Study register · detailSystematic Review · Dementia · 2019
How effective and safe is medical cannabis as a treatment of mental disorders? A systematic review
Hoch et al.·European Archives of Psychiatry and Clinical NeuroscienceImpact 2.9
MixedGRADEHigh129 citations
Samplek = 18 Studien n = 1.629 Pat.
DurationSearch period 2006-August 2018
ControlPlacebo or active control
EndpointSymptom severity
Blindingunklar
DesignSystematic Review
”Key finding
THC- and CBD-based medications were associated with symptom improvements in several mental disorders, but not with remission; adverse effects occurred, severe adverse effects only in isolated cases.
Summary
Umbrella review on medical cannabinoids in psychiatric disorders; k=18 studies (4 SRs across 11 RCTs + 14 standalone RCTs), n=1.629 participants. Diagnoses include dementia, cannabis dependence, psychoses, PTSD, anorexia, ADHD, Tourette, among others. THC- and CBD-based medications as adjuvant showed improvements in individual symptoms, but no remission. Severe adverse effects only in isolated cases. Heterogeneous outcomes, no meta-analysis possible; narrative synthesis applied.
P
PopulationPatients with mental disorders (dementia, cannabis/opioid dependence, psychoses/schizophrenia, social anxiety disorder, PTSD, anorexia nervosa, ADHD, Tourette syndrome); pooled n=1629
I
InterventionTHC- and CBD-based medications (adjunctive to pharmacotherapy and psychotherapy)
C
ControlPlacebo or active control (varying by RCT)
O
OutcomeImprovement of several symptoms of mental disorders, but no remission; severe adverse events only in isolated cases
Confidence in the evidence
Very lowLowModerateHigh
High
The highest of four GRADE levels, the effect estimate is very reliable.
We conducted a review of systematic reviews (SRs) and randomized-controlled trials (RCTs) to analyze efficacy and safety of cannabis-based medication in patients with mental disorders. Five data bases were systematically searched (2006-August 2018); 4 SRs (of 11 RCTs) and 14 RCTs (1629 participants) were included. Diagnoses were: dementia, cannabis and opioid dependence, psychoses/schizophrenia, general social anxiety, posttraumatic stress disorder, anorexia nervosa, attention-deficit hyperactivity disorder, and Tourette;s disorder. Outcome variables were too heterogeneous to conduct a meta-analysis. A narrative synthesis method was applied. The study quality was assessed using the risk-of-bias tool and SIGN-checklists. THC- and CBD-based medicines, given as adjunct to pharmaco- and psychotherapy, were associated with improvements of several symptoms of mental disorders, but not with remission. Side effects occurred, but severe adverse effects were mentioned in single cases only. In order to provide reliable treatment recommendations, more and larger RCTs with follow-up assessments, consistent outcome measures and active comparisons are needed.