Bonnet Udo, Preuss Ulrich W
Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Castrop-Rauxel.
Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen.
Subst Abuse Rehabil. 2017 Apr 27;8:9-37. doi: 10.2147/SAR.S109576. eCollection 2017.
The cannabis withdrawal syndrome (CWS) is a criterion of cannabis use disorders (CUDs) () and cannabis dependence (International Classification of Diseases [ICD]-10). Several lines of evidence from animal and human studies indicate that cessation from long-term and regular cannabis use precipitates a specific withdrawal syndrome with mainly mood and behavioral symptoms of light to moderate intensity, which can usually be treated in an outpatient setting. Regular cannabis intake is related to a desensitization and downregulation of human brain cannabinoid 1 (CB1) receptors. This starts to reverse within the first 2 days of abstinence and the receptors return to normal functioning within 4 weeks of abstinence, which could constitute a neurobiological time frame for the duration of CWS, not taking into account cellular and synaptic long-term neuroplasticity elicited by long-term cannabis use before cessation, for example, being possibly responsible for cannabis craving. The CWS severity is dependent on the amount of cannabis used pre-cessation, gender, and heritable and several environmental factors. Therefore, naturalistic severity of CWS highly varies. Women reported a stronger CWS than men including physical symptoms, such as nausea and stomach pain. Comorbidity with mental or somatic disorders, severe CUD, and low social functioning may require an inpatient treatment (preferably qualified detox) and post-acute rehabilitation. There are promising results with gabapentin and delta-9-tetrahydrocannabinol analogs in the treatment of CWS. Mirtazapine can be beneficial to treat CWS insomnia. According to small studies, venlafaxine can worsen the CWS, whereas other antidepressants, atomoxetine, lithium, buspirone, and divalproex had no relevant effect. Certainly, further research is required with respect to the impact of the CWS treatment setting on long-term CUD prognosis and with respect to psychopharmacological or behavioral approaches, such as aerobic exercise therapy or psychoeducation, in the treatment of CWS. The up-to-date ICD-11 Beta Draft is recommended to be expanded by physical CWS symptoms, the specification of CWS intensity and duration as well as gender effects.
大麻戒断综合征（CWS）是大麻使用障碍（CUDs）（）和大麻依赖（《国际疾病分类》[ICD]-10）的一项标准。来自动物和人体研究的多项证据表明，长期且规律使用大麻后停止使用会引发一种特定的戒断综合征，主要表现为轻度至中度的情绪和行为症状，通常可在门诊环境中进行治疗。规律摄入大麻与人类大脑大麻素1（CB1）受体的脱敏和下调有关。这种情况在禁欲的头2天内开始逆转，受体在禁欲4周内恢复正常功能，这可能构成CWS持续时间的神经生物学时间框架，但未考虑停止使用大麻前长期使用大麻所引发的细胞和突触长期神经可塑性，例如，这可能是导致大麻渴望的原因。CWS的严重程度取决于戒断前使用的大麻量、性别、遗传因素以及多种环境因素。因此，CWS的自然严重程度差异很大。女性报告的CWS比男性更严重，包括恶心和胃痛等身体症状。合并精神或躯体疾病、严重的CUD以及社会功能低下可能需要住院治疗（最好是有资质的戒毒治疗）和急性后期康复。加巴喷丁和δ-9-四氢大麻酚类似物在治疗CWS方面有令人鼓舞的结果。米氮平有助于治疗CWS失眠。根据小型研究，文拉法辛会使CWS恶化，而其他抗抑郁药、托莫西汀、锂盐、丁螺环酮和丙戊酸二钠没有相关影响。当然，关于CWS治疗环境对长期CUD预后的影响以及关于精神药理学或行为方法，如有氧运动疗法或心理教育，在治疗CWS方面的影响，还需要进一步研究。建议在最新的ICD-11 Beta草案中增加CWS的身体症状、CWS强度和持续时间的具体说明以及性别影响。
