Can Cannabis Help With Bipolar Disorder?

Overview

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.

Potential side effects of cannabis use

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.