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Treating Bipolar Disorder with Marijuana: Is It Safe?

Bipolar disorder and marijuana

Bipolar disorder is a mental health condition that can cause extreme changes in mood. This can include low, depressive episodes and high, manic episodes. These shifts in mood can be both extreme and unpredictable.

Someone living with bipolar disorder can also have symptoms of psychosis including:

  • hallucinations (seeing or hearing things that aren’t there)
  • delusions (believing something is true that isn’t)

Going through the emotional highs and lows of bipolar disorder can greatly affect a person’s ability to function in day-to-day life. There’s no cure for bipolar disorder, but treatments can help.

Standard treatments, such as prescription medications and therapy, can help a person manage their mood changes and other symptoms. Researchers continue to look into other treatment options as well, including medical marijuana.

But is it safe? Here’s what we currently know about the pros and cons of marijuana use in people with bipolar disorder.

Marijuana is from the cannabis plant whose dried leaves, stems, and seeds can be smoked, eaten, or “vaped.”

Marijuana contains compounds called cannabinoids. These compounds include a chemical called delta-9-tetrahydrocannabinol, or THC. This is the ingredient in marijuana that can make a person feel “high.”

While marijuana and medical marijuana aren’t currently legal in all states, doctors are discovering how the compounds could help relieve certain symptoms in people with chronic conditions.

According to the National Institute on Drug Abuse (NIDA), compounds in marijuana may help treat symptoms such as:

  • appetite loss
  • inflammation
  • muscle control issues
  • nausea
  • pain

Today, there are medications available that contain compounds similar to cannabinoids, but don’t make a person feel high. An example is dronabinol (Marinol), which doctors prescribe for people with cancer to stimulate their appetite.

Smoking or consuming marijuana on its own might be helpful in reducing the side effects of some conditions, such as certain types of cancer. However, the research isn’t as conclusive when it comes to bipolar disorder.

Because marijuana can have anxiety-relieving effects, some people think it can help people with bipolar disorder to improve their moods.

Some research has found no harmful effects from marijuana use, while other research has found actual benefits. Examples include the following:

Low mental impairment and better moods

A pilot study published in 2016 found that people with bipolar disorder didn’t experience significant mental impairment when using marijuana compared to people with bipolar disorder who didn’t use marijuana.

Critics of marijuana use for bipolar disorder say that it affects a person’s thinking and memory. This study didn’t find that to be true.

The study also found that after using marijuana, the participants with bipolar disorder reported better moods.

Mood enhancing and a positive outlook

A study published in 2015 found that marijuana use in some people with bipolar disorder enhanced their mood and promoted a more positive outlook. However, the researchers found that people were more likely to use marijuana when they were already having a good day mood-wise and not when their symptoms were more severe.

It’s important to keep in mind that the research surrounding the beneficial effects of marijuana use in bipolar disorder is very preliminary. Also, marijuana can affect each person differently, so these results don’t suggest that marijuana can benefit everyone with bipolar disorder.

Some researchers have actually found that marijuana use can make symptoms of bipolar disorder worse in some people. Examples of their studies include:

Triggering manic episodes and worsening symptoms

A review published in early 2015 found that using marijuana could make manic symptoms worse in a person with bipolar disorder. They also found that marijuana use could trigger a manic episode.

In addition, the 2015 study above touting benefits to marijuana use, also found that it worsened manic or depressive symptoms in some people.

Higher rates of attempted suicide and early onset

According to another study from 2015, suicide attempt rates in people with bipolar disorder were higher in those who used marijuana than in those who didn’t use marijuana.

The study also found that people who used marijuana were younger at bipolar disorder onset (when their symptoms first started) than those who didn’t use it. This is a concern, as doctors think that a younger age at onset causes worse symptoms throughout a person’s life.

The effect of marijuana on early onset and suicide rates wasn’t clear however, researchers said.

While marijuana may help some people with bipolar disorder, these studies show that it could also cause problems for others with the condition.

Research has also shown that the use of marijuana can affect people differently based on their genetics.

According to the NIDA, people who carry certain gene types are more likely to experience psychosis. For instance, people who have an unusual variation of the AKT1 gene are more likely to have psychosis, and the risk is higher if they use marijuana.

Also, psychosis risks from adolescent use of marijuana have been linked with a genetic variation in the gene that controls an enzyme called catechol-O-methyltransferase (COMT).

If you have bipolar disorder and are considering using marijuana as a treatment, talk to your doctor about possibly testing for these or other genetic variations.

Right now, there isn’t enough research to say whether marijuana use for treating bipolar disorder is a good thing or a bad thing.

Some people have reported positive effects, such as improved mood. But others have reported negative effects, such as worsened mania or suicidal thoughts. Further research is needed on marijuana’s effects on bipolar disorder, as well as the long-term effects of prolonged use.

What doctors do know is that marijuana isn’t as effective as prescription medication and therapy can be in managing the symptoms of bipolar disorder. So if you have this condition, be sure to stick to the treatment plan prescribed by your doctor.

If you’re considering using medical marijuana, talk to your doctor about the pros and cons first. Then, if you decide to try it, keep your doctor posted about how it affects you.

Together, you and your doctor can determine if it’s a good addition to your treatment plan.

Is CBD Legal? Hemp-derived CBD products (with less than 0.3 percent THC) are legal on the federal level, but are still illegal under some state laws. Marijuana-derived CBD products are illegal on the federal level, but are legal under some state laws. Check your state’s laws and those of anywhere you travel. Keep in mind that nonprescription CBD products are not FDA-approved, and may be inaccurately labeled.

If you or a loved one has bipolar disorder, you may wonder about medicinal marijuana as a treatment option. We've got answers for you.

Can Marijuana Help Your Bipolar Disorder?

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Deux / The Image Bank / Getty Images

Award-winning mental health journalist and author, John McManamy, wrote a thoughtful blog about the implications of medical marijuana as a treatment for bipolar. It’s reasonable to think that the risks outweigh any possible benefits, but the topic is certainly worth discussing.

Since both bipolar depression and mania can have psychotic features, there is some evidence that even medical marijuana use might have negative effects in people with bipolar disorder.  

Studies Show Links to Worse Outcomes

Medical research shows that cannabis use in people with psychosis is associated with an earlier age of their first psychotic episode. It’s also associated with manic symptoms and problems thinking.  

In one study, patients who quit using marijuana or reduced its use following their first psychotic episode had the greatest improvement in symptoms at the one-year mark, compared both to continuing cannabis users and people who had never used cannabis.   Long-term cannabis use may have a negative effect on long-term clinical outcomes for those with bipolar spectrum disorders, as well.

A 2015 study found lower bipolar disorder remission rates for current regular cannabis users (those who used it three times a week or more often) and those who regularly smoke tobacco when compared to people who don’t use either substance. That study, which lasted two years, concluded that regular marijuana users who also have bipolar didn’t do as well long-term as people who didn’t use the drug.  

Another study looked at the short-term effects of cannabis use in people with bipolar disorder and concluded that the drug was associated with both manic and depressive symptoms. However, that study couldn’t find evidence that people with bipolar were using cannabis to self-medicate on a regular basis.  

Now, none of these studies prove that cannabis is actually causing these problems in people with bipolar—they just show an association between marijuana use and problems. But you should factor this information into your thinking when deciding whether or not to use cannabis.

Substance Abuse Risk With Marijuana

All drugs have risks and side effects, and cannabis is no exception.

Substance abuse can be quite prevalent among those with bipolar disorder. People have used alcohol and drugs to try to control their systems in great numbers and may reduce their likelihood of successful treatment of their bipolar as a result.

By using marijuana to self-medicate for bipolar disorder, you run the risk of gaining a second diagnosis in addition to your bipolar diagnosis: substance abuse (Substance use disorder).

There's some interest in using marijuana to treat symptoms of bipolar disorder but the risks may outweigh any benefits. ]]>