Can Medicinal Cannabis Represent a Potential Treatment For Personality Disorders?

Emotionally unstable personality disorder (EUPD) is a mental health condition characterized by intense and unstable emotions, impulsive behavior, distorted self-image, and difficulty in maintaining stable relationships. Patients with EUPD often struggle with regulating their emotions and may experience intense feelings of emptiness, anxiety, anger, or depression that can be triggered by even minor stressors. In addition to emotional instability, patients with EUPD may have a distorted self-image and a fear of abandonment, which can result in intense and unstable relationships with others. They may also struggle with identity issues, rapidly changing interests and goals, and difficulty in making decisions. The causes of EUPD are complex and can include genetic and environmental factors such as childhood trauma or neglect, a history of abuse, and dysfunctional family dynamics. The current treatment options for EUPD are limited and often ineffective. Pharmacological treatments are not recommended by NICE as there is no evidence for their efficacy in EUPD, but they are frequently prescribed off-label, mainly to target specific symptoms such as mood instability, impulsivity, or psychosis. However, these medications have significant side effects and may interact with each other or with illicit substances that some patients with EUPD may use to cope with their distress.

Cannabis-based medicinal products (CBMPs) have gained a lot of attention in recent years for their potential therapeutic effects in a variety of neurological diseases, including multiple sclerosis, epilepsy, and Parkinson’s disease, among others. Cannabis contains more than 100 active compounds, known as cannabinoids, which have been shown to interact with the body’s endocannabinoid system. This system is involved in regulating many physiological processes, including pain, inflammation, and immune function. Cannabinoids such as delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) have been studied extensively for their potential therapeutic effects. Multiple sclerosis (MS) is one neurological disease that has been studied in depth regarding the use of cannabis-based medicinal products. Studies have shown that cannabis-based products can help reduce muscle stiffness and spasticity, which are common symptoms of MS. In 2019, the US Food and Drug Administration (FDA) approved the use of a cannabis-based oral spray called Sativex for the treatment of spasticity in MS. Epilepsy is another neurological disease that has been studied extensively in relation to the use of cannabis-based products. CBD, in particular, has been shown to be effective in reducing the frequency and severity of seizures in some patients with certain types of epilepsy, such as Dravet syndrome and Lennox-Gastaut syndrome. In 2018, the FDA approved the first-ever cannabis-based medication for the treatment of these two types of epilepsy, called Epidiolex. Parkinson’s disease is a neurodegenerative disorder that affects the dopamine-producing neurons in the brain. Studies have shown that cannabis-based products may be helpful in managing some of the symptoms of Parkinson’s disease, such as tremors, rigidity, and sleep problems.

There is limited research on the potential use of CBMPs for the treatment of EUPD. While some studies have suggested that cannabis-based medications may be helpful in managing some symptoms of EUPD, such as anxiety and depression, more research is needed to fully understand their potential benefits and risks.

In a recent study published in the journal Brain Sciences, Dr. Guillermo Moreno-Sanz from Khiron Life Sciences and colleagues reported the use of cannabis as a clinical strategy for managing symptoms associated with EUPD and related illnesses in a case series of seven patients. The researchers have also delved into the possible cellular and molecular mechanisms of action of this treatment and  analyzed the available evidence supporting the use of CBMP as an adjunct therapy for EUPD. This study provides valuable insights into the potential benefits of cannabis in managing the symptoms of EUPD and highlights the need for further research in this field. One potential mechanism by which cannabis-based medications may be helpful in EUPD is through their interaction with the body’s endocannabinoid system. This system plays a role in regulating mood, stress, and anxiety, which are all symptoms commonly associated with EUPD. Cannabinoids such as CBD have been shown to have anti-anxiety and anti-depressant effects, which could be beneficial for individuals with EUPD.

The research team presented a narrative expert review of the literature on the role of the ECS in EUPD and the potential therapeutic effects of CBMPs on EUPD symptoms. The paper also reports a case series of seven patients with EUPD who were treated with CBMPs at two clinics in London-England and Bogotá-Colombia. The ECS is involved in regulating emotional processing and stress response, and its dysfunction may contribute to the development and maintenance of EUPD symptoms. CBMPs, which contain various combinations of cannabinoids such as THC and CBD, may modulate the ECS and have beneficial effects on mood, cognition, pain, inflammation, and immune function. CBMPs may be a novel and promising alternative for the management of EUPD, as they may target multiple symptoms and have fewer side effects than conventional medications. The case series showed that CBMPs were well-tolerated and effective in reducing EUPD symptoms and improving functioning in most patients after just one month of treatment. Further research is needed to ascertain the long-term tolerability, efficacy, and dosing strategy for CBMPs in EUPD.

In summary, the study by Dr. Guillermo Moreno-Sanz and colleagues provides the first clinical evidence of the use of CBMPs for managing patients with EUPD, a disorder that often has limited pharmacological treatment options beyond the off-label use of psychiatric medications. The use of cannabinoids may provide a novel, safe, and effective alternative treatment for EUPD patients. The neuro- and immune-modulatory effects of THC and CBD may align well with the cellular and molecular deficits thought to contribute to the pathogenesis of EUPD. Therefore, further research on this therapeutic strategy is needed. Overall, this study highlights the potential benefits of CBMPs in managing the symptoms of EUPD and recommends more research is needed to fully understand the potential benefits and risks of using cannabis-based products in EUPD management. In a statement to Medicine Innovates Professor Moreno-Sanz said: “This study is a prime example of successful interdisciplinary collaboration and demonstrates how real-world data can provide clinical evidence supporting the efficacy of cannabinoid-based medical products (CBMPs) for treating symptoms of conditions where cannabinoids have not been previously explored. Notably, emerging human research suggests that EUPD may be related with a tonic endocannabinoid deficiency, which has been proposed to underlie other chronic conditions. These findings provide a scientific rationale for the usage of cannabinoid medications and warrant further research into the role of the endocannabinoid system in human emotional processing and personality disorders.”