Effects of cannabis use on antidepressant treatment response to repetitive transcranial magnetic stimulation and ketamine
Abstract
<h4>Background</h4> The antidepressant effects of ketamine and repetitive transcranial magnetic stimulation (rTMS) are hypothesized to rely on mechanisms of long-term-potentiation and synaptic plasticity. Cannabis, via activation of CB1 receptors has been shown to impair synaptic plasticity, suggesting that cannabis use might moderate the antidepressant effects of ketamine and/or rTMS. <h4>Methods</h4> We performed a retrospective chart review of 222 Veterans, including 58 females, treated for depression with either rTMS or ketamine/esketamine at the VA San Diego Medical Center (VASDMC). We estimated the effects of treatment using changes in the Patient-Health-Questionnaire 9 (PHQ-9) split by cannabis use. Cannabis use was determined using self-report for rTMS (102 total, 23 screening positive for cannabis use) or urinary drug screens for ketamine (120 total, 40 screening positive for cannabis use). Mixed-level repeated measures ANOVA was utilized to determine whether cannabis use affected PHQ-9 scores (group effect) or the change in PHQ-9 over time (group x time interaction). <h4>Results</h4> Cannabis use did not affect overall symptom severity (group effect F (1, 100) = 0.58, p = 0.45) for rTMS, group effect (F (1, 118) = 0.58, p = 0.45) for ketamine, nor did it impact changes in symptoms for either treatment (group x time effect for ketamine: (F (7, 759) = 0.36, p = 0.93); group x time effect for rTMS (F (5, 412) = 0.4160, p = 0.83). <h4>Conclusions</h4> Cannabis use was unrelated to antidepressant treatment outcomes for either rTMS or ketamine, suggesting that cannabis use should not be a contraindication for these treatments.
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