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
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.
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.
Psychiatry Advisor: Are there distinct challenges or effects of cannabis use in patients with bipolar I vs bipolar II?
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.
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.
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 spoke with customers of Southwest Patient Group, a San Diego marijuana dispensary.
Psychiatry Advisor: Has the legalization of recreational marijuana use in California had any noticeable effect on your treatment of bipolar disorder?
In some patients, cannabis use can complicate the management of bipolar disorder by causing mood instability and psychosis. Other patients believe it helps manage their moods.