Improvement in Refractory Obsessive Compulsive Disorder With Dronabinol

Improvement in Refractory Obsessive Compulsive Disorder With Dronabinol

FRANK SCHINDLER, M.D., ION ANGHELESCU, M.D., Ph.D., FRANCESCA REGEN, M.D., and MARIA JOCKERS-SCHERUBL, M.D., Ph.D.
Berlin, Germany To the Editor: It has been reported that 40%â??60% of patients with obsessive-compulsive disorder (OCD) do not respond to first-line treatment. Treatment options for these patients include switching to another agent or augmentation (1). We report on two patients with treatment-resistant OCD and comorbid axis I disorders who responded to an augmentation with the cannabinoid dronabinol.

"Mrs. L" was a 38-year-old woman who was admitted with recurrent major depression and OCD (Yale-Brown Obsessive Compulsive Scale score: 20) after outpatient treatment with paroxetine (60 mg) for 8 months and cognitive behavioral therapy (CBT) were not efficacious. Switching to clomipramine (300 mg) resulted in partial response after 12 weeks of treatment. Based on the patientâ??s report that smoking marijuana usually relieved her symptoms, an augmentation with dronabinol (2.5%; 10 mg t.i.d.) was started. The prior medication was continued. While undergoing treatment with dronabinol (2.5%), the patientâ??s OCD symptoms decreased significantly within 10 days (Yale-Brown Obsessive Compulsive Scale score: 10). "Mr. K" was a 36-year-old man with schizophrenia and OCD who was admitted for deterioration of psychotic and obsessive symptoms (Yale-Brown Obsessive Compulsive Scale score: 23). During his course of illness, Mr. K had been treated with antipsychotics (including haloperidol, olanzapine, risperidone, quetiapine, and aripiprazole), both in monotherapy and in combination with selective serotonin reuptake inhibitors. His OCD symptoms in particular remained predominately treatment resistant. Treatment with clozapine (400 mg), which he had already received for more than 1 year (in combination with paroxetine [60 mg] for 13 weeks) resulted only in partial response of his psychotic and OCD symptoms. Switching paroxetine to clomipramine (for another 10 weeks), followed by an additional course of 18 electroconvulsive therapy treatments (right unilateral high dose), did not improve the patientâ??s psychotic or OCD symptoms significantly. After the addition of dronabinol to ongoing treatment with clomipramine (150 mg) and clozapine (400 mg), a significant reduction of OCD symptoms was observed within 2 weeks (Yale-Brown Obsessive Compulsive Scale score: 15). In order to prevent psychotic deterioration, dronabinol (2.5%) was carefully increased to 10 mg b.i.d.
Apart from anticholinergic symptoms that preceded the addition of dronabinol (patient 1: dry mouth, constipation; patient 2: constipation, hypotension), both patients reported no side effects. In particular, there was no deterioration of psychotic or mood disorder symptoms.

Based on data from case reports and small clinical trials suggesting that cannabinoids can reduce symptoms of tic disorder (2) and on findings from genetic studies linking tic disorder with OCD (3), we hypothesized that cannabinoids might also reduce OCD symptoms. Moreover, there is evidence suggesting that besides serotonergic and dopaminergic systems, glutamatergic hyperactivity is involved in the pathophysiology of OCD (4, 5). This view is supported by data suggesting the efficacy of glutamate modulating drugs, such as topiramate, memantine, riluzole, or N-acetylcysteine, in the treatment of OCD (6). It has been reported that cannabinoids inhibit glutamate release in the CNS (7, 8). Additionally, cannabinoid type 1 (CB1) receptors are distributed abundantly in the striatum (8), a brain region frequently associated with OCD. Hence, it can be speculated that the anti-obsessive effect observed in our patients may have been a consequence of the glutamate modulation of the cannabinoid dronabinol. Since it is well known that cannabinoids may trigger psychotic symptoms in patients with schizophrenia (8), caution is warranted when prescribing for patients with a history of the disorder.

Footnotes
The authors report no competing interests.
This letter (doi: 10.1176/appi.ajp.2007.07061016) was accepted for publication in September 2007.
References

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epilepticme, do you find weed helps you with with OCD? and what's the differnece between that and refractory OCD? (never heard of it)

Opie Yutts,

Luckily I do not suffer from OCD, at least I do not think I do. I use cannabis for other reasons. Epilepsy being the most obvious hence my screen name. I also treat my anxiety with it.

I just share what I find interesting in hopes it is useful to someone in the community.

:hippy:

Ah, I see. Is there a thread where you talk about the ways weed helps you, as far as epilepsy goes? And am I wrong, or is epilepsy excluded from the list of qualifying medical conditions? Maybe I just dreamed I read that somewhere.

I am not sure what you mean by qualifying?

I did post some research I found about epilepsy and weed.

Quote:

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Originally Posted by epilepticme

I am not sure what you mean by qualifying?

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Is epilepsy one of the conditions to qualify for a medical mj card?

I think that is state independent. We do not have legal medical cannabis in my state. I think states like California, you get a recommendation from a doc for whatever you and him feel cannabis should work for.

Awesome, THANX. You were right to hope that it helps someone, you may just have helped me! :D
At least now I have some scientific proof that it works. I knew it did, but now I have some evidence!
I'm gonna print this and most likely bring it to my doctor next time I see her. If not I'll just show it to my mum so she will be alright with my smoking.

Any tips to introduce this to a doctor?

It's becoming less and less a secret as more studies are documented...That's why the government does everything they can to prevent research like this being done in the united states..

Pot for next to nothing for treatment doesn't sound NEAR as good as $5-10 a dose to pharmaceutical companies though..

By going to the link in my sig and loading up the printer! Actually, just print the first 10 pages, or the pages that concern your condition + a few random pages - that should be enough.

Granny's been thinking- there may be some of you who aren't quite sure the the doctor (or Mom, or whoever ;) ) may experience too much "culture shock" at C.com. (Although this place DOES "have manners" compared to some, lol) Well, I got that covered, too- I have my list mirrored on a brand-new, very "innocent", purely medical site! When the doc wants to see more- or demands to check the URLs to see if you are scamming him...head him over there!

Granny Storm Crow's List- - Medical Marijuana Patient Forums


There was a survey done of doctors in Canada, which has a legal, federal MMJ program. The doctors admitted that MOST of what they know about cannabis comes from their PATIENTS! Now how much do you think your doctor knows about cannabis beyond the prohibitionist's lies?

If your doctor is just "too over-the-top" in his/her prohibitionist views, and you want to avoid a scene, there is always the US post office! Send it anonymously with the "innocent" URL.

We win the war on prohibition, ONE MIND AT A TIME! EDUCATE!

Granny :hippy:

If anyone's interested, I just renewed my card, and yes convulsions of any kind are a qualifying condition.