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marijuana for bipolar

Can Marijuana Help Your Bipolar Disorder?

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Deux / The Image Bank / Getty Images

Award-winning mental health journalist and author, John McManamy, wrote a thoughtful blog about the implications of medical marijuana as a treatment for bipolar. It’s reasonable to think that the risks outweigh any possible benefits, but the topic is certainly worth discussing.

Since both bipolar depression and mania can have psychotic features, there is some evidence that even medical marijuana use might have negative effects in people with bipolar disorder.  

Studies Show Links to Worse Outcomes

Medical research shows that cannabis use in people with psychosis is associated with an earlier age of their first psychotic episode. It’s also associated with manic symptoms and problems thinking.  

In one study, patients who quit using marijuana or reduced its use following their first psychotic episode had the greatest improvement in symptoms at the one-year mark, compared both to continuing cannabis users and people who had never used cannabis.   Long-term cannabis use may have a negative effect on long-term clinical outcomes for those with bipolar spectrum disorders, as well.

A 2015 study found lower bipolar disorder remission rates for current regular cannabis users (those who used it three times a week or more often) and those who regularly smoke tobacco when compared to people who don’t use either substance. That study, which lasted two years, concluded that regular marijuana users who also have bipolar didn’t do as well long-term as people who didn’t use the drug.  

Another study looked at the short-term effects of cannabis use in people with bipolar disorder and concluded that the drug was associated with both manic and depressive symptoms. However, that study couldn’t find evidence that people with bipolar were using cannabis to self-medicate on a regular basis.  

Now, none of these studies prove that cannabis is actually causing these problems in people with bipolar—they just show an association between marijuana use and problems. But you should factor this information into your thinking when deciding whether or not to use cannabis.

Substance Abuse Risk With Marijuana

All drugs have risks and side effects, and cannabis is no exception.

Substance abuse can be quite prevalent among those with bipolar disorder. People have used alcohol and drugs to try to control their systems in great numbers and may reduce their likelihood of successful treatment of their bipolar as a result.

By using marijuana to self-medicate for bipolar disorder, you run the risk of gaining a second diagnosis in addition to your bipolar diagnosis: substance abuse (Substance use disorder).

There's some interest in using marijuana to treat symptoms of bipolar disorder but the risks may outweigh any benefits.

Marijuana for bipolar

on April 20, 2020

In the past few years, cannabis has been legalized in Canada and much of the United States. Its use and legality continue to be an open subject of debate worldwide. In North America, increasing media buzz has questioned how marijuana might support mental health. CBD oil, most notably, has been touted as a treatment for chronic pain, anxiety, and depression – and early research seems to support this (1,2) . But what does the research show about bipolar disorder and cannabis?

From the experts: answers from our Reddit AMA

At our annual World Bipolar Day AMA (ask me anything), our experts on bipolar disorder responded to these three questions about cannabis and bipolar disorder. Read along to learn what the data shows so far.

Erin here – the short answer is no, the research in this area is not yet strong enough to be conclusive. But you could say that about a lot of mental health/psychiatric research!

I actually had an email convo with Dr. Rebecca Haines-Saah about this not long ago

Rebecca is a Health Sociologist working in public health research, with particular expertise in public health and harm reduction approaches to substance use. (As an interesting aside, she was also a teen TV star in the Canadian TV series Degrassi Junior High).

I learnt from her that past versions the guidelines have stated that’s best to avoid cannabis if you have a risk for, or family history of mental illness. This new version is updated to be specific to psychosis, chiefly. This is because this is one area where there is general consensus that there is a clear and robust relationship between use and onset. But she also noted that fierce debate continues about the direction and nature of this relationship (i.e. correlation or causal, chicken or egg). Specific to BD she to pointed me to this high-level review evidence from the National Academies of Sciences, Engineering, and Medicine review:

So, I’d say the jury is still (mostly) out. Clinically, I know people with BD who smoke pot regularly and are doing just fine, and I’ve worked with other people for whom it’s pure poison.

Regarding psychedelics and BD – I’m not aware of any studies (expect perhaps for a few case reports) that have looked specifically at BD and psychedelic use, as a treatment or otherwise. This is hugely interesting area of research though, and one that might/should see real traction in coming years – watch this space. I’ll open this question out to the CREST.BD team and see if there are additional comments on this point…

Erin here. I’m going to lean on the expertise of Dr. Rebecca Haines-Saah here, who’s one of the people I respect the most working in the Canadian cannabis/mental health/public health arena. She has said to me previously “Specific to bipolar disorders I would look at this high-level review evidence from the NAM review”

Previously the guidelines have stated that it is best to avoid cannabis if you have a risk for, or family history of mental illness. This new version is updated to be specific to psychosis, chiefly. This is because this is one area where there is general consensus that there is a clear and robust relationship between use and onset – but there is however much fierce debate about the direction and nature of this relationship (i.e. correlation or causal).

This is a fast-moving and controversial area of research and public health policy though – I’ll be interested to hear whether other members of our CREST.BD team have insights to offer. I’ll also drop Rebecca a message to see if she wants to weigh in further on this question.

Erin again. Dr. Haines-Saah weighed in further by email noting that:

“Specific to bipolar, there is some evidence to suggest that heavy cannabis use puts people at greater risk for suicide. But again, not causal or a trigger of the illness as the person asks. I have had this question from patients with BD interested in medical use for other reasons, so I always advise to consult with their MD because it would be something to watch closely in terms of mood”

She’s referring I believe to this study (note again: weak data currently): https://www.ncbi.nlm.nih.gov/pubmed/31121199

Victoria here – Great question! I live with bipolar disorder, anxiety and psychosis. I can’t cite exact studies – I’ll let my colleagues do that. But from what I know smoking pot can make you more vulnerable to bipolar disorder if you have a family history of it. My opinion is that it’s not worth the risk – especially if you have a history of psychosis.

For myself – I don’t and can’t smoke it. The few times I did, I went into mild to moderate psychoses. It is something I know increases the chances of triggering a mood swing or psychosis for me. I stay away from it.

The takeaway

At present, it looks like more research is required to truly assess the effects of cannabis in people with bipolar disorder. Sorry! That said, early research does suggest that marijuana can increase risk of suicidality and psychosis. So, if you have bipolar disorder, have a family member with bipolar disorder, or have experienced psychosis, it’s advisable to be very careful about using cannabis. If you do want to try it, work with a doctor if at all possible, and be sure to monitor your mood carefully.

Thanks for reading along. This is a fast-growing area of research – hopefully we’ll have more to report in the next couple of years!

Upcoming Free Webinar: Substance Use, Bipolar Disorder, and COVID-19

You’re invited to attend our next #TalkBD online gathering on April 30th at 7pm British time (11am PDT, 2pm Eastern). Dr. Steven Jones from the University of Lancaster will be joining this session, to share information about substance use during times of crisis. If you have a question about substances and bipolar disorder that you’d like Dr. Jones and our other presenters to weigh in on, you can submit it using the form at talkbd.live. Hope to see you there!

Finally, in a few days, we’ll also be releasing a blog with some of the top questions from our AMA. In the meantime, check out the full AMA on Reddit!

References
1. de Mello Schier AR, de Oliveira Ribeiro NP, Coutinho DS, Machado S, Arias-Carrión O, Crippa JA, Zuardi AW, Nardi AE, Silva AC. Antidepressant-like and anxiolytic-like effects of cannabidiol: a chemical compound of Cannabis sativa. CNS Neurol Disord Drug Targets 2014;13(6):953–960. PMID:24923339
2. Laczkovics C, Kothgassner OD, Felnhofer A, Klier CM. Cannabidiol treatment in an adolescent with multiple substance abuse, social anxiety and depression. Neuropsychiatr 2020 Feb 12; PMID:32052321
3. Bartoli F, Crocamo C, Carrà G. Cannabis use disorder and suicide attempts in bipolar disorder: A meta-analysis. Neurosci Biobehav Rev 2019;103:14–20. PMID:31121199

Evidence about bipolar disorder and cannabis is limited. What do researchers know so far? Read answers from the experts in our blog!