Helps marijuana with obsessive-compulsive disorder

How Can Medical Cannabis Help With Obsessive Compulsive Disorder?

Obsessive-Compulsive Disorder: what is it?

An obsessive-compulsive disorder (OCD for short) is a mental disorder. Essential characteristics of this disease are recurring unwanted, unpleasant thoughts (obsessions) and compulsive behavior. In other words, certain actions that the affected patient repeats stereotypically over and over again. Or recurring thoughts of compulsion.

However, doctors only speak of an OCD disease if these behaviors are repeated over a long period of time and then assume such an extent that everyday life is impaired and a high level of suffering arises. Affected people are often ashamed of the compulsions and try to hide them. This also gave rise to the term "secret illness".

Diagnostic criteria according to ICD-10 and DSM

Diagnosis criteria obsessive-compulsive disorder according to ICD-10

In medicine, the ICD-10 assigns the code F42 for obsessive-compulsive disorder if the following requirements are met:

  • The patient must acknowledge the obsessions or thoughts as his own.
  • The patient must resist at least one compulsive act or obsession.
  • The patient must not find the compulsions or thoughts comfortable.
  • The obsessions and obsessions must repeat themselves in an uncomfortable way.
  • The obsessive-compulsive symptoms appear on several days for at least two weeks.

Diagnosis criteria obsessive-compulsive disorder according to DSM V

The US diagnostic system Diagnostic and Statistical Manual fo mental Disorders (DSM) distinguishes between several levels of obsessive-compulsive disorder. The DSM IV criteria for obsessive-compulsive disorder have now been replaced by the DSM V criteria. For example, at DSM V, the chapter “Obsessive-compulsive disorder and related disorders” was added. Which includes:

  • Trichotillomania (impulse control disorder; patients pull out their own scalp hair)
  • Dermatillomania (impulse control disorder; patients feel an irresistible urge to pinch or scratch certain areas of skin)
  • body dysmorphic disorder
  • compulsive hoarding
  • analogous disorders in combination with drugs or psychotropic substances

What are the symptoms?

Most people are familiar with compulsive actions and thoughts. It is typical, for example, that a check is carried out to determine whether the front door is actually locked, although the person knows that they have only just locked it.

Obsessive-compulsive disorder symptoms usually include obsessive-compulsive thoughts and compulsive actions at the same time. The person concerned perceives obsessive thoughts and impulses as exaggerated and nonsensical. Nevertheless, these thoughts force themselves again and again and trigger unpleasant feelings such as discomfort, disgust or fear. Compulsive acts usually proceed in the same way. They are behaviors that are repeated over and over again. The person concerned feels compelled to carry out this behavior. Often times, these compulsive acts are aimed at reducing the uncomfortable feelings that the thoughts trigger.

A typical compulsion can be, for example, compulsory washing. Just as often there is a compulsion to clean, collect or check.

Obsessive thoughts can have different contents and are thought through again and again by those affected. This can be, for example, individual sentences or series of numbers. Intrusive thoughts (intrusions) that keep recurring are also possible.

Although those affected are aware of the nonsense and senselessness of the behavior, the certainty can vary depending on the extent of the disease and the situation. Only in the case of children and a small proportion of the people affected is there little or no insight that their behavior is unfounded and exaggerated.

How does obsessive-compulsive disorder develop?

The causes have not been fully researched. However, it is believed that genetic predisposition plays a role and increases the risk of obsessive-compulsive disorder. In addition to the genetic predisposition, there are also psychological factors and personal “brain chemistry” that can have an influence on the development of the psychiatric illness.

Doctors and scientists see a high risk factor in disorders that can occur in the brain messenger metabolism (neurotransmitters). These include the messenger substances serotonin and dopamine. These are among other things responsible for the impulsiveness, mood, fear and sexuality and can also be important in the case of obsessive-compulsive disease. It is not uncommon for patients to suffer not only from compulsion, but also from recurring anxiety and depression.

Another cause is seen in the basal ganglia in the brain. Among other things, these control the movement sequences and are located under the cerebral cortex in the right and left hemispheres of the brain. If a disturbance occurs, the interaction between movement impulse and movement no longer works.

In addition to these triggering factors, psychological causes can also come into question.

Psychological causes

In clinical psychology and psychoanalysis, obsessive-compulsive disorder was formerly referred to as "obsessive-compulsive disorder". The cause is internal defense mechanisms, which should help to control subconscious thoughts from the instinctual part of the individual personality.

Various factors such as the upbringing (e.g. fearfully exaggerated parenting style or extreme toilet training), personal life experience, experiences of violence or sexual assault can be a cause. Such experiences can lead to adult sufferers being too strict with themselves. As a result, they develop a perfectionism to avoid mistakes. Statistics show that an obsessive-compulsive personality is often related to perfectionist and anxious-insecure personality traits.

When compulsions arise, a previously neutral stimulus (e.g. dirt) is combined with an unpleasant experience. This link is also known as the conditioning process. Later on, just the sight or even just the idea of ​​dirt arouses fear and inner tension. These feelings are then "broken down" by washing and those affected feel better for a short time. However, the relief only lasts until the next stimulus occurs. In the long run, this makes the obsessive-compulsive disorder worse.

Therapy and Treatment

The therapy depends on the type and severity of the disease. Psychotherapy or cognitive-behavioral treatment as well as drug therapy can be considered. A combination of psychotherapy or cognitive behavioral therapy and medication is also possible.

Above all, cognitive behavioral therapy is an effective treatment. This is used when primarily compulsive acts occur without depression. With the support of the therapist, the person concerned exposes himself to the situations and stimuli that trigger his compulsion. As part of cognitive behavioral therapy, the person concerned learns to endure the feelings that arise until they subside on their own. The prerequisite for the success of this therapy is a high level of motivation on the part of the person concerned.

Obsessive-Compulsive Disorder: Group therapy can be a complementary treatment option.

A supplement to behavioral therapy might be another form of psychotherapy. Group therapy led by a therapist. Other complementary and supportive therapies could be, for example, gestalt therapy or hypnosis.

What drugs for obsessive-compulsive disorder?

To relieve the compulsions, doctors usually prescribe serotonin reuptake inhibitors (SSRIs), which are also often prescribed for depression. Serotonin reuptake inhibitors (SSRIs) are not physically dependent, but psychological dependence can be a side effect that should not be underestimated. In addition, various side effects such as insomnia, loss of appetite, nausea and vomiting, diarrhea and inner restlessness can occur. Other undesirable side effects can include decreased libido and erectile dysfunction and ejaculation disorders.

For drug treatment, doctors can choose from SSRIs such as fluoxetine, fluvoxamine, sertraline and paroxetine, among others. The chances of success are different. Complete healing cannot be achieved with medication. In most cases, however, the compulsions can be reduced to a tolerable level.

Other medication for an obsessive-compulsive disorder

If depressive symptoms or fears are in the foreground or if patients do not respond adequately to the SSRI medication, patients are also given neuroleptics in some cases. Medicines such as quetiapine or risperidone, which can also have severe side effects, are then used.

In addition to a serotonin uptake inhibitor, some doctors also recommend tricyclic antidepressants such as the active ingredient clomipramine. Various research suggests that clomipramine could be effective for an obsessive-compulsive disorder. In contrast, the tricyclic antidepressant opipramol does not appear to be effective in this mental illness.

The following drugs are also ineffective, but are often associated with obsessive-compulsive disorders:

  • MAOIs such as jatrosome (tranylcypromine)
  • NDRI like bupropion (Elontril)
  • SSNRIs such as Cymbalta (duloxetine) and venlafaxine
  • NaSSA like mirtazapine

Natural remedies for obsessive-compulsive disorder

Natural remedies can be an alternative to antidepressants without causing serious undesirable side effects. In particular, the secondary messenger substance inositol can, under certain circumstances, bring about an alleviation of the obsessive-compulsive symptoms. It is a hexavalent alcohol that is found in many plants and animal tissues. As early as 1996, researchers from the Israeli Faculty of Health Sciences reported that 13 subjects with an obsessive-compulsive disorder experienced a significant improvement in symptoms under inositol. Valerian root extracts also seem to be effective. In 2011, researchers from Jundishapur University of Medical Sciences gave valerian to their subjects. Here, too, there were positive results.

St. John's wort has long been known for its antidepressant effects, which has been confirmed by many studies. The effects of St. John's wort (e.g. Laif 900) against obsessive-compulsive disorder have been less well researched. The same goes for lavender (e.g. Lasea).

In addition, some of those affected also use homeopathic remedies as part of their treatment. But even for this there are no scientifically founded studies that confirm its effectiveness.

Brain pacemaker promises improvement in symptoms

Medicines in combination with psychotherapy or behavioral therapy help around 80 to 90 percent of those affected. In 10 to 20 percent, the therapy goals are not achieved. The therapy methods are ineffective and it is not uncommon for such people to be classified as "out of therapy". But for some years now there has been hope for precisely these patients: an operation (deep brain stimulation) should help.

If all therapy options are unsuccessful, the use of a brain pacemaker (deep brain stimulation - DBS) may be an option. During this operation, electrodes are implanted in the nucleus accumbens (core structure in the forebrain). The electrodes are then supplied with electricity via a pulse generator installed in the collarbone or abdominal cavity. Smaller case studies have shown that brain stimulation significantly improved symptoms. However, it should not be forgotten that this operation is not a routine procedure and that it should be carefully considered together with the attending physician.

Compulsions / obsessions self-help

Those affected can find further information and help at the German Society for Obsessive Compulsive Diseases e.V. (DGZ). We recommend participating in a self-help group in which those affected can exchange ideas and support one another.

Cannabis as a medicine for obsessive-compulsive disorder

Medical cannabis in psychiatry and neurology

For a long time, the use of cannabis for recreational purposes was mainly associated with the development of mental illnesses (e.g. psychosis, anxiety, depression). The therapeutic potential of medical cannabis was ignored. However, this has changed in recent years. Current research suggests that medicinal cannabis may have therapeutic benefits in the treatment of mental illness.

Cannabis-based medicines for ADHD and PTSD

Adults with attention deficit / hyperactivity disorder (ADHD) often benefit from cannabis as it can improve concentration, sleep, and impulse control. The situation is similar for people who receive cannabis-based medicines to lighten their moods when they have depression. Even with severe mental illnesses such as post-traumatic stress disorder (PTSD), symptom relief is possible with the help of cannabis as a medicine, according to an Israeli study.

Studies on therapy with cannabis drugs in medicine

Scientists from the University of Minnesota (USA) found in a clinical study that THC has a positive effect on patients suffering from trichotillomania. This is a special type of obsessive-compulsive disorder in which hair is compulsively torn out. Of 14 women treated with THC, 9 subjects responded to the therapy. The scientists concluded that the cannabinoids from the cannabis plant can be useful in treating various obsessive-compulsive symptoms.

In addition to delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD) is another important cannabis active ingredient. Currently, CBD is being used more and more by patients. Compared to THC, CBD is only slightly psychoactive and counteracts the THC effect. Because of this, it is currently being investigated whether cannabidiol can also be used in psychiatry for cannabis-induced psychoses and schizophrenia.

Read more about schizophrenia and medicinal cannabis here.

Most of the knowledge about the medical effects of cannabidiol is still poorly established. It was found that CBD can have a relaxing effect, so that the cannabis drug Sativex is used for spasticity in the context of multiple sclerosis. This has an equally high THC content and CBD content.

Much knowledge about the medical effects of CBD is still poorly established. In addition to extensive experience reports, there are hardly any well-founded studies. Usually these are just cell experiments, animal experiments or individual case descriptions.

How does medical cannabis work in the body?

The body's own cannabinoid system (endocannabine iodine system) consists of the cannabinoid receptors CB1 and CB2. In obsessive-compulsive disorder, the protective function of the CB1 receptors probably plays an important role. These are located at the nerve cell ends in a gap between two nerve cells. At these points, the nerve cells transmit signals to other nerve cells. In the nervous system, the CB1 receptors inhibit the transmission of signals by neurotransmitters (messenger substances) in the brain. This means that overactivity of various messenger substances such as serotonin, dopamine and norepinephrine is reduced by activating the CB1 receptors.

Activation of the CB1 receptors can be achieved by taking cannabinoids from the cannabis plant. This can be done with both cannabis-based medicines and vaping medicinal dried flowers. Basically, cannabis patients are recommended to use a vaporizer to vaporize cannabis flowers for medical purposes. As a result, the active ingredients (cannabinoids) from the cannabis do not burn. So it is a gentle intake of the active ingredients.

The endocannabinoid system plays an important role

The endocannabinoid system protects against overexcitation in the central nervous system. At the same time, it balances brain activity, which could explain the broad spectrum of effects of cannabis.

When THC binds to the CB1 receptors, overactivity in the brain's pain control loops is reduced. As a result, chronic pain is relieved. If neurotransmitter overactivity occurs in regions of the brain that are responsible for nausea and vomiting, the activation of the CB1 receptors can inhibit them. Similar mechanisms are used to reduce obsessive-compulsive disorder such as epileptic seizures, muscle spasticity, hyperactivity or anxiety disorder.

In the American Journal of Psychiatry, researchers reported two patients diagnosed with obsessive-compulsive disorder. The 38-year-old patient and the 36-year-old patient did not respond to conventional therapy with an antidepressant and neuroleptic. In addition to the drug clomipramine, the patient received 10 mg of oral THC (dronabinol) three times a day. There was a significant decrease in symptoms within 10 days of taking dronabinol.In the second patient, the dose of dronabinol drops was slowly increased to 10 mg twice daily. A significant reduction in symptoms occurred within two weeks.

As a result, the effectiveness of medical cannabis therapy was described as good. No serious side effects have been reported with the use of dronabinol.

Study proves the effectiveness of medical cannabis in Tourette's syndrome

Tourette's syndrome usually occurs in childhood and manifests itself through linguistic and physical tics. This can be, for example, repeated jerky movements or socially unacceptable verbal utterances. There is a close connection between this tic disorder and obsessive-compulsive disorder. About 30 to 60 percent of people with Tourette's syndrome also have obsessive thoughts and / or compulsive acts.

Researchers believe that using cannabis as a medicine can reduce the frequency of tics. Prof. Dr. Kirsten Müller-Vahl stated in a study that 17 out of 64 people with Tourette's syndrome consumed cannabis flowers for recreational purposes.

After smoking the cannabis flowers, 14 test persons stated that their tics had partially or completely disappeared. Further studies were then carried out. These confirm that the majority of the test subjects experienced a significant improvement after taking cannabinoids. Side effects, however, only occurred in a few test subjects.

Müller-Vahl and her colleagues explained that the cannabinoids from the cannabis plant act via the cannabinoid receptors and that the endocannabinoid system could play an important role in Tourette's pathology.

CONCLUSION

Various studies have already provided important indications that cannabis as a medicine may have therapeutic potential to supportively alleviate symptoms such as obsession, anxiety and depression. In this respect, it might be possible to use cannabis-based drugs in psychiatry or for psychiatric illnesses. The study situation on the use of medicinal cannabis in obsessive-compulsive disorder is not yet conclusive enough to be able to derive a general therapy recommendation from it.

 

Note: In this article we report on prescription CBD or cannabidiol. This article makes no suggestion as to the possible purpose. Promises of use are left to the pharmacists.

 

 

Swell:

  • Department of Psychiatry, Hadassah Hebrew University Medical Center, Jerusalem, Israel, Roitman P1, Mechoulam R, Cooper-Kaza R, Shalev A, 2014, “Preliminary, open-label, pilot study of add-on oral Δ9-tetrahydrocannabinol in chronic post -traumatic stress disorder ”
  • Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, USA, Grant JE, Odlaug BL, Chamberlain SR, Kim SW, 2011, “Dronabinol, a cannabinoid agonist, reduces hair pulling in trichotillomania: a pilot study”