Andrew Farah - Academia.edu (original) (raw)
Papers by Andrew Farah
Traditionally, patients who are considered treatment-resistant, or who present with more severe s... more Traditionally, patients who are considered treatment-resistant, or who present with more severe symptoms, are often considered for clozapine therapy. The combination of clozapine with another SGA, Oran FGA, is also commonly utilized for such severe cases, and may be considered standard-of-care given the prevalence of these strategies. The following case report involves a chronically symptomatic schizophrenic who developed NMS on a combination of long acting injectable aripiprazole and clozapine. A review of the literature regarding clozapine associated NMS in combination with other agents vs. monotherapy indicates that, at least based on case reports, it is possible that combination clozapine-aripiprazole therapy may convey a higher risk of NMS than either agent as monotherapy.
Current psychiatry, 2021
All letters are subject to editing. High-dose lumateperone: A case report Lumateperone is a novel... more All letters are subject to editing. High-dose lumateperone: A case report Lumateperone is a novel antipsychotic that possesses a variety of unique receptor affinities. The recommended dose of lumateperone is 42 mg/d. In clinical trials, reductions in Positive and Negative Syndrome Scale scores observed with lumateperone, 28 mg/d and 84 mg/d, failed to separate from placebo. 1 However, in these trials, safety profiles were similar for all 3 doses. Despite the popular understanding of lumateperone's "unexplained narrow therapeutic window," 2 we report the case of a patient with schizophrenia who responded well to lumateperone, 84 mg/d, without adverse effects or EKG changes. Case report. Mr. W, age 26, has treatment-resistant schizophrenia (paranoid type). He failed to achieve remission on fluphenazine (10 to 25 mg/d), perphenazine (4 to 24 mg/d), risperidone (started at 4 mg/d and increased
Major depressive disorder (MDD) is a debilitating illness affecting 7% to 12% of men and 20% to 2... more Major depressive disorder (MDD) is a debilitating illness affecting 7% to 12% of men and 20% to 25% of women.1,2 It is usually a recurrent illness, with up to 30% of patients experiencing a depressive episode lasting over 2 years.3 Depression may also increase the morbidity and mortality of numerous medical conditions, such as cardiac disease, myocardial infarction, chronic pain, diabetes, cerebrovascular events, and respiratory illnesses.4-11 The goal of antidepressant therapy is to achieve full remission and functional recovery, and continuing treatment beyond the acute phase is usually necessary to maintain remission. In contrast with full remission, individuals who experience residual symptoms, however mild, have a higher chance of experiencing one or more additional episodes. An initial antidepressant trial is effective at achieving remission for ~30% of patients when prescribed as monotherapy, with the majority of patients returning as either partial or non-responders.12 Switc...
Pediatric depression remains a treatment challenge, not only because of its increasing prevalence... more Pediatric depression remains a treatment challenge, not only because of its increasing prevalence over the past year, but the “black box warning,” which elaborates the possibility of suicidal thoughts or behaviors associated with antidepressant use in younger patients. We report a case series of pediatric patients, the majority of whom achieved remission of their depressive illnesses utilizing B vitamin-based coenzymes as monotherapy, and some of whom required an antidepressant medication added to daily coenzymes as adjunctive therapy. No patient reported side effects, and none reported an increase in suicidal thoughts utilizing B-vitamin-based, coenzyme therapy. The authors believe further study is needed to explore this safe treatment option for some of our most vulnerable patients.
What are the therapeutic advantages of escitalopram, the purified S-enantiomer of the racemate ci... more What are the therapeutic advantages of escitalopram, the purified S-enantiomer of the racemate citalopram? The biological activity and therapeutic effects of citalopram, which has been used for over a decade to effectively treat depression and other psychiatric disorders, have been shown to reside exclusively in escitalopram. Escitalopram has been shown in vitro to be more than twice as potent as citalopram in the inhibition of serotonin uptake. It is the most selective agent in its class, with virtually no affinity for other neurotransmitters. The efficacy of escitalopram in the treatment of depression has been demonstrated in several clinical trials. Sustained improvement in symptoms of depression was first seen at 1–2 weeks, and continuing improvement and effective prevention of depressive relapse were observed during long-term studies. Further, escitalopram has also been shown to be an effective treatment for anxiety disorders such as panic disorder, generalized anxiety disorder...
In this podcast, B. Andrew Farah, MD, looks at shortcomings of current therapy that make treatmen... more In this podcast, B. Andrew Farah, MD, looks at shortcomings of current therapy that make treatment-resistant depression so common, offers insights into the genetic underpinnings of TRD, and focuses on a new treatment paradigm.
Schizophrenia Research, 2020
Journal of Addiction and Therapies, 2018
Studies of genetic polymorphisms associated with the diseases of opiate dependency and abuse have... more Studies of genetic polymorphisms associated with the diseases of opiate dependency and abuse have focused primarily on genes related to dopamine and opioid receptors, neurotrophic factors, or the catechol-o-methyltransferase (COMT) gene [1,2]. Despite the high prevalence of methylene tetrahydrofolate reductase (MTHFR) polymorphisms in numerous neuropsychiatric and neurodegenerative diseases, only one prior study examined the prevalence of MTHFR C677T variants in opiate dependency [3]. We screened consecutively admitted patients who were dependent on heroin and/or other opiates, for C677T and A1298C polymorphisms. Over a six-month period, 86 of 96, or 90% of subjects, were positive for at least one of these MTHFR variants. The mean age of all qualifying patients was 31.6 years, and majority of subjects, 68%, were female. The MTHFR distribution was fairly even; of the 86 patients who were MTHFR positive, 28% were heterozygous for only C677T (CT:AA), 11% were homozygous for only C677T (TT:AA), 22% were heterozygous for only A1298C (CC:AC), 13% were homozygous for only A1298C (CC:CC), while 26% were heterozygous for both mutations (CT:AC). We theorize that impaired methylation, and the inadequate monoamine synthesis that result from MTHFR variants, likely contribute to the illness of opiate use disorder. These vulnerable individuals are incapable of adequate monoamine balance, and may seek opiates as compensation. These findings may further imply a new treatment option, in the form of fully metabolized folate. This therapy would circumvent the less functional MTHFR enzymes expressed by the C677T and A1298C mutations, and therefore allow for more optimal monoamine synthesis.
Hemingway's Brain, 2017
Detailed biography of the aging author’s mental decline by a forensic psychiatrist. Farah draws o... more Detailed biography of the aging author’s mental decline by a forensic psychiatrist. Farah draws on letters, family history, memoirs, biographies, and FBI files to conclude that multiple factors led to Hemingway’s permanent dementia, including genetic influences, alcohol abuse, and the cumulative effect of traumatic brain injuries. Comments on the numerous head traumas Hemingway sustained from his World War I wounding to the African plane crashes and discusses his writings, particularly A Moveable Feast, considering his progressive illness. Concludes by summing up the various treatment options available to Hemingway at the time and today had his condition been properly diagnosed. Includes notes, critical bibliography, and index
CNS Spectrums, 2009
Major depressive disorder (MDD) is a debilitating illness affecting 7% to 12% of men and 20% to 2... more Major depressive disorder (MDD) is a debilitating illness affecting 7% to 12% of men and 20% to 25% of women. It is usually a recurrent illness, with up to 30% of patients experiencing a depressive episode lasting over 2 years. Depression may also increase the morbidity and mortality of numerous medical conditions, such as cardiac disease, myocardial infarction, chronic pain, diabetes, cerebrovascular events, and respiratory illnesses. The goal of antidepressant therapy is to achieve full remission and functional recovery, and continuing treatment beyond the acute phase is usually necessary to maintain remission. In contrast with full remission, individuals who experience residual symptoms, however mild, have a higher chance of experiencing one or more additional episodes.
Psychiatric Annals, 2017
Despite the high prevalence of traumatic brain injury, and the subsequent occurrence of neuropsyc... more Despite the high prevalence of traumatic brain injury, and the subsequent occurrence of neuropsychiatric sequelae, our evidence-based treatment strategies are thus far confined to physical therapy and rehabilitation medicine. Further, there are no standardized medication or natural-based recommendations for patients with postconcussion syndrome (PCS). Yet, clinicians are often presented with patients who have PCS seeking relief and who are anxious about their futures. Prescription-based treatment has traditionally limited to attempts at symptomatic relief, yet at least 20% of PCS patients will have persistent symptoms for more than 6 months, and a subset will face indefinite issues. Thus, clinicians should also be aware of neuroprotective strategies aimed at reducing the risk of prolonged deficits and future dementias as the result of multiple concussive injuries. Treatment of PCS should involve not only symptomatic relief, but also neuroprotective strategies, and both modalities sh...
Psychiatric Annals, 2015
Over the past 100 years, theories regarding the etiology of major depression have appeared as the... more Over the past 100 years, theories regarding the etiology of major depression have appeared as the proverbial blind man’s interpretation of the elephant. It is now possible to discuss depression in terms of neuroendocrine dysregulation, differences in neuroanatomy, inflammatory response, a gene-environment interaction, or in purely psychological terms—and without any contradiction in the evidence. Indeed, a disorder as complex and variable as depression is expected to have multiple risk factors and etiologic influences. Yet, all roads eventually lead to a functional shortage of monoamines, and the monoamine hypothesis remains the basis of treatment for millions of patients. Elevated homocysteine (HCY) has long been recognized as a risk factor for major depressive disorder (MDD), and many neurologic and psychiatric conditions; however, a full understanding of HCY metabolism and monoamine synthesis indicates that perhaps HCY elevation in the central nervous system is the driving force ...
The Journal of Clinical Psychiatry, 2016
Objective: This study was designed to evaluate the efficacy and safety of reduced B vitamins as m... more Objective: This study was designed to evaluate the efficacy and safety of reduced B vitamins as monotherapy in adults with major depressive disorder (MDD) who were also positive for at least 1 methylenetetrahydrofolate reductase (MTHFR) polymorphism associated with depression and further test the hypothesis that reduced (metabolized) B vitamins will lower homocysteine in a majority of clinically responding patients. Methods: 330 adult patients with MDD (DSM-5) and positive for either MTHFR C677T or A1298C polymorphism were enrolled in a trial conducted between August 1, 2014, and April 3, 2015. 160 patients received placebo, while 170 received a capsule containing a combination of reduced B vitamins. Plasma homocysteine levels were measured at baseline and week 8. The Montgomery-Asberg Depression Rating Scale (MADRS) was used to evaluate efficacy for MDD. Results: 159 of 170 vitamin-treated patients and 123 of 160 placebo-treated patients were completers. Of the active treatment group, 131 (82.4%) showed a reduction in homocysteine (for a mean in this subgroup of 25%, P < .001), while 28 (17.6%) showed no significant change. Placebo patients demonstrated a small elevation in homocysteine. Active-treatment patients demonstrated, on average, a 12-point reduction on the MADRS by week 8, and 42% achieved full remission (P < .001). No side effect was significantly different between groups. No patients experienced mania. Conclusions: A combination of reduced B vitamins and micronutrients, when used in the treatment of MDD in patients with MTHFR polymorphism, resulted in a separation from placebo by week 2, and 42% of the treatment arm achieved remission by week 8. Further, clinical improvement correlated with a significant reduction in homocysteine levels in a majority of responders. These results support the homocysteine theory of depression and the safety and therapeutic benefit of reduced B vitamins as monotherapy for MDD, particularly in patients with MTHFR polymorphism. Trial registration: ClinicalTrials.gov identifier: NCT02709668
Journal of Addiction Research & Therapy, 2017
The recent trend towards legalization and commercialization of marijuana in the US has resulted i... more The recent trend towards legalization and commercialization of marijuana in the US has resulted in a significant drop in the perceived risks of cannabis use among all age groups. Thus, legalization has further advances the common misperception that cannabis abuse and dependence are generally safe and devoid of neuropsychiatric sequelae. Yet there are numerous acute, as well as numerous long-term neuropsychiatric consequences of cannabis use. In addition to acute psychosis and agitation, this review will discuss the long-term issues of cognitive decline, permanent psychotic disorders, syndromes of prolonged depersonalization, as well as psychological and physical dependence, and related withdrawal symptoms. Cannabis use, particularly repeated exposure, is an established contributory cause of schizophrenia by way of a classic gene-environment interaction, with the vulnerabilities associated with cannabis-induced schizophrenia involving multiple genes. There is also evidence that in utero cannabinoid exposure will impair brain maturation in developing infants and predispose them to neurodevelopmental disorders during childhood. This summary will inform clinicians of the most prevalent consequences associated with cannabis abuse and dependence, and better equip them to educate patients as to these risks. Further, there are treatments that may help patients achieve abstinence, and even neuroprotective strategies to employ in cases of new-onset cannabisinduced psychosis, as well as for cases of in utero exposure.
Traditionally, patients who are considered treatment-resistant, or who present with more severe s... more Traditionally, patients who are considered treatment-resistant, or who present with more severe symptoms, are often considered for clozapine therapy. The combination of clozapine with another SGA, Oran FGA, is also commonly utilized for such severe cases, and may be considered standard-of-care given the prevalence of these strategies. The following case report involves a chronically symptomatic schizophrenic who developed NMS on a combination of long acting injectable aripiprazole and clozapine. A review of the literature regarding clozapine associated NMS in combination with other agents vs. monotherapy indicates that, at least based on case reports, it is possible that combination clozapine-aripiprazole therapy may convey a higher risk of NMS than either agent as monotherapy.
Current psychiatry, 2021
All letters are subject to editing. High-dose lumateperone: A case report Lumateperone is a novel... more All letters are subject to editing. High-dose lumateperone: A case report Lumateperone is a novel antipsychotic that possesses a variety of unique receptor affinities. The recommended dose of lumateperone is 42 mg/d. In clinical trials, reductions in Positive and Negative Syndrome Scale scores observed with lumateperone, 28 mg/d and 84 mg/d, failed to separate from placebo. 1 However, in these trials, safety profiles were similar for all 3 doses. Despite the popular understanding of lumateperone's "unexplained narrow therapeutic window," 2 we report the case of a patient with schizophrenia who responded well to lumateperone, 84 mg/d, without adverse effects or EKG changes. Case report. Mr. W, age 26, has treatment-resistant schizophrenia (paranoid type). He failed to achieve remission on fluphenazine (10 to 25 mg/d), perphenazine (4 to 24 mg/d), risperidone (started at 4 mg/d and increased
Major depressive disorder (MDD) is a debilitating illness affecting 7% to 12% of men and 20% to 2... more Major depressive disorder (MDD) is a debilitating illness affecting 7% to 12% of men and 20% to 25% of women.1,2 It is usually a recurrent illness, with up to 30% of patients experiencing a depressive episode lasting over 2 years.3 Depression may also increase the morbidity and mortality of numerous medical conditions, such as cardiac disease, myocardial infarction, chronic pain, diabetes, cerebrovascular events, and respiratory illnesses.4-11 The goal of antidepressant therapy is to achieve full remission and functional recovery, and continuing treatment beyond the acute phase is usually necessary to maintain remission. In contrast with full remission, individuals who experience residual symptoms, however mild, have a higher chance of experiencing one or more additional episodes. An initial antidepressant trial is effective at achieving remission for ~30% of patients when prescribed as monotherapy, with the majority of patients returning as either partial or non-responders.12 Switc...
Pediatric depression remains a treatment challenge, not only because of its increasing prevalence... more Pediatric depression remains a treatment challenge, not only because of its increasing prevalence over the past year, but the “black box warning,” which elaborates the possibility of suicidal thoughts or behaviors associated with antidepressant use in younger patients. We report a case series of pediatric patients, the majority of whom achieved remission of their depressive illnesses utilizing B vitamin-based coenzymes as monotherapy, and some of whom required an antidepressant medication added to daily coenzymes as adjunctive therapy. No patient reported side effects, and none reported an increase in suicidal thoughts utilizing B-vitamin-based, coenzyme therapy. The authors believe further study is needed to explore this safe treatment option for some of our most vulnerable patients.
What are the therapeutic advantages of escitalopram, the purified S-enantiomer of the racemate ci... more What are the therapeutic advantages of escitalopram, the purified S-enantiomer of the racemate citalopram? The biological activity and therapeutic effects of citalopram, which has been used for over a decade to effectively treat depression and other psychiatric disorders, have been shown to reside exclusively in escitalopram. Escitalopram has been shown in vitro to be more than twice as potent as citalopram in the inhibition of serotonin uptake. It is the most selective agent in its class, with virtually no affinity for other neurotransmitters. The efficacy of escitalopram in the treatment of depression has been demonstrated in several clinical trials. Sustained improvement in symptoms of depression was first seen at 1–2 weeks, and continuing improvement and effective prevention of depressive relapse were observed during long-term studies. Further, escitalopram has also been shown to be an effective treatment for anxiety disorders such as panic disorder, generalized anxiety disorder...
In this podcast, B. Andrew Farah, MD, looks at shortcomings of current therapy that make treatmen... more In this podcast, B. Andrew Farah, MD, looks at shortcomings of current therapy that make treatment-resistant depression so common, offers insights into the genetic underpinnings of TRD, and focuses on a new treatment paradigm.
Schizophrenia Research, 2020
Journal of Addiction and Therapies, 2018
Studies of genetic polymorphisms associated with the diseases of opiate dependency and abuse have... more Studies of genetic polymorphisms associated with the diseases of opiate dependency and abuse have focused primarily on genes related to dopamine and opioid receptors, neurotrophic factors, or the catechol-o-methyltransferase (COMT) gene [1,2]. Despite the high prevalence of methylene tetrahydrofolate reductase (MTHFR) polymorphisms in numerous neuropsychiatric and neurodegenerative diseases, only one prior study examined the prevalence of MTHFR C677T variants in opiate dependency [3]. We screened consecutively admitted patients who were dependent on heroin and/or other opiates, for C677T and A1298C polymorphisms. Over a six-month period, 86 of 96, or 90% of subjects, were positive for at least one of these MTHFR variants. The mean age of all qualifying patients was 31.6 years, and majority of subjects, 68%, were female. The MTHFR distribution was fairly even; of the 86 patients who were MTHFR positive, 28% were heterozygous for only C677T (CT:AA), 11% were homozygous for only C677T (TT:AA), 22% were heterozygous for only A1298C (CC:AC), 13% were homozygous for only A1298C (CC:CC), while 26% were heterozygous for both mutations (CT:AC). We theorize that impaired methylation, and the inadequate monoamine synthesis that result from MTHFR variants, likely contribute to the illness of opiate use disorder. These vulnerable individuals are incapable of adequate monoamine balance, and may seek opiates as compensation. These findings may further imply a new treatment option, in the form of fully metabolized folate. This therapy would circumvent the less functional MTHFR enzymes expressed by the C677T and A1298C mutations, and therefore allow for more optimal monoamine synthesis.
Hemingway's Brain, 2017
Detailed biography of the aging author’s mental decline by a forensic psychiatrist. Farah draws o... more Detailed biography of the aging author’s mental decline by a forensic psychiatrist. Farah draws on letters, family history, memoirs, biographies, and FBI files to conclude that multiple factors led to Hemingway’s permanent dementia, including genetic influences, alcohol abuse, and the cumulative effect of traumatic brain injuries. Comments on the numerous head traumas Hemingway sustained from his World War I wounding to the African plane crashes and discusses his writings, particularly A Moveable Feast, considering his progressive illness. Concludes by summing up the various treatment options available to Hemingway at the time and today had his condition been properly diagnosed. Includes notes, critical bibliography, and index
CNS Spectrums, 2009
Major depressive disorder (MDD) is a debilitating illness affecting 7% to 12% of men and 20% to 2... more Major depressive disorder (MDD) is a debilitating illness affecting 7% to 12% of men and 20% to 25% of women. It is usually a recurrent illness, with up to 30% of patients experiencing a depressive episode lasting over 2 years. Depression may also increase the morbidity and mortality of numerous medical conditions, such as cardiac disease, myocardial infarction, chronic pain, diabetes, cerebrovascular events, and respiratory illnesses. The goal of antidepressant therapy is to achieve full remission and functional recovery, and continuing treatment beyond the acute phase is usually necessary to maintain remission. In contrast with full remission, individuals who experience residual symptoms, however mild, have a higher chance of experiencing one or more additional episodes.
Psychiatric Annals, 2017
Despite the high prevalence of traumatic brain injury, and the subsequent occurrence of neuropsyc... more Despite the high prevalence of traumatic brain injury, and the subsequent occurrence of neuropsychiatric sequelae, our evidence-based treatment strategies are thus far confined to physical therapy and rehabilitation medicine. Further, there are no standardized medication or natural-based recommendations for patients with postconcussion syndrome (PCS). Yet, clinicians are often presented with patients who have PCS seeking relief and who are anxious about their futures. Prescription-based treatment has traditionally limited to attempts at symptomatic relief, yet at least 20% of PCS patients will have persistent symptoms for more than 6 months, and a subset will face indefinite issues. Thus, clinicians should also be aware of neuroprotective strategies aimed at reducing the risk of prolonged deficits and future dementias as the result of multiple concussive injuries. Treatment of PCS should involve not only symptomatic relief, but also neuroprotective strategies, and both modalities sh...
Psychiatric Annals, 2015
Over the past 100 years, theories regarding the etiology of major depression have appeared as the... more Over the past 100 years, theories regarding the etiology of major depression have appeared as the proverbial blind man’s interpretation of the elephant. It is now possible to discuss depression in terms of neuroendocrine dysregulation, differences in neuroanatomy, inflammatory response, a gene-environment interaction, or in purely psychological terms—and without any contradiction in the evidence. Indeed, a disorder as complex and variable as depression is expected to have multiple risk factors and etiologic influences. Yet, all roads eventually lead to a functional shortage of monoamines, and the monoamine hypothesis remains the basis of treatment for millions of patients. Elevated homocysteine (HCY) has long been recognized as a risk factor for major depressive disorder (MDD), and many neurologic and psychiatric conditions; however, a full understanding of HCY metabolism and monoamine synthesis indicates that perhaps HCY elevation in the central nervous system is the driving force ...
The Journal of Clinical Psychiatry, 2016
Objective: This study was designed to evaluate the efficacy and safety of reduced B vitamins as m... more Objective: This study was designed to evaluate the efficacy and safety of reduced B vitamins as monotherapy in adults with major depressive disorder (MDD) who were also positive for at least 1 methylenetetrahydrofolate reductase (MTHFR) polymorphism associated with depression and further test the hypothesis that reduced (metabolized) B vitamins will lower homocysteine in a majority of clinically responding patients. Methods: 330 adult patients with MDD (DSM-5) and positive for either MTHFR C677T or A1298C polymorphism were enrolled in a trial conducted between August 1, 2014, and April 3, 2015. 160 patients received placebo, while 170 received a capsule containing a combination of reduced B vitamins. Plasma homocysteine levels were measured at baseline and week 8. The Montgomery-Asberg Depression Rating Scale (MADRS) was used to evaluate efficacy for MDD. Results: 159 of 170 vitamin-treated patients and 123 of 160 placebo-treated patients were completers. Of the active treatment group, 131 (82.4%) showed a reduction in homocysteine (for a mean in this subgroup of 25%, P < .001), while 28 (17.6%) showed no significant change. Placebo patients demonstrated a small elevation in homocysteine. Active-treatment patients demonstrated, on average, a 12-point reduction on the MADRS by week 8, and 42% achieved full remission (P < .001). No side effect was significantly different between groups. No patients experienced mania. Conclusions: A combination of reduced B vitamins and micronutrients, when used in the treatment of MDD in patients with MTHFR polymorphism, resulted in a separation from placebo by week 2, and 42% of the treatment arm achieved remission by week 8. Further, clinical improvement correlated with a significant reduction in homocysteine levels in a majority of responders. These results support the homocysteine theory of depression and the safety and therapeutic benefit of reduced B vitamins as monotherapy for MDD, particularly in patients with MTHFR polymorphism. Trial registration: ClinicalTrials.gov identifier: NCT02709668
Journal of Addiction Research & Therapy, 2017
The recent trend towards legalization and commercialization of marijuana in the US has resulted i... more The recent trend towards legalization and commercialization of marijuana in the US has resulted in a significant drop in the perceived risks of cannabis use among all age groups. Thus, legalization has further advances the common misperception that cannabis abuse and dependence are generally safe and devoid of neuropsychiatric sequelae. Yet there are numerous acute, as well as numerous long-term neuropsychiatric consequences of cannabis use. In addition to acute psychosis and agitation, this review will discuss the long-term issues of cognitive decline, permanent psychotic disorders, syndromes of prolonged depersonalization, as well as psychological and physical dependence, and related withdrawal symptoms. Cannabis use, particularly repeated exposure, is an established contributory cause of schizophrenia by way of a classic gene-environment interaction, with the vulnerabilities associated with cannabis-induced schizophrenia involving multiple genes. There is also evidence that in utero cannabinoid exposure will impair brain maturation in developing infants and predispose them to neurodevelopmental disorders during childhood. This summary will inform clinicians of the most prevalent consequences associated with cannabis abuse and dependence, and better equip them to educate patients as to these risks. Further, there are treatments that may help patients achieve abstinence, and even neuroprotective strategies to employ in cases of new-onset cannabisinduced psychosis, as well as for cases of in utero exposure.