Bipolar disorder is a mental health condition characterized by extreme mood swings, including manic episodes of high energy and depressive episodes of low mood. Managing these symptoms is crucial for individuals to lead stable and fulfilling lives. Standard treatments include mood stabilizers, antipsychotic medications, and psychotherapy.
Recently, medical cannabis has gained attention as a possible tool for addressing symptoms of various conditions, including mental health disorders. However, understanding the safety and utility of medical cannabis for Bipolar illness is essential.
What is Medical Cannabis?
Medical cannabis refers to the use of cannabis and its compounds for therapeutic purposes. The cannabis plant contains many active substances known as cannabinoids. One of the most studied cannabinoids is tetrahydrocannabinol (THC), which is responsible for many of the benefits of cannabis, including pain control, improved sleep, and better appetite. THC has side effects, as do all medications, in particular the psychoactive effects—or the “high”—of cannabis.
Potential Benefits of Medical Cannabis for Mental Health
1. Depression and Anxiety Relief
Research on cannabis for Generalized Anxiety Disorder (GAD) and for unipolar Depression has shown benefit to these conditions with careful dosing and timing. Despite anxiety being a common feature in Bipolar disease, particularly during depressive episodes, no evidence supports benefit to anxiety or depression in Bipolar patients.
2. Improved Sleep
Sleep disturbances, such as insomnia, are prevalent among individuals with Bipolar disorder. Medical cannabis has been noted for its sedative properties which may help people fall asleep and stay asleep more easily. Improved sleep can contribute to better overall mental health and stability. However, there are no data to support these observations in Bipolar disease.
Risks and Concerns of Medical Cannabis Use in Bipolar Disorder
Bipolar diseases are unique and different from GAD and unipolar depression. As such the risks associated with cannabis use are greater and less well understood.
1. Triggering Manic Episodes
A significant concern with using cannabis in individuals with Bipolar disorder is its potential to trigger or worsen manic episodes. THC may trigger manic episodes and during such an episode can have stimulating effects that may exacerbate symptoms of mania, including impulsivity, racing thoughts, or heightened irritability.
2. Transforming Mania into Psychosis
There is a substantial body of research among Schizophrenic patients implicating cannabis use in the development of psychotic features. Whether the cannabis use is causal or reactive is unclear. However, among Bipolar patients there appears to be substantial risk of stimulating mania to transform into psychosis.
3. Substance Misuse and Dependence
Cannabis has the potential for misuse, especially in individuals who may already be prone to substance use disorders. During manic episodes, when impulsivity and risk-taking behaviors are heightened, individuals with Bipolar disorder may overuse cannabis, leading to dependence and/or Cannabis Use Disorder (addiction).
Scientific Evidence and Research Gaps
Current research primarily focuses on the effects of cannabis on anxiety (GAD), unipolar depression with less attention being given to its specific impact on Bipolar disorder.
Studies to date highlight the risks of worsening mania or depression. These findings underscore the need for more controlled studies to clarify the potential benefits and risks.
Are There Any Use Cases for Bipolar Disease at Present?
Generally, it is clear that the risks of cannabis use in active Bipolar patients outweigh any potential benefit. Put another way, Bipolar patients generally should not use cannabis.
Are there any circumstances in which cannabis could be used for Bipolar patients? Not to treat their Bipolar illness. However, Bipolar patients, like everyone else, get other illnesses for which cannabis would, ordinarily, be a treatment option. For example, chronic pain due to arthritis.
In a Bipolar patient who has an unrelated chronic condition like arthritis pain, the safety of using medical cannabis depends on the severity, frequency, and recentness of their manic episodes. In someone who had a single manic event in their 20s, none since, and is now in their 70s with back pain, their risk of recurrent mania is likely different from a 20 year old who just got out of the psychiatric hospital in the past few months.
Recommendations for Use
In general, patients with active Bipolar disease should not use cannabis either medically or recreationally. For individuals with distant or stable Bipolar disease who may be considering medical cannabis as a treatment for other chronic illness, careful planning, follow-up, and ongoing professional guidance are essential. Below are some recommendations:
1. Consult a Healthcare Professional
See a knowledgeable Cannabinoid Specialist who has experience with the risks and benefits of cannabis treatment in general, and with specific experience with caring for Bipolar patients.
2. Monitor Outcomes Closely
Your Cannabinoid Specialist should follow you closely – in fact, more closely than other patients. Further, they should maintain contact with your psychiatrist and/or therapist. All of these care-team members should be keeping an eye out for worsening of your Bipolar illness and should be free to connect with each other should there be any signs of deterioration.
Of course, if you perceive any changes to your mental health, you should report this to your care-team immediately.
3. Follow Your Doctor’s Orders
The risk from cannabis is dose-dependent. Higher doses pose more risk. Your Cannabinoid Specialist should give you clear and specific instructions about what to take, when, and how much. Do not deviate from this unless told to by your care-team. Be especially careful not to listen to advice from buddies or dispensary employees.
4. Do Not Use Cannabis Recreationally
Recreational approaches to cannabis use and recreationally-oriented cannabis products, especially those with high THC levels, are more likely to worsen symptoms of Bipolar disorder. It is important to use cannabis specifically for medical purposes in strict accordance with your Cannabinoid Specialist’s directions and follow a structured treatment plan.
Medical cannabis may offer potential benefits for managing certain chronic conditions, such as anxiety, sleep disturbances, and pain. However, in Bipolar patients cannabis also poses significant risks, including the potential to trigger manic episodes, transform mania into psychosis, and lead to substance misuse.
Individuals with Bipolar disorder should generally avoid cannabis use, although for very stable patients with extensive supervision and strict regimen adherence, it may be safe and effective.