Skip to main content

Advertisement

SpringerLink
Log in

Treatment studies with cannabinoids in anorexia nervosa: a systematic review

  • Review
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Introduction

Anorexia nervosa (AN) is a psychiatric disorder with a high mortality and unknown etiology, and effective treatment is lacking. For decades, cannabis has been known to cause physical effects on the human body, including increasing appetite, which may be beneficial in the treatment of AN.

Objective

To systematically review the literature for evidence of an effect of cannabinoids on (1) weight gain, and (2) other outcomes, in AN.

Method

A systematic review was done using three databases Embase, PubMed and Psychinfo. The review was registered in PROSPERO with ID number CRD42019141293 and was done according to PRISMA guidelines.

Results

There were 1288 studies identified and after thorough review and exclusion of copies, 4 studies met the inclusion criteria. Three studies used the same AN population and utilized data from one original study, leaving only two original studies. Both of these were Randomized Controlled Trials that explored the effects of delta-9-tetrahydrocannabinol (Δ9-THC) or dronabinol in AN, whereof one study was properly designed and powered and showed a weight increase of an added 1 kg over 4 weeks over placebo.

Discussion and conclusion

There are few studies and the level of evidence is low. The only properly designed, low bias and highly powered study found a weight increasing effect of dronabinol in AN, while the other, using Δ9-THC at a high dose, found no effect and where the dose may have counteracted the weight gaining effects due to adverse events. More research on cannabinoids in anorexia nervosa is warranted, especially its effects on psychopathology.

Level of evidence

Level I, systematic review.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. A Solvay Pharmaceuticals IC, Marietta G (2004) MARINOL®. https://www.accessdata.fda.gov/drugsatfda_docs/label/2005/018651s021lbl.pdf. Accessed 1 Nov 2019

  2. Adams R, Baker BR, Wearn RB (1940) Structure of cannabinol. III. synthesis of cannabinol, 1-hydroxy-3-n-amyl-6,6,9-trimethyl-6-dibenzopyran1. J Am Chem Soc 62(8):2204–2207. https://doi.org/10.1021/ja01865a083

    Article  CAS  Google Scholar 

  3. Andries A, Frystyk J, Flyvbjerg A, Stoving RK (2014) Dronabinol in severe, enduring anorexia nervosa: a randomized controlled trial. Int J Eat Disord 47(1):18–23. https://doi.org/10.1002/eat.22173

    Article  PubMed  Google Scholar 

  4. Andries A, Frystyk J, Flyvbjerg A, Stoving RK (2015) Changes in IGF-I, urinary free cortisol and adipokines during dronabinol therapy in anorexia nervosa: results from a randomised, controlled trial. Growth Horm IGF Res 25(5):247–252. https://doi.org/10.1016/j.ghir.2015.07.006

    Article  CAS  PubMed  Google Scholar 

  5. Andries A, Gram B, Stoving RK (2015) Effect of dronabinol therapy on physical activity in anorexia nervosa: a randomised, controlled trial. Eat Weight Disord 20(1):13–21. https://doi.org/10.1007/s40519-014-0132-5

    Article  PubMed  Google Scholar 

  6. Avraham Y, Latzer Y, Hasid D, Berry EM (2017) The impact of Delta9-THC on the psychological symptoms of anorexia nervosa: a pilot Study. Isr J Psychiatry Relat Sci 54(3):44–51. https://cdn.doctorsonly.co.il/2018/05/08_The-Impact-of.pdf

  7. Banister SD, Arnold JC, Connor M, Glass M, McGregor IS (2019) Dark classics in chemical neuroscience: DELTA9-tetrahydrocannabinol. https://doi.org/10.1021/acschemneuro.8b00651

  8. Begg DP, Woods SC (2013) The endocrinology of food intake. Nat Rev Endocrinol 9(10):584–597. https://doi.org/10.1038/nrendo.2013.136

    Article  CAS  PubMed  Google Scholar 

  9. Cristino L, Becker T, Di Marzo V (2014) Endocannabinoids and energy homeostasis: an update. BioFactors 40(4):389–397. https://doi.org/10.1002/biof.1168

    Article  CAS  PubMed  Google Scholar 

  10. Gaoni Y, Mechoulam R (1964) Isolation, structure, and partial synthesis of an active constituent of Hashish. J Am Chem Soc 86(8):1646–1647. https://doi.org/10.1021/ja01062a046

    Article  CAS  Google Scholar 

  11. Gross H, Ebert MH, Faden VB, Goldberg SC, Kaye WH, Caine ED et al (1983) A double-blind trial of delta 9-tetrahydrocannabinol in primary anorexia nervosa. J Clin Psychopharmacol 3(3):165–171. https://doi.org/10.1097/00004714-198306000-00004

    Article  CAS  PubMed  Google Scholar 

  12. Hao S, Avraham Y, Mechoulam R, Berry EM (2000) Low dose anandamide affects food intake, cognitive function, neurotransmitter and corticosterone levels in diet-restricted mice. Eur J Pharmacol 392(3):147–156. https://doi.org/10.1016/S0014-2999(00)00059-5

    Article  CAS  PubMed  Google Scholar 

  13. Hoch E, Niemann D, von Keller R, Schneider M, Friemel CM, Preuss UW et al (2019) How effective and safe is medical cannabis as a treatment of mental disorders? A systematic review. Eur Arch Psychiatry Clin Neurosci 269(1):87–105. https://doi.org/10.1007/s00406-019-00984-4

    Article  PubMed  PubMed Central  Google Scholar 

  14. Howlett A, Barth F, Bonner T, Cabral G, Casellas P, Devane W et al (2002) International Union of Pharmacology. XXVII. Classification of cannabinoid receptors. Pharmacol Rev 54(2):161-202. https://doi.org/10.1124/pr.54.2.161

  15. Howlett A, Barth F, Bonner T, Cabral G, Casellas P, Devane W et al (2002) International union of pharmacology. XXVII. Classification of cannabinoid receptors. Pharmacol Rev 54(2):161–202. https://doi.org/10.1124/pr.54.2.161

    Article  CAS  PubMed  Google Scholar 

  16. MacDonald E, Adams A (2019) CADTH rapid response reports. In the use of medical cannabis with other medications: a review of safety and guidelines—an update. Canadian Agency for Drugs and Technologies in Health, Ottawa. https://www.ncbi.nlm.nih.gov/books/NBK549545/

    Google Scholar 

  17. Matsuda LA, Lolait SJ, Brownstein MJ, Young AC, Bonner TI (1990) Structure of a cannabinoid receptor and functional expression of the cloned cDNA. Nature 346(6284):561. https://doi.org/10.1038/346561a0

    Article  CAS  PubMed  Google Scholar 

  18. Mechoulam R (2019) The pharmacohistory of cannabis sativa, pp 1–20. https://doi.org/10.1201/9780429260667-1

  19. Mechoulam R, Ben-Shabat S, Hanus L, Ligumsky M, Kaminski NE, Schatz AR et al (1995) Identification of an endogenous 2-monoglyceride, present in canine gut, that binds to cannabinoid receptors. Biochem Pharmacol 50(1):83–90. https://doi.org/10.1016/0006-2952(95)00109-d

    Article  CAS  PubMed  Google Scholar 

  20. Mechoulam R, Shvo Y (1963) Hashish—I: the structure of cannabidiol. Tetrahedron 19(12):2073–2078. https://doi.org/10.1016/0040-4020(63)85022-X

    Article  CAS  PubMed  Google Scholar 

  21. Monteleone P, Matias I, Martiadis V, De Petrocellis L, Maj M, Di Marzo V (2005) Blood levels of the endocannabinoid anandamide are increased in anorexia nervosa and in binge-eating disorder, but not in bulimia nervosa. Neuropsychopharmacology 30(6):1216–1221. https://doi.org/10.1038/sj.npp.1300695

    Article  CAS  PubMed  Google Scholar 

  22. Munro S, Thomas KL, Abu-Shaar M (1993) Molecular characterization of a peripheral receptor for cannabinoids. Nature 365(6441):61. https://doi.org/10.1038/365061a0

    Article  CAS  PubMed  Google Scholar 

  23. Nelson K, Walsh D, Deeter P, Sheehan F (1994) A phase II study of delta-9-tetrahydrocannabinol for appetite stimulation in cancer-associated anorexia. J Palliat Care 10(1):14–18. https://doi.org/10.1177/082585979401000105

    Article  CAS  PubMed  Google Scholar 

  24. Pertwee RG (2015) Endocannabinoids and their pharmacological actions. In: Pertwee RG (ed) Endocannabinoids. Springer, Cham, pp 1–37. https://doi.org/10.1007/978-3-319-20825-1_1

    Chapter  Google Scholar 

  25. Phillips B, Ball C, Sackett D, Badenoch D, Straus S, Haynes B, Dawes M (1998, 2009). Oxford Centre for Evidence-based Medicine—levels of Evidence (March 2009). https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. Accessed 31 Jan 2019

  26. Steinhausen HC (2009) Outcome of eating disorders. Child Adolesc Psychiatr Clin N Am 18(1):225–242. https://doi.org/10.1016/j.chc.2008.07.013

    Article  PubMed  Google Scholar 

  27. Sugiura T, Kondo S, Sukagawa A, Nakane S, Shinoda A, Itoh K et al (1995) 2-Arachidonoylglycerol: a possible endogenous cannabinoid receptor ligand in brain. Biochem Biophys Res Commun 215(1):89–97. https://doi.org/10.1006/bbrc.1995.2437

    Article  CAS  PubMed  Google Scholar 

  28. Treasure J (2019) Feighner’s diagnostic criteria. Personal Communication

  29. William AD, Lumir H, Aviva B, Roger GP, Lesley AS, Graeme G et al (1992) Isolation and structure of a brain constituent that binds to. Science 258(5090):1946. https://doi.org/10.1126/science.1470919

    Article  Google Scholar 

Download references

Acknowledgements

We acknowledge our support from Mental Health Center Ballerup and Mental Health Services in the Capital Region of Denmark. We are thankful for the support from Emilie Jensen in preparing a figure for the manuscript.

Author information

Authors and Affiliations

  1. Mental Health Center Ballerup, Copenhagen University, Institute for Clinical Medicine, Maglevaenget 32, 2750, Ballerup, Denmark

    Emilie Vangsgaard Rosager, Christian Møller & Magnus Sjögren

Authors
  1. Emilie Vangsgaard Rosager
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christian Møller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Magnus Sjögren
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Magnus Sjögren.

Ethics declarations

Conflict of interest

All the authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

This article does not contain any studies performed by any of the authors involving human participants or animals.

Informed consent

For this type of study, formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 19 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rosager, E.V., Møller, C. & Sjögren, M. Treatment studies with cannabinoids in anorexia nervosa: a systematic review. Eat Weight Disord 26, 407–415 (2021). https://doi.org/10.1007/s40519-020-00891-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-020-00891-x

Keywords

Search

Navigation