All In The Mind #5: Cannabis And Bipolar Disorder
It’s difficult to get a firm scientific consensus on cannabis and bipolar disorder. But, is there evidence that the herb can actually help?
Bipolar disorder and cannabis have a troubled relationship. Some people sware by the herb, and others wouldn’t touch it with a ten-foot pole. Research is limited, but is there evidence that the herb can symptoms of manic depression? Here’s the nitty gritty on cannabis and bipolar disorder.
What is bipolar disorder?
Bipolar disorder is one of the most mysterious and misunderstood mental health ailments around. It’s the disorder that led Vincent van Gogh to cut off his own ear. It’s the suspected culprit behind the deaths of many of our creative icons. Virginia Woolf, Robin Williams, and Amy Winehouse were all thought to have this condition.
Bipolar disorder is manic depression. The condition was called “manic-depressive illness” up until “bipolar” took hold in the 1990s. Bipolar disorder is a mood disorder. It falls into the same class as clinical depression.
Unlike unipolar depression, bipolar disorder causes prolonged depressive episodes intermixed with episodes of mania. Some folks with milder versions of this condition experience more subdued mood elevations called hypomania.
Some of the symptoms of bipolar disorder include:
- Excessive, elevated mood or intense irritation
- Unexplainable energy
- Rapid, unstoppable, “pressured” speech
- Racing thoughts
- Inability to sleep and/or lack of desire for sleep
- Psychomotor agitation such as excess pacing or fidgeting
- Increased promiscuous sexual behavior
- Delusions, loss of touch with reality
- Substance abuse
- Extreme fatigue
- Flu-like symptoms (aching muscles and joints, headache, nausea, etc.)
- Loss of self-worth
- Excessive feelings of guilt, sadness, or numbness
- Mental fog, inability to concentrate
- Suicidal ideation
- Loss of interest in things you once loved
- Sudden disinterest in hygiene
- Oversleeping or insomnia
Cannabis and bipolar disorder
Bipolar disorder and cannabis have a rocky relationship. Why? The disorder itself is incredibly complicated. The active components of the herb will affect people differently depending on each stage in the bipolar cycle.
Hypomania and Mania
Consuming cannabis during or leading up to mania is tricky. Anecdotal reports and medical evidence have come to two very different conclusions. Many bipolar patients find that cannabis helps calm them down when they’re getting a little too revved up from a manic episode. Yet, the medical community is quick to tell you that the herb worsens manic symptoms. Some research even correlates cannabis use with the onset of mania.
A study completed last year asked bipolar patients to track how cannabis affected their mood in daily journals. The results were a little dismal. The majority of patients claimed that cannabis use actually increased both manic and depressive symptoms. Participants wrote things like:
I have found though that if I have smoked more excessively it can make me feel depressed for days afterwards.
I do not use weed to manage depression as it can make it worse, making me anxious and paranoid.
I do smoke a small amount to lift my mood and make myself slightly manic but it also lifts my mood and switches me into a different mindset.
However, this is far from a controlled study. These claims also rely solely on subjective self-reporting. With the wide variety of strains and products out there these days, it’s possible to find herb without these negative effects. For example, opting for a high-CBD strain allows you to avoid anxiety and paranoia altogether.
In different studies, patients have come forward with claims that cannabis reduces manic symptoms. Here’s what one 35-year-old woman had to say:
I smoked marihuana for the first time in high school and couldn’t believe how good it made me feel. My normally chaotic emotions subsided and I had asudden sense of calm, peace, and well-being. My perceptions of others and life changed dramatically.
The world no longer seemed hostile but more within my control. I could sleep easily and actually had cravings for food. There were practically no side effects. When I had enough marihuana I would just naturally stop, because once you’ve gotten a certain effect you really don’t want any more.
What goes up must come down. For every manic episode, a depressive one inevitably comes right before or right after. Whether or not cannabis is an effective treatment for mania is highly debatable. But, there is substantially better scientific evidence for cannabis as a natural antidepressant.
Low doses of THC have been shown to have powerful antidepressant effects. Somewhat similar to a SSRI, the psychoactive boosts serotonin when used in very low concentrations. Serotonin is a neurotransmitter thought to inspire a happy, feel-good mood.
Like THC, CBD increases the amount of available serotonin. This lifts your mood. However, the cannabinoid also has mood-stabilizing properties. This fact makes CBD quite different from its psychoactive relative.
While CBD boosts serotonin, it also increases the amount of GABA in your system. GABA is a calming neurotransmitter. It dampens excitability in the brain. At least one researcher has gone as far as to compare CBD to Depakote. Depakote is one of the most commonly prescribed mood stabilizers to bipolar patients and epileptics alike.
As another bonus, CBD is fast-acting. Traditional pharmaceuticals can take several weeks to kick in. For those in an acute depressive episode, this is agony. Most cannabis users can tell you that this is one fast-acting herb. A study published earlier this year confirmed this idea after testing the antidepressant effects of CBD.
A group of researchers examined the effectiveness of CBD in rats showing anxious and depressive behaviors. After a CBD injection, the rats’ hyperactivity decreased. While they had once lost interest in normal rodent activities, the creatures began to act like themselves again minutes after treatment.
So, if you’re suddenly hit with an intense bout of the blues, CBD can take the edge off in a hurry. This study is discussed in more detail in an earlier All In The Mind segment, How Cannabis Treats Depression.
Are there benefits to cannabis use in bipolar disorder?
Unfortunately, there isn’t much research out there on cannabis and bipolar disorder. Each stage in the bipolar cycle has its own symptom fingerprint. So, it’s very difficult to get consistent results with the herb. Cannabis may be extremely effective in managing some bipolar symptoms. In others, it may be aggravating. It all depends on your unique body chemistry.
Yet, a few dedicated scientists have tried to tackle the condition. Back in 1998, famous cannabis activist Dr. Lester Grinspoon made a plea for more research. He suspected that cannabis may prove to be a powerful mood stabilizer. In his paper, he cites several anecdotal case studies supporting cannabis for bipolar.
One case came from a 47-year-old woman. She used the herb to supplement lithium treatment. She explains:
[…] I discovered that [cannabis] was effective against most of my symptoms. Suppose I am in a fit of manic rage-the most destructive behavior of all. A few puffs of this herb and I can be calm. My husband and I have both noticed this; it is quite dramatic.
One minute out of control in a mad rage over a meaningless detail, seemingly in need of a strait jacket, and somewhere, deep in my mind, asking myself why this is happening and why I can’t get a handle on my own emotions. Then, within a few minutes, the time it takes to smoke a few pinches. Why, I could even, after a round of apologies, laugh at myself!
Additional research has shown that CBD has potent anti-psychotic effects. So potent that pharmaceutical companies like British GW Pharmaceuticals are looking into the compound. Current research initiatives aim to discover whether or not CBD can be used in conjunction with traditional medications for schizophrenia. This is potentially good news for bipolar patients. Antipsychotics are often prescribed along with mood stabilizers to control psychotic features of mania.
Another study suggests that cannabis use is associated with increased cognitive functioning in bipolar disorder. Cannabis-using bipolar patients were pitted against non-users. The cannabis fans out-performed their counterparts on every account. Processing speed, working memory, and attention were all improved in those that used the herb.
How do I tell if cannabis impacts my mood?
It’s easy to figure out whether nor not cannabis works for you. Keep a mood chart! Most people who have gone through psychotherapy for bipolar disorder will be familiar with this. A mood chart can help you find patterns in your changing moods. The idea is that you make a note of daily activities and rate your mood on a simple scale. Over time, you will be able to identify specific triggers.
So, each time you consume a little herb, keep track of how you feel for the rest of the week. If you notice that it makes either your depressive or manic symptoms worse, you might need to try something else. If it seems like it is helping, awesome!
3 Tips for staying safe with cannabis
Every person reacts differently to cannabis. This is especially true for those with bipolar disorder. The vast majority of medical providers will tell you to stay away from cannabis. But, if you’re hoping to try it regardless, there are a few ways to stay safe while you test out the herb.
1. Be choosy
Opt for high-CBD strains, indicas, or well-balanced hybrids. Indica strains are strong sedatives, which can help you sleep and slow things down. CBD is largely considered the safest, most mild option when it comes to cannabis. It also works to combat both depression and over-excitability. If neither of those options works for you, consider a mellow hybrid like Middlefork.
If you notice that you are sensitive to THC, try to avoid it during manic episodes. THC causes a spike in dopamine. Too much dopamine in the wrong place at the wrong time is thought to trigger psychotic symptoms. If you’re prone to psychosis, be wary of this.
As mentioned earlier, CBD is a powerful antipsychotic. So, if you’re a cannabis lover and are concerned that the herb is making things worse, consider a non-psychoactive variety.
2. Avoid strains associated with paranoia
Use a strain database like Leafly to help you make informed decisions before picking up from a dispensary. Leafy allows you to filter out strains that are known to cause paranoia. You definitely want to avoid increased anxiety during all stages of the bipolar cycle.
3. Everything in moderation
When you’re trying to decide whether or not cannabis works for you, it’s best to start small. Starting with a small amount of a mild strain can help you avoid a sudden, debilitating mood swing. If you feel comfortable with the plant and it seems to be helping you, mindfully work up from there.
3 Additional therapies
Medication alone is not an effective treatment for bipolar disorder. This is as true for lithium as it is for medical cannabis. Those who experience the best recovery from episodes use an integrated treatment approach.
1. Dialectical behavioral therapy
Dialectical behavioral therapy (DBT) was originally designed for treatment of Borderline Personality Disorder. It has since been adopted for bipolar. It combines methods from Cognitive Behavioral Therapy and Zen Buddhism. This helps you reframe the way that you think about day-to-day challenges and teaches you compressive stress-management techniques.
2. Mindfulness meditation
Stress management is vital to those with bipolar. The more stress you experience, the greater the likelihood of an episode. Taking a little time each day to focus and calm the mind can drastically improve symptoms and help you cope when they become overwhelming.
3. Strict routine
Maintaining a stable routine is also crucial for overall wellness. Medicate at the same times each day. Make sure you eat at regular intervals and avoid fasting. Stick to the same bedtime as much as possible. All of these factors help your body adjust to a natural daily rhythm. When this rhythm is disrupted, your body becomes stressed. This increases your chance of an episode.
Unfortunately, there’s no easy answer when it comes to cannabis and bipolar disorder. Even anecdotal evidence swings both ways. Some folks swear by the herb for managing their symptoms and mellowing out mania. Others report that cannabis only makes things worse. What is certain, however, is that there is quite a bit of interest in the mood stabilizing properties of the cannabis plant.
It’s important to note that we are not doctors, so the information in this article should not be used in place of medical advice or treatment.
Does cannabis ease or worsen your bipolar symptoms? Share your story with us on social media or in the comments below. We’d love to hear from you!