Abstract Objective: This review discusses the relationship between cannabis use and psychotic, bipolar, depressive, and anxiety disorders, as well as suicide. It summarizes epidemiological evidence from cross-sectional and long-term prospective studies and considers possible etiological mechanisms. Methods: Systematic reviews and methodologically robust studies in the field (from inception to February 2019) were identified using a comprehensive search of Medline, PsychINFO, and Embase and summarized using a narrative synthesis. Results: Consistent evidence, both from observational and experimental studies, has confirmed the important role of cannabis use in the initiation and persistence of psychotic disorders. The size of the effect is related to the extent of cannabis use, with greater risk for early cannabis use and use of high-potency varieties and synthetic cannabinoids. Accumulating evidence suggests that frequent cannabis use also increases the risk for mania as well as for suicide. However, the effect on depression is less clear and findings on anxiety are contradictory with only a few methodologically robust studies. Furthermore, the relationship with common mental disorders may involve reverse causality, as depression and anxiety are reported to lead to greater cannabis consumption in some studies. Pathogenetic mechanisms focus on the effect of tetrahydrocannabinol (THC, the main psychoactive ingredient of cannabis) interacting with genetic predisposition and perhaps other environmental risk factors. Cannabidiol (CBD), the other important ingredient of traditional cannabis, ameliorates the psychotogenic effects of THC but is absent from the high-potency varieties that are increasingly available. Conclusions: The evidence that heavy use of high-THC/low-CBD types of cannabis increases the risk of psychosis is sufficiently strong to merit public health education. Evidence of similar but smaller effects in mania and suicide is growing, but is not convincing for depression and anxiety. There is much current interest in the possibility that CBD may be therapeutically useful.

中文翻译：

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大麻的使用与精神病和情感障碍的风险

摘要 目的：本综述讨论了大麻使用与精神病、双相情感障碍、抑郁症和焦虑症以及自杀之间的关系。它总结了横断面和长期前瞻性研究的流行病学证据，并考虑了可能的病因机制。方法：使用对 Medline、PsychINFO 和 Embase 的全面搜索确定了该领域的系统评价和方法论上稳健的研究（从开始到 2019 年 2 月），并使用叙述性综合进行总结。结果：来自观察性和实验性研究的一致证据证实了大麻的使用在精神障碍的发生和持续中的重要作用。效果的大小与使用大麻的程度有关，早期使用大麻和使用高效品种和合成大麻素的风险更大。越来越多的证据表明，频繁使用大麻还会增加躁狂症和自杀的风险。然而，对抑郁症的影响还不太清楚，而且关于焦虑的研究结果与只有少数方法论稳健的研究相矛盾。此外，与常见精神障碍的关系可能涉及反向因果关系，因为据报道，在某些研究中，抑郁和焦虑会导致大麻消费量增加。发病机制侧重于四氢大麻酚（THC，大麻的主要精神活性成分）与遗传易感性和其他环境风险因素相互作用的影响。大麻二酚 (CBD)，传统大麻的另一个重要成分，改善 THC 的精神作用，但在越来越多的高效品种中不存在。结论：大量使用高 THC/低 CBD 类型的大麻会增加精神病风险的证据足够强大，值得进行公共卫生教育。越来越多的证据表明，躁狂症和自杀有类似但较小的影响，但对于抑郁症和焦虑症却没有说服力。目前人们对 CBD 可能在治疗上有用的可能性非常感兴趣。但对抑郁和焦虑没有说服力。目前人们对 CBD 可能在治疗上有用的可能性非常感兴趣。但对抑郁和焦虑没有说服力。目前人们对 CBD 可能在治疗上有用的可能性非常感兴趣。