Bipolar Disorder/Manic Depression

Bipolar Disorder / Manic Depression and Medical Cannabis

Definition

Bipolar disorder is characterized by a “cycling” of moods from extreme depression to an extreme elated feeling known as “mania”. Those going through a “manic” phase may seem unusually productive and/or happy, but rest assured this is not usually the case, and it is in this phase that risk of suicide of highest.

Potential Efficacy / Quality of Evidence (Low, Average, High) of Medical Marijuana for Bipolar Disorder (aka “Manic Depression”)

Low, although cannabidiol (CBD) may help. Care must be taken with THC, especially during manic periods, as delusional thinking and psychosis-like symptoms are not uncommon in those with bipolar disorder.

Cannabinoids, Terpenes/Terpenoids, Strains and Ratios that May Help

CBD in particular may help for its antipsychotic properties. Small amounts of THC may help, but care must be taken when using cannabis (especially high-THC strains/products) during manic stages of bipolar disorder.

CBD:THC 20:1; CBD:THC 18:1

Medical Cannabis Pros

The right cannabinoid-terpenoid profiles may help replace many more harmful drugs prescribed for bipolar disorder.

CBD may have antipsychotic properties.

CBD-rich cannabis may help stabilize the mood to some extent.

May help with insomnia and sleeplessness.

Medical Cannabis Cons

It may be best to avoid THC altogether for a bipolar disorder sufferer, although very small doses during depressive periods may help. Regular use of high-THC cannabis is associated with an earlier onset of bipolar disorder and more rapid cycling.

More About the Condition

Bipolar disorder affects approximately 1%-3% of the global population, with approximately 2.6% of US citizens (5.7 million) suffering from bipolar disorder. Hallucinations and psychosis can also occur with bipolar disorder. Delusional thinking, impulsive decision-making and extreme excitement or energy increases the likelihood of a bad decision to occur. A less severe form of bipolar disorder, cyclothymic disorder, is characterized by less extreme swings between mania and depression, but more rapid cycling between the two moods.

There does seem to be a genetic link, as an individual who has family members with bipolar disorder is more likely to suffer from bipolar disorder. Polymorphisms in BDNF, DRD4, DAO and TPH1 genes have been implicated in the development of bipolar disorder. Environmental stressors such as abuse and long-term stress may trigger abnormalities in these genes as well. CRH, cardiac β-adrenergic, Phospholipase C, glutamate receptor, cardiac hypertrophy, Wnt, Notch, and endothelin 1 signalling pathways have also been implicated in the development of bipolar disorder.

Due to the extreme low moods, it is not unusual for a bipolar sufferer to be misdiagnosed with unipolar depression. In the past, bipolar disorder was often referred to as “manic depression”. Although there are some similarities between the two conditions, there are also many key differences. Indeed, during a manic phase, antidepressants are contraindicated for bipolar disorder, which shows that there is definitely a difference between the two conditions and how they should be treated.

Benzodiazepines, anticonvulsants, mood stabilizers (e.g. lithium) and antipsychotics are often prescribed to a person with bipolar disorder. Antidepressants may be prescribed during low moods, but doses must be monitored carefully and stopped should signs of a manic phase start to appear. There are three main types of bipolar disorder:

Bipolar I disorder – at least one manic episode, with or without depressive episodes.

Bipolar II disorder – at least one hypomanic episode and one major depressive episode, but not any manic episode.

Cyclothymic disorder is often considered a third type of bipolar disorder. Those suffering from schizophrenia, multiple sclerosis (MS), a personality disorder, or Alzheimer’s may present similar symptoms to those suffering from bipolar disorder, but the conditions are markedly different in many respects.

Quotes from Experts

“Bipolar affective disorder is often poorly controlled by prescribed drugs. Cannabis use is common in patients with this disorder and anecdotal reports suggest that some patients take it to alleviate symptoms of both mania and depression. We undertook a literature review of cannabis use by patients with bipolar disorder and of the neuropharmacological properties of cannabinoids suggesting possible therapeutic effects in this condition.

No systematic studies of cannabinoids in bipolar disorder were found to exist, although some patients claim that cannabis relieves symptoms of mania and/or depression. The cannabinoids Delta(9)-tetrahydrocannabinol (THC) and cannabidiol (CBD) may exert sedative, hypnotic, anxiolytic, antidepressant, antipsychotic and anticonvulsant effects.

Pure synthetic cannabinoids, such as dronabinol and nabilone and specific plant extracts containing THC, CBD, or a mixture of the two in known concentrations, are available and can be delivered sublingually. Controlled trials of these cannabinoids as adjunctive medication in bipolar disorder are now indicated.” Source: Ashton CH, Moore PB, Gallagher P, Young AH. ‘Cannabinoids in bipolar affective disorder: a review and discussion of their therapeutic potential‘ J Psychopharmacol. 2005 May;19(3):293-300. doi: 10.1177/0269881105051541. PMID: 15888515.

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Case Studies – Patient Stories

CBD for Bipolar Disorder

Featured image by Blacktc. From Wikimedia Commons. This file is licensed under the Creative Commons Attribution 4.0 International license (CC BY 4.0).