Can Cannabis Help With Bipolar Disorder?
Jan 26, 2020
Case studies and anecdotal reports suggest that cannabis and its main chemical constituents, THC and CBD, can be helpful for treating bipolar disorder. Still, the studies on treating cannabis for bipolar have had mixed results — with some suggesting cannabis can help but most suggesting cannabis can worsen bipolar symptoms.
In addition, there is evidence that the endocannabinoid system plays a role in bipolar, in that it plays a part in regulating emotions. Since cannabis is able to affect endocannabinoid system activity, this provides some reason to believe that cannabis could impact the progression of bipolar disorder — either improving or aggravating the condition. Still, more rigorous research is needed to fully understand how cannabis can impact bipolar, and whether it can play a helpful role in treatment of the disorder.
How Cannabis Works on Bipolar Disorder
The endocannabinoid system (ECS) exists in all vertebrates and helps regulate crucial functions such as sleep, pain, and appetite. The human body produces its own cannabinoids, which modulate and activate its various functions, but as its name suggests, the endocannabinoid system can also be modulated and activated by cannabinoids found in the cannabis plant. Because the entire system was only discovered in the past 30 years, scientists still have much to learn about the myriad ways cannabis affects the human body.
Interestingly, cannabinoids (some of the active chemicals in cannabis), are also able to activate receptors in the ECS, and thus trigger similar effects. So when something is regulated by the endocannabinoid system, there is a good chance cannabis can impact it.
Some researchers believe that bipolar might be able to be treated by cannabis, in part because of how both are tied to this important system. Since bipolar is a disorder related to emotional regulation, and emotion is partly regulated by the ECS, researchers hypothesize that modulating this system with cannabinoids could be a potential treatment option. Based on what we know about emotional regulation and the ECS, activating particular ECS receptors could help stabilize mood. Other researchers point to different receptors in the ECS, which can help boost positive mood, particularly during depressive episodes.
Medical Studies on Cannabis and Bipolar Disorder
While what we know about how cannabis works with the endocannabinoid system can help give clues about how it might impact bipolar, we really need to look to the human studies on bipolar to learn whether it could be effective. Unfortunately, very little research has been done on treating bipolar disorder with cannabis, but there is a large body of data looking at potential harms. In general, the medical community has concluded that cannabis is not a good option for bipolar because it is causally correlated with higher rates of mania and psychosis. Because of the severity of this risk factor, and the lack of high quality research on using cannabis for bipolar, most doctors advise against using cannabis for this condition.
Still, other researchers point out that cannabis has some pharmacological properties that could be helpful for bipolar if used in the right way, and are similar to those found in approved medications for the disorder. THC, for example, can reduce anxiety, improve mood and help with sleep.
Since cannabis is known to have biphasic effects — meaning it can often cause opposite effects in different doses and contexts — and different cannabinoids produce different effects, it is still possible that cannabis may be helpful for some with bipolar.
And there are a few studies that support this view. Most of the positive evidence that we have suggesting cannabis can help comes from case studies and anecdotal reports.
Doctors have reported experiences with patients who have had big success using cannabis to treat bipolar. Patients have reported it helping with their manic rages, depressive episodes, or both. There are patients who also reported a better outcome with cannabis than conventional medications used to treat bipolar, like lithium. Others have found cannabis very useful to help deal with the side effects of other medications they are on.
These case studies are full of dramatic stories of how well cannabis worked. In one study, a psychiatrist describes a man with difficult to control manic episodes. After trying all kinds of medications unsuccessfully, he went to the man’s home for a home visit. He found him smoking cannabis — and noted that the cannabis seemed to have drastically changed his behavior. He was calm and tranquil, without signs of the manic episode.
In an anecdotal story published online, one woman described how cannabis has aided her in her lifelong struggle with bipolar. “Using cannabis has been extremely effective in treating all aspects of my Bipolar Disorder” she explains. “It alleviates the depression, the dark hole one crawls into and cannot seem to escape, without thoughts of suicidal and homicidal ideation. Cannabis also calms the racing mind and helps to control the impulsivity…”
From this woman’s perspective, cannabis stabilized her life and going off of it for other treatment options severely diminished her quality of life. She shares that “when unable to afford or access cannabis, I tend to decompensate quickly and usually end up being forcibly admitted to lock down psychiatric facilities where numerous pharmaceuticals are pumped into my system, often times without my full consent or even knowledge.”
Still, despite the positive stories of success, the medical research is still conflicted with inconsistent results. Overall, most studies show cannabis seems to be more of a detriment to the condition than a help.
- A two-year observational study of bipolar found that those patients who continued to use cannabis during manic episodes had poorer functioning and higher risk of recurrence than those who never used cannabis or who stopped during the manic episodes.
- A six-day diary-based study found that cannabis use did improve positive mood for those with bipolar disorder, but it also increased manic and depressive symptoms.
An assessment of 133 patients with bipolar disorder found that cannabis use was associated with better neurocognitive function — including better attention, logical thinking and memory.
CBD and Bipolar Disorder
The inconsistencies in the research could be due, in part, to the fact that cannabis is not one single chemical but includes a wide range of different chemical constituents. Different studies may be on different blends of these chemicals — and thus could produce different results.
CBD, for example, is approved by the FDA as an anticonvulsant for certain types of seizures, much like the medications that are generally given for bipolar disorder. It is not generally associated with an increased risk of psychosis or mania. Thus, perhaps CBD as a component of cannabis can be a promising breakthrough therapy for bipolar. THC on the other hand is a more psychotropic component to cannabis, and caution should be used when taking THC if someone has a history of mania or psychosis. Furthermore, CBD can help mitigate some of the more problematic effects of THC.
In addition to the normal range of side effects people experience with cannabis (such as dry mouth, difficulty with concentration and memory, anxiety, nausea, and impaired coordination), those with bipolar may be more likely to experience hypomania, mania and psychosis in response to using high-THC cannabis. Substance abuse in general can also increase risk of suicide for those with bipolar.
In addition, cannabis may interact negatively with certain drugs — slowing their metabolism and thus increasing the amount present in the bloodstream. This has been found for bipolar treatments like clozapine, olanzapine and lithium. Those taking other medications should consult with a doctor before beginning cannabis use.
Some also worry that those with bipolar are particularly susceptible to the addictive properties of cannabis, since their use rates are much higher than the general population. One study showed individuals with bipolar are 6.8 times more likely to report cannabis use, and 29.4% meet the criteria for cannabis use disorder. Still, it is possible that some of these cannabis users are doing so because they’ve noticed cannabis helps with their symptoms — rather than because of addiction. Notably, research suggests that most bipolar sufferers using cannabis do not do so for the ‘high. Still, more research is needed to sort out this question.
Given the causal effect of mania and psychosis, extreme caution should be used when considering cannabis, and specifically THC, for people who may have a history of bipolar, even if it hasn’t been a factor in years. The best thing to do would be to speak to your doctor, preferably one with experience in recommending cannabis before consuming cannabis.
The Cannigma content is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Always consult with an experienced medical professional with a background in cannabis before beginning treatment.
About Bipolar Disorder
Bipolar disorder, formerly known as manic-depressive disorder, is a brain disorder marked by periods of depression and mania.
People who have bipolar disorder experience periods of mania or hypomania, when they feel extremely happy, full of energy and vigor, along with euphoria. They also experience periods of depression, when they feel hopeless, sad, lethargic, and not interested in anything around them. These alternating periods can impact every aspect of life and can be devastating.
Bipolar disorder affects approximately 1% of the global population. Studies have estimated that around 5.7 million adult Americans and 46 million people worldwide suffer from bipolar disorder, with a slightly higher prevalence among women.
People with bipolar disorder can have extreme difficulty living a regular stable life. It’s one of the leading causes of disability given how common it is and how severely it can impact quality of life. Studies show that people with bipolar disorder tend to have a shorter life span. This is partly due to the high suicide rate among people with bipolar disorder, with as many 6% attempting suicide and 30-40% causing self harm. It’s also partly because many people with bipolar disorder also have other conditions like an eating disorder or substance addiction, and they are also at higher risk of medical conditions like heart disease, diabetes, thyroid disease, and migraines.
There is no cure for bipolar disorder, but many people who live with it are able to control their symptoms using the right treatment plan.
Bipolar disorder usually first appears around the age of 25, but recent studies show that teenagers can also have bipolar disorder and that some children who are diagnosed with depression may actually have bipolar disorder.
The main symptoms of bipolar disorder are the periods of mania and depression.
Symptoms of mania and hypomania
Mania and hypomania are two different types of episodes, but they share similar symptoms. Mania is more severe and noticeable than hypomania, but both of them impact interactions at school or at work, relationships, and social life. Symptoms of mania and hypomania include these symptoms:
- Feeling extremely happy, euphoric, and upbeat
- Abnormally energetic, active, and jumpy without needing to sleep as much as usual, as well as extended periods of time without sleeping at all.
- Feeling very self-confident
- Restlessness and easily distracted
- Talking very fast
- Racing thoughts but low ability to concentrate on any one thing
- Impulsive behavior and increased risk-taking
- Drug and alcohol abuse
- Showing poor judgment
- Excessive spending
In extreme cases, mania can also lead to a total break from reality, and require a period of hospitalization.
Symptoms of major depressive episode
To be considered a major depressive episode, the symptoms have to be severe enough to affect your daily activities and cause difficulty in going to school or work, in relationships, or in joining in social activities. Generally, it includes five or more of these symptoms:
- Feeling sad, hopeless, and/or worthless
- Uncontrollable crying
- Losing interest in or pleasure from most activities, including ones which you used to enjoy
- Difficulty concentrating and making decisions
- Sleep issues, either sleeping too much or not sleeping well (insomnia)
- Unintentional weight loss or weight gain
- Lack of energy and lethargy
- Suicidal thoughts, plans, or actions
It’s also possible to have mixed episodes when someone has both manic and depressive symptoms at the same time.
There are 4 main types of bipolar disorder. Bipolar I and II are the most common forms, with the main difference between them being how severe the mania is.
- Bipolar I disorder. This is characterized by at least one manic episode, with or without accompanying depressive episodes.
- Bipolar II disorder. Sufferers experience a less intense mania, known as hypomania, which most often does not require hospitalization. They also experience depressive periods.
- Cyclothymic disorder. This is at least 2 years of multiple periods of depressive and manic symptoms that aren’t severe enough to be diagnosed as depressive or manic episodes.
- Other types of bipolar disorder. These are bipolar symptoms that don’t fit into the 3 categories described above.
When people suffering from episodes of depression and mania also have symptoms of schizophrenia, they may be given a diagnosis of schizoaffective disorder, which is a combination of both conditions.
Complications of Bipolar Disorder
If it goes undiagnosed and untreated, bipolar disorder can lead to severe complications. Many people with untreated bipolar disorder end up abusing drugs and alcohol, and/or making serious poor life choices. There is a high rate of suicide among people with untreated bipolar disorder.
Bipolar disorder is often misdiagnosed as depression because people are more likely to seek help during a depressive episode than a manic one. It can also often be mistaken for other disorders like anxiety disorder, and there’s no simple test to prove or disprove the condition. As a result, diagnosing bipolar disorder is largely a matter of ruling out other possible causes for the reported symptoms.
Often the disease itself will be apparent when symptoms of mania start to present. First-time episodes are often devastating as people can go on spending sprees and empty all their bank accounts and savings. It is not uncommon for manic episodes to lead to hospitalization in a psychiatric facility until the manic period is over. Needless to say, this can have a significantly detrimental effect on every aspect of life including work and family.
The doctor begins by listening carefully to all the symptoms from the sufferer or those around them. They will also conduct a physical examination, and probably order blood tests to check for substance abuse or the effect of other medications, and imaging tests to see if there are any neurological disorder that could be causing the symptoms. Once there is a high suspicion for bipolar disorder, the doctor will probably refer you to a psychiatrist for further workup and management. The psychiatrist will ask about mood and behavior patterns, and may also ask your close family about your symptoms.
The exact cause of bipolar disorder is still unclear and can vary between individuals. There is a strong genetic component and it is thought to be the cause in a majority of sufferers. Specific genes have been associated with bipolar disorder, and people with a first degree relative such as a brother, sister, or parent with the disorder have a 10 fold chance of developing it themselves.
Environmental factors play a role to a smaller extent than genetics but may play a significant role in how the disease affects individuals. About half of bipolar sufferers report traumatic experiences during childhood and have much higher rates of PTSD than the general population.
More rarely, certain neurological conditions or injury can also lead to bipolar disorder.
When scientists look at imaging of the brain, those suffering from bipolar disorder may have structural changes, most often seen in the parts of the brain responsible for emotion and fear, along with regulation of mood.
Bipolar disorder is a lifelong illness that never goes away entirely. There is no cure for the disease. However, the right treatment can significantly manage the disease and reduce its impact on quality of life.
Effective treatment for bipolar disorder usually includes a combination of medication and therapy to treat symptoms of mania and depression along with helping to prevent episodes of mania. It’s important to keep up with the treatment plan even in between episodes when you’re feeling fine, because skipping maintenance treatment increases the risk of an even more severe relapse.
Medication usually includes mood stabilizers, antipsychotics, and antidepressants. These medications are sometimes used individually, or multiple therapies are used in combination.
- Mood stabilizers like lithium, valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol) and lamotrigine (Lamictal) are the mainstay of treatment in bipolar disease. They work by reducing neuronal activity in the brain and, besides, lithium, are also used to control epilepsy and seizure disorders.
- Next-generation antipsychotics are often used if mood stabilizers haven’t worked to control manic episodes. They include olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris).
- Antidepressants are prescribed to manage depressive episodes. Because reducing depressive episodes can often trigger manic episodes, antidepressants are used carefully, and are often prescribed together with a mood stabilizer or antipsychotic medication.
- Symbyax combines both an antidepressant (fluoxetine) and an antipsychotic (olanzapine) in one drug, so it’s often prescribed instead of a combination of antidepressant and antipsychotic.
People with bipolar disorder might also be prescribed anti-anxiety medication to help with anxiety disorders, sleep medication to help establish a regular sleep rhythm, and other medication to address other secondary disorders.
These medications all have their own host of side effects and adverse reactions.
- Psychotherapy may be helpful for people with bipolar disorder and is a common form of therapy administered.
- Interpersonal and social rhythm therapy (IPSRT) guides people to set up a consistent routine of meals, exercise, and sleep, which can help reduce bipolar episodes.
- Cognitive-behavioral therapy (CBT) can help people identify the triggers for their manic and depressive episodes, and learn how to manage stress in a healthier way.
- Electroconvulsive therapy (ECT) is carried out under general anaesthesia. Electrodes are attached to their scalp and used to send small electric current to the brain. It’s usually only used if medication and other therapeutic treatments are not effective.