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His history revealed compulsive online gaming (approximately 10\u2009hours\/day) and chronic cannabis use, and urine toxicology was positive for cannabis. He was treated with antipsychotics and antidepressants, a short course of benzodiazepines, psychoeducation and family work, with plans for cannabis abstinence and gaming restriction. Psychotic symptoms and suicidality remitted over 4\u2009weeks. At follow-up, up to 3\u2009months, clinical stability was maintained, urine toxicology was negative for cannabis and symptom measures improved. This case illustrates a clinically important temporal and phenomenological association between severe depression, problematic gaming, cannabis use and psychotic decompensation while emphasising that causality cannot be inferred from a single case.<\/jats:p>","DOI":"10.1136\/bcr-2026-272917","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T14:20:11Z","timestamp":1784730011000},"page":"e272917","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Psychotic depression with suicidality in the context of internet gaming disorder and chronic cannabis use"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9810-5057","authenticated-orcid":false,"given":"Mirela","family":"\u0106eli\u0107 Ru\u017ei\u0107","sequence":"first","affiliation":[{"name":"Jankomir Psychiatric Hospital, Zagreb, City of Zagreb, Croatia"},{"name":"Josip Juraj Strossmayer University of Osijek, Osijek, Osijek-Baranja County, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Rossini Gaj\u0161ak","sequence":"additional","affiliation":[{"name":"Department of Integrative Psychiatry, Jankomir Psychiatric Hospital, Zagreb, City of Zagreb, Croatia"},{"name":"Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Osijek-Baranja County, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darjan","family":"Svetinovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Integrative Psychiatry, Jankomir Psychiatric Hospital, Zagreb, City of Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marijana","family":"Knezovi\u0107 Florijan","sequence":"additional","affiliation":[{"name":"Jankomir Psychiatric Hospital, Zagreb, City of Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"2026072207200822000_19.7.e272917.1","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-025-07576-8","article-title":"Gaming disorder in the ICD-11: the state of the game","volume":"25","author":"Musetti","year":"2025","journal-title":"BMC Psychiatry"},{"key":"2026072207200822000_19.7.e272917.2","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association . 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