title: Cannabis withdrawal is common among treatment-seeking adolescents with cannabis dependence and major depression, and is associated with rapid relapse to dependence.
abstract: Recently, reports have suggested that cannabis withdrawal occurs commonly in adults with cannabis dependence, though it is unclear whether this extends to those with comorbid depression or to comorbid adolescents. We hypothesized that cannabis withdrawal would be common among our sample of comorbid adolescents and young adults, and that the presence of cannabis withdrawal symptoms would be associated with a self-reported past history of rapid reinstatement of cannabis dependence symptoms (rapid relapse). The participants in this study included 170 adolescents and young adults, including 104 with cannabis dependence, 32 with cannabis abuse, and 34 with cannabis use without dependence or abuse. All of these subjects demonstrated current depressive symptoms and cannabis use, and most demonstrated current DSM-IV major depressive disorder and current comorbid cannabis dependence. These subjects had presented for treatment for either of two double-blind, placebo-controlled trials involving fluoxetine. Cannabis withdrawal was the most commonly reported cannabis dependence criterion among the 104 subjects in our sample with cannabis dependence, being noted in 92% of subjects, using a two-symptom cutoff for determination of cannabis withdrawal. The most common withdrawal symptoms among those with cannabis dependence were craving (82%), irritability (76%), restlessness (58%), anxiety (55%), and depression (52%). Cannabis withdrawal symptoms (in the N=170 sample) were reported to have been associated with rapid reinstatement of cannabis dependence symptoms (rapid relapse). These findings suggest that cannabis withdrawal should be included as a diagnosis in the upcoming DSM-V, and should be listed in the upcoming criteria list for the DSM-V diagnostic category of cannabis dependence.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, PAARC Suite, Pittsburgh, PA 15213, United States. Electronic address: corneliusjr@upmc.edu.
authors.forename: Jack R
authors.initials: JR
authors.lastname: Cornelius
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, PAARC Suite, Pittsburgh, PA 15213, United States.
authors.forename: Tammy
authors.initials: T
authors.lastname: Chung
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, PAARC Suite, Pittsburgh, PA 15213, United States.
authors.forename: Christopher
authors.initials: C
authors.lastname: Martin
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, PAARC Suite, Pittsburgh, PA 15213, United States.
authors.forename: D Scott
authors.initials: DS
authors.lastname: Wood
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, PAARC Suite, Pittsburgh, PA 15213, United States.
authors.forename: Duncan B
authors.initials: DB
authors.lastname: Clark
mesh_terms: D000293:Adolescent; D002186:Cannabinoids / Q000009:adverse effects*; D018849:Controlled Clinical Trials as Topic; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013375:Substance Withdrawal Syndrome / Q000523:psychology*; D055815:Young Adult
chemical_list: D002186:Cannabinoids; D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors