy. Yet its potential application in the field of psychiatry is lesser known.

Methods: The first clinically-focused systematic review on the emerging medical application of cannabis across all major psychiatric disorders was conducted. Current evidence regarding whole plant formulations and plant-derived cannabinoid isolates in mood, anxiety, sleep, psychotic disorders and attention deficit/hyperactivity disorder (ADHD) is discussed; while also detailing clinical prescription considerations (including pharmacogenomics), occupational and public health elements, and future research recommendations. The systematic review of the literature was conducted during 2019, assessing the data from all case studies and clinical trials involving medicinal cannabis or plant-derived isolates for all major psychiatric disorders (neurological conditions and pain were omitted).

Results: The present evidence in the emerging field of cannabinoid therapeutics in psychiatry is nascent, and thereby it is currently premature to recommend cannabinoid-based interventions. Isolated positive studies have, however, revealed tentative support for cannabinoids (namely cannabidiol; CBD) for reducing social anxiety; with mixed (mainly positive) evidence for adjunctive use in schizophrenia. Case studies suggest that medicinal cannabis may be beneficial for improving sleep and post-traumatic stress disorder, however evidence is currently weak. Preliminary research findings indicate no benefit for depression from high delta-9 tetrahydrocannabinol (THC) therapeutics, or for CBD in mania. One isolated study indicates some potential efficacy for an oral cannabinoid/terpene combination in ADHD. Clinical prescriptive consideration involves caution in the use of high-THC formulations (avoidance in youth, and in people with anxiety or psychotic disorders), gradual titration, regular assessment, and caution in cardiovascular and respiratory disorders, pregnancy and breast-feeding.

Conclusions: There is currently encouraging, albeit embryonic, evidence for medicinal cannabis in the treatment of a range of psychiatric disorders. Supportive findings are emerging for some key isolates, however, clinicians need to be mindful of a range of prescriptive and occupational safety considerations, especially if initiating higher dose THC formulas.

Keywords: CBD; Cannabidiol; Cannabinoids; Cannabis; Marijuana; Medicinal plants; Mental health; Pharmacogenomics; THC.

Conflict of interest statement

JS1 and JS2 conduct cannabis research as university members of the Australia Medicinal Cannabis Research and Education Collaboration ( JS1 has received consultancy payment from a cannabis manufacturing company as an independent scientific advisor (Australian Natural Therapeutics Group); this was however received many months after the creation and submission of this publication and was unrelated to this manuscript. He has also received either presentation honoraria, travel support, clinical trial grants, book royalties, or independent consultancy payments from: Integria Healthcare & MediHerb, Pfizer, Scius Health, Key Pharmaceuticals, Research Reviews, Taki Mai, Fiji Kava, Bioceuticals & Blackmores, Soho-Flordis, Healthworld, HealthEd, HealthMasters, Kantar Consulting, Elsevier, Chaminade University, International Society for Affective Disorders, Complementary Medicines Australia, SPRIM, Terry White Chemists, ANS, Society for Medicinal Plant and Natural Product Research, Sanofi-Aventis, Omega-3 Centre, the National Health and Medical Research Council, CR Roper Fellowship. JS2 has sat on the Scientific Advisory Board for BioCeuticals.

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