Cannabis Use in Bipolar Disorder Presents a Treatment Challenge
Among patients with bipolar disorder, cannabis is the most commonly abused drug. Lifetime use of cannabis among bipolar patients is estimated to be around 70%, and 30% present a comorbidity of cannabis abuse or dependence. The risk for psychotic disorders increases with the frequency and intensity of cannabis use. Researchers have found that cannabis use is also associated with a younger age at onset of first manic episode, increased manic and depressive episodes, increased risk of rapid cycling, poorer outcome, and poorer treatment compliance. 1
These findings illuminate the challenges in treating patients with bipolar disorder who use cannabis, especially as an increasing number of US states legalize marijuana. Self-medication with cannabis was recently found to be 3.73 percentage points higher among those living in states with medical marijuana laws. 2 Although further investigations are needed to clarify the relationship between mania onset and cannabis use, researchers say they are “undeniably correlated.” 1
Psychiatry Advisor spoke with Girish Subramanyan, MD, a psychiatrist in full-time private practice in San Francisco, California, specializing in the treatment of adults with mood and anxiety disorders, including treatment-resistant mood and anxiety disorders.
Psychiatry Advisor: Does cannabis use present any challenges in treating patients with bipolar disorder? If so, what are the challenges and how do they affect treatment?
Dr Girish Subramanyan: Yes. It can complicate the management of bipolar disorder by virtue of causing mood instability and psychosis in certain patients with bipolar disorder. Cannabis is a known psychotogenic drug for some people, although the majority of people who use it do not develop psychosis. But, among those that do, there seems to be a higher risk for conversion to schizophrenia and bipolar disorders, unfortunately. Moreover, it’s not uncommon for me to see patients with bipolar disorder relapse into mania with recent cannabis use. Observational studies have demonstrated a correlation between cannabis use and hypomanic and manic relapse in bipolar disorder.
Psychiatry Advisor: Are there distinct challenges or effects of cannabis use in patients with bipolar I vs bipolar II?
Dr Subramanyan: Yes. The possibility of cannabis contributing to manic relapse in bipolar I disorder makes it potentially more dangerous in bipolar I disorders. Manias have the potential to cause devastating consequences in the lives of patients and their families. Plus, there is a real possibility that cannabis can contribute to psychotic manic episodes. This risk is probably lower in individuals with bipolar II disorder, but it is possible, I suppose, that someone with a true diagnosis of bipolar II disorder could have a cannabis-induced manic episode with psychotic features, something that may never have occurred spontaneously for this individual.
In bipolar II disorder, you may end up seeing more mood instability, mixed states, and hypomanic episodes, and although these states are uncomfortable, and even dangerous, if they are accompanied by suicidal ideations, they generally don’t do as much damage as full-blown manic episodes.
Psychiatry Advisor: Has the legalization of recreational marijuana use in California had any noticeable effect on your treatment of bipolar disorder?
Dr Subramanyan: Surprisingly, I don’t think I’ve seen much in the way of increased incidence of mania or psychosis in my practice since the legalization of recreational marijuana in California. What I have noticed, however, is that more and more patients in my practice are using some kind of cannabinoid for a variety of reasons: treatment of anxiety, treatment of pain, treatment of insomnia, etc. Patients seem to be using cannabidiol (CBD) products, in particular, more frequently. CBD is interesting in that it seems to have opposite effects in the brain as does THC. There is a thought that it could actually have antipsychotic function.
Psychiatry Advisor spoke with customers of Southwest Patient Group, a San Diego marijuana dispensary.
Amanda Hasten: I was diagnosed with dipolar disorder at age 12. I always knew I was different because, one minute I’d be happy, [the] next minute I was crying, and then it all became too much and I ended up trying to commit suicide at 14. I was prescribed all kinds of medication, but nothing seemed to work. At the age of 16 years, I began smoking marijuana and my life was changed. No longer do I have these constant mood changes, and my mind doesn’t run a mile a minute with dread and fear. I have a medical marijuana card now as an adult, and I am grateful to the marijuana industry for saving my life.
Nicholas G.: I have been struggling with and managing my manic and depressive episodes since 2004. I experience a lesser form of mania called hypomania, which means that although I may not experience grandiosity or psychosis like those with a bipolar 1 diagnosis, my behaviors are impulsive and have lasting consequences. This has cost me educational and professional opportunities, relationships, and even a bankruptcy. When I am on my prescribed meds I am able to reduce the frequency and severity of my manic and depressive episodes, but they will never completely go away.
I began using cannabis as a senior in high school. I increased my cannabis use as an undergrad when, unbeknownst to me, I began using cannabis to self-medicate. I had never seen a psychiatrist and knew little about mental health, but I did notice that smoking indica-heavy cannabis helped me sleep better and was one of the only methods I had ever discovered that slows my manic thoughts to a manageable level (which is why I stay far away from anything sativa, as that accelerates my thinking and makes things much worse). I used cannabis to stimulate my appetite when depression and anxiety made it too difficult to eat, and as a common activity with friends to help maintain a supportive network of friends. I stopped using cannabis completely for 6 years after I was initially diagnosed and stabilized on psychotropic medication. Unfortunately, once…I lost my insurance and was no longer able to afford to see my psychiatrist or pay for my medications…I turned back to cannabis to help manage my symptoms. The psychotropic medications are essential for me to maintain stable mental [health], but cannabis helps make things a little softer and more manageable.
Is CBD Oil Good for Bipolar Disorder?
Treating bipolar disorder, mania, and depression associated with it continues to challenge patients and doctors alike — many people with bipolar depression experience difficult-to-treat, recurring manic-depressive episodes.
You may be wondering if CBD could provide much-needed relief for you or a loved one’s symptoms. We will dive into the topic within this article.
In early 2016, a blogger wrote about his son’s struggle to find an effective treatment for bipolar disorder. After four years of almost yearly hospitalization, cannabis was the only option that seemed to be helpful.
“From my first breath, I could see the momentary improvement of mood,” Father wrote. But curiously, he also thought his son’s smoking habits of the “street pot” increased his psychosis, even causing manic episodes.
How can the same plant shake and alleviate the symptoms of his child?
The boy’s father claimed to find the key to effective treatment. When looking into this further, he determined that the chemical composition of the cannabis strain he used contained large amounts of cannabidiol (CBD).
Can CBD Help Alleviate Bipolar Disorder Symptoms?
Whether or not CBD is helpful in alleviating Bipolar Disorder Symptoms remains a contested subject.
An investigation into the association between cannabis and bipolar disorder has led to some conflicting results. Some studies claim that using cannabis improves cognitive function and that patients feel that the effects are better than conventional drugs for treating their symptoms.
However, other studies suggest that it may increase depressive symptoms or that continued cannabis use is associated with a higher incidence of manic episodes. There is also a risk of drug dependence and drug abuse. Research has shown that people with bipolar disorder have a 6.8 times higher chance of using marijuana illegally than the rest of the population.
There is numerous evidence suggesting that CBD has the same antipsychotic and anticonvulsant properties as conventional bipolar disorder treatments. Also, it appears that the chemical composition of strain you use is crucial.
The balance between the two most notable compounds within cannabis seems to be the critical component of effective treatment. Strains with higher CBD over THC seem more effective than others.
What Is Bipolar Disorder?
Bipolar disorder (BD), also known as manic depression, is a mental health problem that results in extreme mood swings, including acute (mania or hypomania) and minimal (depressive) emotional disturbances.
When you are depressed, you may feel sad or hopeless and lose interest or enjoyment for most activities. When your mood becomes manic or hypomanic (less extreme than manic), you may feel euphoric, full of energy, or unusually irritable. BD can affect sleep, energy, activity, behavior, and ability to think clearly.
Mood swings may occur infrequently or a few times a year. Although most people experience emotional symptoms between episodes, some may not feel it.
Although bipolar disorder is a chronic disease, you can control your mood swings and other symptoms following the treatment plan your doctor prescribes. In most cases, therapists treat bipolar disorder with drugs and psychological counseling (psychotherapy).
What Causes Bipolar Disorder?
The exact causes of bipolar disorder are difficult to pinpoint, but several factors may be involved, such as:
- Biological Differences: It seems that people with bipolar disorder have physical changes in the brain. The importance of these changes is still uncertain but can help identify causes.
- Genetics Bipolar disorder: Hereditary symptoms are common in people with first-degree relatives, such as a brother or sister, or a father with that illness. Researchers are attempting to locate the genes involved with the suspected causes of bipolar disorder.
People who struggle with bipolar disorder appear to also struggle with addiction and substance dependence.
A study by the Epidemiologic Catchment Area found that 46% of patients with bipolar disorder also had a history of alcohol dependence, while 41% had a history of other substance abuse and addiction .
Treatment Options for Bipolar Disorder Symptoms
If you experience symptoms of depression or mania, contact your doctor or mental health professional. Bipolar disorder does not improve alone. Being treated by mental health professionals with bipolar disorder experience can help you manage your symptoms.
While CBD is not a cure for any disease, it has been shown to help with symptoms you may be experiencing. If you want relief and think CBD may be a solution for you, be sure to check out Mana Artisan Botanics™
A variety of drugs are used to treat bipolar disorder. The types and doses of prescription drugs depend on your specific symptoms.
Medications may include:
- Mood stabilizers like lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal)
- Antipsychotics like olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help.
- Anti-anxiety medications
Depending on your needs, other treatments may help treat your symptoms.
During electroconvulsive therapy (ECT), electrical currents go through the brain, deliberately causing a short seizure. ECT seems to cause changes in brain chemistry that may reverse the symptoms of some mental illness.
Bipolar therapy may be a treatment option if symptoms do not improve with medication. It may also help if you cannot take antidepressants for health reasons such as pregnancy or if it presents a high risk of suicide.
Transcranial Magnetic Stimulation (SMT) is an option for those who do not respond favorably to antidepressants.
Cannabidiol inhibits serotonin reuptake in rats, suggesting that it improves abnormalities of CB1 receptors that inhibit release to mice. If CBD works the same way in the human brain, this could be an alternative to conventional antidepressants, especially in people with refractory BD.
How CBD Can Treat Bipolar Disorder Symptoms
There are many types of bipolar symptoms and related disorders, which include mania or hypomania and depression. Symptoms can cause unpredictable mood swings and behavior, causing significant difficulties in life.
- Bipolar Disorder I: You have had at least one manic episode that can precede or follow great hypnosis or depression episodes. In some cases, mania can cause interruptions with reality (psychosis).
- Bipolar Disorder II: You had at least one severe depression episode and at least one episode of hypomania, but you never had a manic episode.
- Cyclothymic Disorder: Symptoms appear for a longer-term (1-2 years)in children and adolescents. There are frequent periods of hypomanic and depressive symptoms (though less severe than depression).
- Other Types: This includes, for example, bipolar and related disorders induced by certain drugs or alcohol or due to a pathological condition such as Cushing’s disease, or multiple sclerosis.
CBD rarely causes side effects. However, conventional methods of treating and using cannabis derivatives as a treatment may have potentially adverse side effects.
NOTE: The most dangerous side effect of any BD treatment is a potentially aggravated symptom.
People with symptoms of bipolar disorder, or who have had one of the variants previously diagnosed, should consult a doctor before starting treatment or modifying a medical procedure.
Even those with variations in disease-resistant diseases can benefit from traditional methods (such as psychotherapy).
Regulation of the endocannabinoid system with CBD may be a way of reducing symptoms in patients with bipolar affective disorder. There is a need for more clinical trials on people to check for preliminary data, but the future of cannabinoids as a BD treatment seems promising.
The Links Between Cannabis, CBD and Bipolar Depression
Cannabis use for Bipolar Depression is highly contested these days. On the one hand, THC-heavy cannabis use has been shown to worsen bipolar symptoms, while other studies show cannabis use as a potentially useful alternative treatment for the disease.
THC is a psychoactive compound found in cannabis, which may exacerbate bipolar symptoms. However, CBD’s antipsychotic properties not only mitigate the effects of THC in that it reduces the impact and duration of THC’s psychoactivity, but it also works as an alternative to traditional antipsychotics without the long-term side effects.
Bipolar depression is not a simple condition to treat. It comes in varieties, noted by the severity of episodes and behaviors during manic events.
According to an inpatient study over a month, patients with Bipolar Disorder underwent a clinical trial to identify if CBD monotherapy was effective in treating manic episodes.
Researchers concluded that CBD might not be sufficient for manic episodes of Bipolar Affective Disorder because patients with BD did not show any improvements for their manic symptoms.
Further clinical trials with larger samples may corroborate or refute current findings.
What’s the CBD Dosage for Bipolar Disorder?
Based on widespread anecdotal evidence only, the standard CBD dosage recommendation may depend on your body weight. Start with 1 to 6 mg for every 10 pounds of body weight.
We’ve built a calculator for you so that you can find the lowest starting dose for your body weight below:
The above dosage recommendation is general and merely a suggestion. Your case may differ in that you may need a lot more, while others may need a lot less. Please consult with your physician before supplementing your treatment with CBD.
Before beginning or attempting any supplement, including CBD oil or other CBD products, first, consult a physician or psychiatrist. CBD may have unintended interaction with psychiatric drugs and may have adverse side effects or health problems.
In short, the CBD looks promising to help alleviate some of the symptoms of some mental disorders. However, much research based on human development is still in the background, but early signs are promising.
About the Author Jessica Jones
Jesse has spent most of her adult life struggling with anxiety. After studying neuroscience at University, she has since dedicated her life into researching the effects of CBD on the human body. The content on this website reflects her research.
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CBD Oil for Bipolar
Bipolar disorder is really not one disorder, but an umbrella term for a category of three distinct disorders. Bipolar I is characterized by manic episodes. Depressive episodes are also common in people with Bipolar I, although they are not required for the diagnosis. Bipolar II is characterized by both a depressive episode and a hypomanic episode.
which is like a less severe form of mania. Cyclothymia, which is less common and less well-known, is characterized by frequent periods of manic or depressive symptoms that do not meet the criteria for the “episodes” that occur with the other bipolar disorders. For simplicity, we will refer to the entire category as “Bipolar” in this article.
As with many other mental disorders, the treatment for Bipolar can include different types of therapy and medication. Unfortunately, the drugs prescribed to treat Bipolar are often quite poor at controlling it. CBD is a natural option which, in conjunction with therapy, may have a more positive effect on Bipolar symptoms than man-made drugs do. Some products that may help to treat your Bipolar can be found in our top 10 list.
10 Best CBD Oil for Bipolar 2022
View all CBD Oil for Bipolar
What is Bipolar, and what causes it?
We already know that Bipolar disorders involve different combinations of manic and depressive episodes or symptoms, but what are those symptoms?
Common manic episode symptoms include:
- Feeling elated or jumpy;
- Decreased appetite and sleep;
- Talking and thinking quickly;
- Feeling powerful and able to do many things at once;
- Taking unusual risks and showing poor judgement.
Unsurprisingly, common depressive episode symptoms are pretty much the opposite:
- Feeling sad or slow;
- Increased appetite and sleep;
- Talking slowly and difficulty concentrating;
- Feeling worthless and unable to perform simple daily tasks;
- Having no interest in any activities.
Like with other mental disorders, we know that the brains of people with Bipolar are somehow different from those of people without it, but what exactly that difference is still eludes us.
Some current thoughts on the subject include that an imbalance of neurotransmitters (chemicals that regulate mood, among other things) may be linked to Bipolar, and that damage to regions of the brain which deal with mood and impulse control may be linked to mood disorders in general.
Fortunately, CBD can help with many of the symptoms and even the possible causes of Bipolar.
CBD and Neurotransmitters
One thing we do know about CBD is that it affects the reuptake of some neurotransmitters (the reabsorption of neurotransmitters, after which they cannot be “used”). By delaying or preventing reuptake, it changes the levels of certain neurotransmitters in the brain.
It is difficult to say with certainty how those changes relate to Bipolar, since the role of neurotransmitters in Bipolar is not yet understood, but the effects seem to be positive. Some data suggests that CBD reinforces healthy neurotransmitter function and helps the brain achieve neurotransmitter levels that are characteristic of non-Bipolar brains.
Early studies on CBD’s neuroprotective properties indicate that it does protect brain cells against being damaged or altered. In particular, it appears to protect brain cells from oxidative stress and free radical damage, which are both phenomena that may cause or contribute to Bipolar disorders.
Based on this, CBD may prevent episodes from being triggered, make episodes less frequent, or make episodes less intense. Individuals with Bipolar I or II may especially benefit from this property of CBD.
CBD and Bipolar Patients
Since both the causes of Bipolar and the effects of CBD are not fully known, which makes them difficult to measure, another meaningful indicator is simply whether individuals with Bipolar report improvement with the use of CBD.
In one study conducted on 133 patients with Bipolar disorders, every single participant showed improvement. All patients reported more stable moods over the course of the study and demonstrated improvement in measurable tasks like memory recall and attention.
Even if we do not know why exactly this happened, the results are meaningful. This study is strong evidence in favor of the idea that CBD is effective as treatment for Bipolar, despite the fact that the reasons for this are unclear for now.
How to Use CBD for Bipolar Disorder
Since people with Bipolar can experience symptoms or episodes at any time, it’s important to choose a method that can be used daily and has long-lasting effects. There are several types of products that offer this.
- Drops – One simple way to take CBD oil is to place a few drops under the tongue. This is normally done once or twice a day, and the effects of it last for around twelve hours.
- Capsules – CBD can also be taken as a supplement, which is similar to drops but may be preferable to those who don’t like the taste of CBD oil. Capsules are also normally taken once or twice daily.
- Edibles – Food that is made with CBD is another product with effects that last a long time. They may be useful for the same reason as gummy vitamins, in that they motivate you to remember to take them by tasting nice.
With any CBD product, it is important to verify that the levels of THC, if any, are quite low. The effects of any significant amount of THC can be especially detrimental to people with Bipolar.
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Side Effects and Possible Risks
Although the side effects of CBD are normally considered mild, a few of them are important to note for individuals with Bipolar.
- Fatigue – The fatigue that can be caused by CBD treatment is not considered a severe side effect, but for individuals with depressive symptoms or episodes, this may be something they already experience. It is possible that CBD could just make the fatigue experienced during depressive episodes or periods of depressive symptoms worse.
- Reduced appetite – Another of the more commonly reported side effects of CBD is a reduced appetite. Again, this is not considered serious, but it may already be a symptom experienced by someone with Bipolar, during manic periods or episodes. CBD could make this symptom worse during mania.
- THC – As we mentioned earlier, THC can have some pretty undesirable effects on people with Bipolar. Many CBD products contain some amount of THC, either intentionally or due to poor processing, so it’s important to do your research on the products you are considering and consult your doctor about the treatment.
As we study it further and learn more about it, CBD may turn out to be a revolutionary treatment tool for mood disorders like Bipolar. Some products that may help to treat your Bipolar can be found in our top 10 list. For now, we can see that it often helps mitigate the symptoms of Bipolar, although the reasons for this aren’t totally clear.
Due to the potential to make some symptoms worse and the fact that CBD products may contain THC as well, it is important to choose high-quality CBD products and discuss CBD as a treatment option with a doctor or mental health professional before beginning to use it.