Marijuana and Bipolar-Yes or No?
The use of marijuana in treating many and various illnesses is a hot topic among many of our San Francisco-area patients. Since legalization for medical uses, and even for recreation, seems to be spreading throughout the country, more and more people are looking into helpful uses for this ancient but little-understood plant.
However, medical advice follows evidence, not fashion or politics. And the evidence for using marijuana for any kind of mental illness is very slim, and sometimes clearly negative. For a real-life example, see the experience of our patient, Elle, who got herself into a morass of troubles by trying to regulate her moods by smoking pot. She also shares what worked for slowly working back to full health.
Up to the present, scientific studies of medical marijuana show moderate evidence of its usefulness for chronic pain and anxiety. Indirectly, then, it can help with sleeplessness that is a result of one or both of these conditions. There are some indications that it can help with nausea and vomiting resulting from chemotherapy treatments for cancer, but many patients reject its use because of the side effects (feeling “high”). No clear evidence has come to light of the usefulness of cannabis in treating depression, mania, or psychosis.
Association between cannabis use disorder and bipolar risk
Moreover, a recent study1 from Denmark, using a large population cohort methodology, found a clear association between cannabis use disorder (addiction) and risk of subsequently being diagnosed with bipolar or unipolar depression. These results held for both men and women, and for varying amounts of time since cannabis use disorder had begun. That is, there may or may not be a causal relationship between cannabis use and mood disorder, but the two clearly affect the same or similar populations.
In general, our clinical experience is that patients using pot to regulate their moods experience greater illness severity, more time spent in manic/mixed episodes, more psychotic symptoms, more rapid cycling, poorer life functioning, and poor adherence to prescribed treatments. Also, there is evidence to show that when the substance use disorder comes first, the bipolar disorder may show an earlier age of onset, and more than half of all bipolar patients may also have a substance use disorder diagnosis as well.
Just do your research before jumping on the cannabis bandwagon!
Reference:
- Jefsen OH, Erlangsen A, Nordentoft M, Hjorthøj C. Cannabis Use Disorder and Subsequent Risk of Psychotic and Nonpsychotic Unipolar Depression and Bipolar Disorder. JAMA Psychiatry. Published online May 24, 2023. doi:10.1001/jamapsychiatry.2023.1256