Abstracts

Rationale: Depression is the most frequent psychiatric comorbidity in epilepsy.It may mimic primary depressive disorders and may present as an overall disturbance in mood. Cannabidiol (CBD) has shown promise as a potential antiepileptic drug (AED). It has been also utilized anecdotally for the treatment of a wide range of non-psychiatric (e.g. pain) and psychiatric (e.g. anxiety, depression, and psychosis) disorders. As part of the open-label expanded access program in patients with medically refractory epilepsy, we also aimed to evaluate the effect of CBD on epilepsy comorbidities, depression and mood problems by observing the changes in POMS (Profile of Mood States) over course of treatment with pharmaceutical grade CBD (Epidiolex). Methods: In all adults participating in the study (19 ?" 62 years, mean 29 years), we collected POMS data every visit over the course of treatment and analyzed the POMS scores at 3 months and 6 months, respectively. Changes in the time weighted average value (TWV) of POMS total score and six subscale score TWV-POMS (anger, confusion, depression, fatigue, tension and vigor) were analyzed by paired t-test, Wilcoxon signed rank sum test and Wilcoxon Rank-Sum Test. Results: Up to date, 39 adults entered the study. Of those, 31 and 26 were included in the analysis of POMS scores at 3 months and 6 months, respectively (remaining patients were in the study less than 3 months and their data were not included). The patients' POMS total score TWV and all except "vigor" subscale score TWV (anger, confusion, depression, fatigue and tension) at 3 and 6 months were significantly decreased (p < 0.05; lower is better) after the treatment of CBD. No significant change in vigor score TWV at 3 and at 6 months was found (higher is better). No significant differences in the change in the POMS total score TWV and six subscale score TWV at 3 and at 6 months were found between those patients who experienced a decrease in >50% of their seizure frequency at baseline compared to those with <=50% decrease. Conclusions: In this expanded access program pharmaceutical grade CBD use was associated with an improvement of mood as documented by 5/6 POMS subscales after 3 months and 6 months of treatment. This effect is independent of the extent of seizure reduction. Thus, CBD may have overall positive effects on mood which should be further investigated in patients with epilepsy as well as other chronic conditions in controlled studies. Funding: State of Alabama