Cannabis & Bipolar Disorder

What is bipolar disorder?

Bipolar disorder is a mental health issue characterised by periods of hypomania and hypermania (or depression and mania).

During a manic episode, the affected person may feel euphoric, overwhelmingly excited, agitated, confident or easily distracted amongst other emotions. This may lead to the bipolar person becoming more active than usual, doing inappropriate and out of character things, barely sleeping and losing all social inhibitions.

By contrast, depressive episodes may involve the affected person feeling down, low in energy and low in confidence. In some cases the bipolar person may also feel suicidal. These feelings may result in the affected person isolating themselves, eating irregularly (either too much or too little), sleeping too much or too little and potentially trying to harm themselves or commit suicide.

Those affected by bipolar may also experience some psychotic symptoms, like paranoia and hallucinations, during their episodes. These symptoms are not experienced by everyone with bipolar, but those who are affected by these symptoms are more likely to experience them during their manic episodes. However, these can be seen during depressive episodes too.

Whilst it’s important to note that there are variations in mood from patient to patient, for many people affected the ongoing variation in mood can be hugely debilitating, as compared to regular mood swings, episodes of bipolar disorder can last for weeks at a time or maybe even longer.

To diagnose someone with bipolar disorder, a doctor will ask the sufferer to disclose the symptoms they’re experiencing, how long the episodes typically last, how many episodes have been experienced, the impact of these episodes on their life and their family history.

People experiencing symptoms may also be asked to keep a diary of their moods and feelings so their assessment can be more thorough. Other health problems that could potentially cause mania-like symptoms may also be ruled out through tests.

It’s important to know that whilst a GP may initially ask questions about a person’s symptoms and assess them accordingly, the affected person will then be referred to a mental health specialist (a psychiatrist for instance) as only they can ultimately diagnose someone with bipolar disorder.

How is bipolar disorder treated?

The treatment options for bipolar are all intended to control the effects of an episode in order to help the diagnosed person live their life as regularly as possible.

The National Institute for Health and Care Excellence (NICE), advises that the best way to treat bipolar is through a combination of medication and talking treatments.

The specific forms of treatment offered will depend upon the relative severity of the symptoms; if the person diagnosed is in the midst of an episode then their treatment methods will differ from a person with bipolar disorder who is attempting to manage their long-term mental health more generally.

The NHS recommends treatments such as:

· Taking mood stabilisers on a daily basis to prevent future episodes of depression and mania.

· Taking medicines whilst experiencing episodes to treat the main symptoms of depression and mania.

· Talking therapies like cognitive behavioural therapy (CBT) that help you to psychologically deal with depression.

· General lifestyle improvements like exercising regularly, improving your diet, getting better quality sleep and so on.

Does cannabis help?

Whilst there are reports of cannabis triggering bipolar episodes, particularly when cannabis is coupled with the use of other drugs and alcohol, there’s also a number of case studies where cannabis seems to act as a mood stabiliser, for instance in a case study by Grinspoon et. al. (1998).

Another case study carried out by El-Mallakh et. al. (2007) examined a single patient’s mood data and cannabis use over two years and found that there was a decrease in depressed days and an increase in hypomanic days.

In a review by Pinto et. al. (2019), it was found that 24% of patients with bipolar disorder used cannabis. Pinto et. al. also found an association between cannabis use, suicide attempts and the use of tobacco, alcohol and other drugs. It’s important to note that Pinto et. al. also mention other socioeconomic factors that could affect this association, including education and access to healthcare.

A review on suicide and bipolar disorder by Bartoli et. al. (2019) found a weak level of evidence correlating cannabis use with an increase in suicidal attempts. Additionally, they concluded that generally there was a poor-quality status of research on bipolar, cannabis and suicide events. This then led them to call for researchers to carry out more comprehensive trials on this topic.

These studies thereby highlight how far the medical community has to go before the effects of cannabis use upon bipolar symptoms are fully understood. It is hoped that with time, more detailed studies will be carried out and greater insight upon the disorder and its machinations will be gained.

For more information on these studies and the treatment of bipolar disorder using medical cannabis, take a look at our evidence base, a ground-breaking systematic review of the history of research in this area and a global first-of-its-kind searchable database for clinical referencing.

Follow this link for more information on our online course on Anxiety and Depression.

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