Assessing Changes in Symptoms of Depression and Anxiety During Four Weeks of Cannabis Abstinence Among Adolescents

Megan E Cooke, Jodi M Gilman, Erin Lamberth, Natali Rychik, Brenden Tervo-Clemmens, A Eden Evins, Randi M Schuster, Megan E Cooke, Jodi M Gilman, Erin Lamberth, Natali Rychik, Brenden Tervo-Clemmens, A Eden Evins, Randi M Schuster

Abstract

Background: Cannabis use is prevalent among adolescents, and many report using in attempts to alleviate negative mood and anxiety. Abstinence from substances such as alcohol and tobacco has been reported to improve symptoms of anxiety and depression. Few studies have examined the effect of cannabis abstinence on symptoms of anxiety and depression. Objective: To test the effect of 4 weeks of continuous cannabis abstinence on depressive and anxious symptoms. Methods: Healthy, non-treatment seeking adolescents who used cannabis at least weekly (n = 179) were randomized to either 4 weeks of cannabis abstinence achieved through a contingency management paradigm (CB-Abst) or cannabis use monitoring without an abstinence requirement (CB-Mon). Abstinence was assessed by self-report verified with quantitative assay of urine for cannabinoids. Anxiety and depressive symptoms were assessed weekly with the Mood and Anxiety Symptom Questionnaire (MASQ). Results: Symptoms of depression and anxiety decreased throughout the study for all participants (MASQ-AA: stnd beta = -0.08, p = 0.01, MASQ-GDA: stnd beta = -0.11, p = 0.003, MASQ-GDD: stnd beta = -0.08, p = 0.02) and did not differ significantly between randomization groups (p's > 0.46). Exploratory analyses revealed a trend that abstinence may be associated with greater improvement in symptoms of anxiety and depression among those using cannabis to cope with negative affect and those with potentially hazardous levels of cannabis use. Conclusions: Among adolescents who use cannabis at least weekly, 4 weeks of cannabis abstinence was not associated with a significant change in anxiety or depressive symptoms compared to continued use. For recreational cannabis users who may be concerned about reducing their use for fear of increased symptoms of anxiety and depression, findings suggest that significant symptom worsening may not occur within the first 4 weeks of abstinence. Further studies are needed in clinical populations where anxiety and depression symptoms are measured more frequently and for a longer period of abstinence. Future studies are also needed to determine whether there are subgroups of adolescents who are uniquely impacted by sustained cannabis abstinence.

Keywords: adolescents; anxiety; cannabis; cannabis abstinence; contingency management; depression; youth.

Conflict of interest statement

AE has received research grant support to her institution from Pfizer Inc, Forum Pharmaceuticals, and GSK, consultation fees from Charles River Analytics, and honoraria for advisory work from Pfizer, and Kaurna Pharmaceuticals in the past 5 years for work unrelated to this project. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Cooke, Gilman, Lamberth, Rychik, Tervo-Clemmens, Evins and Schuster.

Figures

Figure 1
Figure 1
Decreasing CN-THCCOOH concentrations in CB-Abst. Figure shows average urine creatine adjusted 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (CN-THCCOOH) concentration (ng/mL) and confidence intervals at each study visit for CB-Abst and CB-Mon groups.
Figure 2
Figure 2
MASQ scores by group over time. Figures show the individual observations of each MASQ subscale which have been adjusted for age, sex and baseline MASQ subscale as well as predictive slopes across time by randomization group; CB-Abst in coral and CB-Mon in teal. Supplementary Figure 1 displays the mean group differences with confidence intervals between CB-Abst and CB-Mon by visit. (A) age: stnd beta = −0.03, p = 0.58, sex: stnd beta = 0.01, p = 0.96, ethnicity: stnd beta = 0.08, p = 0.57, baseline CN-THCCOOH: stnd beta = −0.01, p = 0.81, baseline MASQ-GDA: stnd beta = 0.65, p < 0.001, time: stnd beta = −0.11, p = 0.003, group: stnd beta = −0.02, p = 0.86, time by group interaction: stnd beta = 0.08, p = 0.18. (B) age: stnd beta = −0.04, p = 0.41, sex: stnd beta = 0.002, p = 0.98, ethnicity: stnd beta = 0.07, p = 0.64, baseline CN-THCCOOH: stnd beta = −0.006, p = 0.91, baseline MASQ-AA: stnd beta = 0.72, p < 0.001, time: stnd beta = −0.08, p = 0.01, group: stnd beta = 0.07, p = 0.51, time by group interaction: stnd beta = 0.07, p = 0.20. (C) age: stnd beta = −0.01, p = 0.84, sex: stnd beta = 0.11, p = 0.27, ethnicity: stnd beta = 0.04, p = 0.75, baseline CN-THCCOOH: stnd beta = 0.01, p = 0.84, baseline MASQ-GDD: stnd beta = 0.66, p < 0.001, time: stnd beta = −0.08, p = 0.02, group: stnd beta = −0.07, p = 0.46, time by group interaction: stnd beta = 0.08, p = 0.12. (D) age: stnd beta = −0.05, p = 0.36, sex: stnd beta = −0.03 p = 0.73, ethnicity: stnd beta = 0.13, p = 0.32, baseline CN-THCCOOH: stnd beta = 0.01, p = 0.84, baseline MASQ-AD: stnd beta = 0.69, p < 0.001, time: stnd beta = −0.03, p = 0.34, group: stnd beta = −0.04, p = 0.72, time by group interaction: stnd beta = 0.03, p = 0.53.

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