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Marijuana and OCD: Will it help or hurt? Ask Dr Reilly Kayser

September 24, 2019

This August, we published a blog post about the effects of marijuana and CBD on OCD symptoms. We receive a lot of questions on this topic, and to address them thoroughly we’re bringing a number of perspectives to this blog.

Today’s post comes from Dr. Reilly Kayser, MD. Dr. Kayser is a psychiatrist and clinical research fellow in the Anxiety Disorders Clinic at the New York State Psychiatric Institute, which is affiliated with Columbia University Medical Center. His research focuses on the use of new treatments for OCD, and he’s currently focusing on the role of the endocannabinoid system in OCD and anxiety disorders.

Now we’ll leave things to Dr. Kayser.

Q: How do you feel about substances / cannabis?

Dr. Kayser: Marijuana, or cannabis, is illegal in most of the United States but is nonetheless one of the most commonly used substances. As our political and cultural landscape has changed, cannabis use appears to be on the rise. For example, a 2019 Gallup poll found that 12% of adults in the US reported having used cannabis in the past week—a rate nearly matching the 15% who say they’d smoked cigarettes. Similarly, a survey by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that, between 2008 and 2018, the number of adults who reported using cannabis on a daily basis increased by 4.8 million.

These trends suggest that cannabis’ presence in our society is growing. Americans increasingly appear to find cannabis use socially acceptable, with the General Social Survey finding that a record 61% support cannabis legalization. An expanding number of states are introducing legislation to increase access to medical and recreational cannabis.

Shifting attitudes toward cannabis among American consumers have also been reflected in an explosion in the marketing of cannabis products as potential treatments for all sorts of different conditions, including mental health problems like anxiety and OCD. The bottom line: with so much information about cannabis out there, and so many different claims about what it can do, it can be difficult to figure out what to believe.

Q: How does cannabis interact with OCD or other mental illnesses? Does smoking weed make OCD worse and make obsessions more real?

Dr. Kayser: Given that cannabis use is more and more common among Americans in general, it’s probably no surprise that many people with OCD symptoms have tried it as well. In fact, a large residential treatment facility for OCD recently reported that around 30% of adults with OCD who sought treatment in their program said they had used cannabis at least once. But although we know that many people do use cannabis, how it interacts with symptoms of OCD and other mental illnesses is less clear.

One thing that most researchers agree on is that cannabis is not without risks. For example, cannabis is known to affect the developing brain, and may cause problems later in life for those who are exposed to it at an early age. Similarly, using cannabis has been associated with increased rates of psychotic symptoms. While in this case no causal link has been found— meaning that it hasn’t been proven that cannabis use causes psychosis directly—it also hasn’t been established that cannabis is not capable of causing psychosis in some individuals. So, in general, it is safest for those who fall into high-risk groups (such as children, adolescents, and anyone with a personal or family history of psychosis) to abstain from using cannabis.

Far less is known about how cannabis interacts with anxiety and OCD symptoms. Most of what we do know comes from studies in animals—aside from a few very small studies looking at social anxiety, almost no human trials have looked into this question. We do know that the effects of cannabis (and products derived from cannabis) depend on a variety of factors, including a person’s genetic background, gender, frequency of use, amount used, and expectations about what they will experience.

Someone who has never used cannabis might be more likely to experience anxiety after using, compared to someone who has tried it many times in the past. Similarly, using cannabis with very high concentrations of THC (the main psychoactive ingredient in the marijuana plant) probably increases the chance that a person will experience anxiety and other adverse effects. There is some evidence that those with certain OCD symptoms, particularly obsessions, may be more likely to use cannabis, possibly as a means of coping with their symptoms. However, there are still more questions than answers regarding how exactly cannabis use affects OCD and anxiety symptoms.

This is an active area of research for us at the Center for OCD Research at Columbia University/New York State Psychiatric Institute. We became interested in this question in part because we were hearing vastly different stories from our patients: some told us that cannabis helped to control obsessions, compulsions, or anxiety; others told us that it did nothing; and still others described the ways it worsened their symptoms.

In addition to studying how cannabis affects OCD symptoms in the clinic, we’re currently recruiting people who have experienced OCD symptoms and have also used cannabis in the past to complete a survey about their experiences. If you think you might meet these criteria, please consider filling out the survey—it will help us answer important questions. We would love to hear from people with a range of experiences, whether they’ve had an OCD diagnosis for years or still aren’t sure if they have OCD, whether they’re regular cannabis users or have only tried it once or twice.

Q: How does CBD oil even work? I don’t like smoking weed because it has always made my anxiety worse, so what’s the difference? Could CBD help my OCD?

Dr. Kayser: The short answer to this question is that nobody knows! Interest in CBD has surged over the past few years, which has been accompanied by a great deal of marketing of CBD products for various medical conditions, including anxiety and OCD. However, even though researchers think that CBD has several different effects on the brain, very little is known about its effects on individuals with anxiety and OCD.

Unfortunately, there are many exaggerated or misleading claims about CBD that do not reflect what is actually known scientifically. In reality, there have only been a few small studies in humans. Though these have given us some hints that CBD may help with certain anxiety symptoms, the results are far from conclusive. We are even more in the dark in terms of how CBD affects obsessions and compulsions, as there have been no studies at all in patients with OCD.

So, at this point, we still cannot say whether CBD would help, harm, or have a neutral effect on OCD symptoms. It’s not all bad news, though: in addition to the survey listed above, our team is currently pursuing a study on CBD’s effects in patients with OCD. So we hope to be able to answer this question in more detail soon.

Q: What can I do for my OCD instead of smoking weed?

Dr. Kayser: Fortunately, there’s a variety of treatment options for those with OCD, including medications, psychotherapy, and device-based treatments. The main medications shown to be effective in OCD are those that work on the brain’s serotonin system—this includes SSRIs and clomipramine. These are often effective on their own, but other classes of medications can also be added, depending on a person’s symptoms.

The main form of psychotherapy for OCD is a specific form of cognitive behavioral therapy (CBT) which includes exposure and response/ritual prevention. This type of therapy, known as ERP or EX/RP, can be just as effective as medication for treating OCD symptoms. Some people may benefit even further from combining medication(s) and ERP.

Though medication and ERP are the first-line treatment options, there are a number of alternatives. These include different forms of psychotherapy like acceptance and commitment therapy (ACT), mindfulness, residential treatment programs, and device-based treatments such as transcranial magnetic stimulation (TMS). TMS, which was recently approved by the FDA for treating OCD, is a non-invasive method that uses magnetic fields to stimulate specific brain circuits known to be involved in OCD symptoms.

Overall, the good news is that many options besides cannabis may be helpful. If you’re experiencing OCD symptoms, we recommend consulting a mental health professional who can help you determine whether any of these treatments might be right for you.

Q: So how can I get the most effective therapy for OCD?

Please note that the following is written by the NOCD team. Dr. Kayser has not endorsed the NOCD Therapy treatment service.

As Dr. Kayser mentioned, the verdict is still out on the effects of marijuana and CBD on people with OCD. But, either way, the most effective treatment we currently have is ERP. Conducted by a licensed OCD therapist, it significantly decreases distress in most people. Trying to “fight” our thoughts directly is a losing battle, so ERP works by helping people recognize and resist their compulsions. And it does so without any substances.

Although this might sound simple, it involves careful planning and constant adjustment; so ERP is most effective when practiced with a therapist who has received specialized training. An OCD-trained therapist knows how to spot compulsions and tease them apart from obsessions. These observations are the building blocks of the personalized treatment programs they create. Their expertise is in teaching you how to manage your OCD and make positive changes in all areas of your life, redirecting all the energy you might otherwise have spent on OCD or trying to eliminate anxiety with drugs like marijuana.

This is the same training all of our NOCD Therapists receive. The goal of NOCD is to reduce your OCD symptoms within just a few weeks of live one-on-one video therapy. You’ll be welcomed into our supportive peer community, with 24/7 access to personalized self-management tools built by people who have been through severe OCD and successfully recovered using ERP.

Schedule a phone call with a member of the NOCD clinical team to learn more about how a licensed OCD therapist can help you get better. This consultation is free and doesn’t take very long—and it could be one of the most important calls you ever make.

We receive a lot of questions on marijuana & OCD, and to address it thoroughly Dr. Reilly Kayser, MD and a psychiatrist will answer the questions on it.

Cannabis and OCD: What does the science say?

C hances are, you’ve heard OCD used flippantly as a pejorative. Claiming to have OCD tendencies, or accusing someone else of OCD behavior, makes light of a mental health condition that affects as many as one in forty adults . Living with the disorder can be distressing and debilitating, and finding methods for managing the condition so that it doesn’t hinder the flow of everyday life can be challenging.

A growing body of research is uncovering the role of the endocannabinoid system (ECS) in managing anxiety, fear, and repetitive behaviors. As a result, scientists specializing in OCD have recently started casting their gaze toward cannabinoids as a potential treatment for the management or alleviation of OCD symptoms.

Existing first-line treatments provide limited efficacy—could cannabis help in the management of OCD? Let’s delve deeper.

First things first—what is OCD?

At its root, OCD, or obsessive-compulsive disorder, is an anxiety disorder that hinders the brain’s ability to transition between habitual behavior and goal-directed behavior.

Like most mental health conditions, it affects people with different degrees of severity and in a spectrum of ways: some individuals may experience OCD as a fixation with contamination, while others may feel an urge to align objects symmetrically. There are also other body-centered obsessive-compulsive-related disorders such as hair pulling or skin picking.

Each person’s experience of OCD is specific to them, but people with OCD share the common experience of obsessions or persistent, uncontrollable thoughts or impulses that are intrusive and disturbing. These obsessive ruminations can cause an individual with OCD to feel anxiety and perform repetitive actions, known as compulsions or rituals—such as checking and rechecking locks—to disperse the anxiety.

So how might cannabis help?

A 2019 review published in Cannabis and Cannabinoid Research has unpacked the evidence, suggesting that the endocannabinoid system could represent a new treatment target for obsessive-compulsive disorder. OCD affects the parts of the brain associated with anxiety, stress reactivity, fear conditioning, and habitual behaviors. The endocannabinoid system can modulate these behavioral patterns and emotional responses.

CB1 receptors, which are a fundamental component of the endocannabinoid system, are found in high densities in regions of the brain that are believed to be implicated in OCD, including the prefrontal cortex, basal ganglia, hippocampus, and amygdala. This connection suggests that the careful activation of CB1 receptors may help ease specific symptoms associated with OCD.

Anxiety and stress

Anxiety is a defining element of OCD and can be so all-consuming that it erodes one’s sense of self. There is already considerable evidence that cannabis can help regulate anxiety and stress when delivered in the right dose.

CB1 receptors , a component of the body’s endocannabinoid system, help calibrate the brain when it fires up neurons or inhibits their action. Agonists, substances that bind to CB1 receptors, can help alleviate anxiety or amp it up, depending on the dose, the way the agonist has been administered, or the sensitivity of the CB1 receptors.

THC is an example of such an agonist. When THC binds with CB1 receptors, it can exert a calming effect at low doses. Conversely, it can also elevate anxiety at higher doses (find out why less is more ).

Research has further shown that when CB1 receptors are blocked, or when genes that encode them are deleted, anxiety increase s .

Studies on rodents have also shown that the endocannabinoid system influences the body’s response to stress. The body’s own endocannabinoids promote adaptation to prolonged stress, while THC and other cannabinoids can decrease the stress response when given at low doses.

Again, high doses of THC may exacerbate stress. For the management of both anxiety and stress, the key seems to be administering the right dosage.

Conditioned fear

Fear, or more specifically, conditioned fear , is a fundamental component of OCD. The fear network of the brain pairs an aversive thought with a neutral trigger, sending a signal that something is wrong and it needs to be addressed immediately. Studies have noted that individuals living with OCD have an impaired ability to extinguish fear and that disordered neural pathways are responsible.

The extinction of conditioned fear is within cannabis’ repertoire. Preclinical studies with mice suggest that the endocannabinoid system, and more specifically, the CB1 receptor, are critical to helping snuff out fear memories in the amygdala.

Exogenous cannabinoids such as THC and CBD have demonstrated the ability to lower conditioned fear in rodents, while CB1 antagonists—these bind to CB1 receptors, preventing them from becoming activated—inhibit the process of fear extinction.

There’s also clinical literature on human participants indicating that CBD and dronabinol, a synthetic form of cannabis, may assist with fear extinction. In a study on healthy individuals, dronabinol reduced the response to stimuli that induced fear. Additionally, CBD has been shown to decrease anxiety and help diminish conditioned fear memories in healthy adults.

Habitual behavior

Rodent studies have connected the endocannabinoid system to learning habits and repetitive behavior. Research has found that both THC and CBD can reduce repetitive behaviors in mice. Specific research on CBD was found to have persistent results on repetitive behavior when administered daily over a week. In contrast, diazepam, a common anti-anxiety medication, showed decreasing efficacy over time.

In a study of people with Tourette Syndrome , smoking cannabis was associated with fewer tics and urges to perform compulsive behavior. In other research, women with hair-pulling disorder experienced a reduction in hair pulling after using dronabinol over 12 weeks.

Research on cannabinoids and OCD, and future directions

At present, there are only three case studies that have specifically explored the effects of cannabinoids on OCD. In each case, the subjects in question responded poorly or not at all to first-line medications, including SRIs, antipsychotic medication, mood stabilizers, or cognitive behavioral therapy.

Each person then received dronabinol, and over ten days to two weeks, each of them reported an improvement in the quality of life along with a reduction in OCD symptoms.

It’s worth pointing out that some people with OCD may use cannabis to relieve their symptoms, but for others, cannabis may produce no effect or even exacerbate their anxiety.

Numerous factors could contribute to these conflicting experiences: For starters, a generous dose may produce unwanted effects. Those who are new to cannabis may be more likely to feel some anxiety about consuming it than those who are already familiar with it. Also, cannabis with high concentrations of THC may intensify anxiety or other adverse symptoms.

While there’s evidence that the endocannabinoid system may impact the neural circuitry underlying OCD, there’s currently scant research investigating cannabinoids as a potential treatment for the condition. That’s set to change, however. Dr. Reilly Kayser, one of the leading authors of the above review, is currently investigating the effects of cannabinoid use in people with OCD. Watch this space.

Not much research has been done on cannabis and OCD, but other studies suggest it can be highly beneficial for OCD symptoms. Read on to see what the science says.