Bipolar disorder affects approximately three million individuals per year in our country. This psychotic condition is also known as manic/depressive disorder and is similar in some ways to anxiety and depression disorders. However, in bipolar disorder, the symptoms and conditions of this illness are more severe and require a higher level of care and treatment than anxiety and depression, which is a much more common illness and diagnosis. Patients with bipolar suffer from periodic episodes of manic behavior alternating with periods of severe depression, and these episodic mood swings can be acute and long-lasting.
Currently, there is no known definitive cure for this illness, and treatment involves a combination of counseling, monitoring, psychiatric care, medications, and lifestyle changes. This disease can be characterized by extreme and schizophrenic like mood changes and behaviors, and in some cases, can result in hospitalizations or legal issues arising from inappropriate behavior and erratic social conduct.
The six A’s of bipolar are anger, anxiety, apathy, apprehension, aggression, and agitation.
Other signs of this illness can include:
*Despair and feelings of helplessness
*Trouble sleeping at night, or difficulty staying awake during the day
*Guilt or feeling of worthlessness
*Extreme feelings of paranoia
*Hostile or grandiose behavior
*Disjointed family, work, or social life
*Occasional unfounded euphoria
*Inappropriate behavior and speech
*Suicidal thoughts and tendencies
The manic phase alternates with the depressive phase, and each phase may last days, weeks, or months. The manic phase would be characterized by the inability to sleep, excess motor activity, high energy, and dissociative thoughts and actions. In short, obvious erratic and inappropriate behavior is easily seen by others. The depressive phase is characterized by low energy, low motivation, loss of interest, apathetic attitude and can lead to negative or suicidal thoughts. These phases can alternate in an extreme and excessive manner, and in some cases, a return to normalcy can occur for intermittent periods.
When examining cannabis and how it relates to this disease, there is some disagreement and conflicting data. Some psychiatric clinicians agree that the use of cannabis may actually cause an acute psychotic event similar to schizophrenia or bipolar disorder. Studies have shown that as the frequency of cannabis use/abuse increases, so does the risk for psychotic disorders. Also, cannabis has been shown to be the most commonly abused drug among those with bipolar. Cannabis intoxication can lead to acute psychosis in some people and can exacerbate the existing psychiatric disease. This may be true especially in younger individuals whose nervous system is not yet established. Researchers have evidence that cannabis consumption during brain development may lead to a disturbance of the endocannabinoid system and may cause adverse neural connections in the brain. For this reason, cannabis is not recommended for patients who are under the age of 21. In Maryland, the allowable age is 18 and this may be cutting it a bit close in terms of brain and nervous system development.
Another view concerning cannabis and bipolar disease is that age-old question “which came first the chicken or the egg?”
There is one school of thought that those individuals with bipolar disorder are using cannabis to help mitigate their symptoms and as a medication that allows them to feel better. As such, their use of cannabis is not a cause for their disease but is used to alleviate the symptoms caused by bipolar disease. In this regard, it may be looked at as a partial cure to get relief of symptoms. If cannabis was a causative agent, then why do only a very small percentage of users develop this disease? Perhaps it can be a trigger only in susceptible individuals who have an underlying predisposition to develop a psychiatric illness.
Those afflicted with this disease are encouraged to receive regular psychiatric care including cognitive behavioral therapy, interaction with social workers, hospital care, and pharmaceuticals. The typical pharmaceutical drugs used in this disease which may or may not be beneficial – would include olanzapine, Divalproex, and vraylar among others. However, there is also evidence that cannabis itself may be an effective therapy for treatment for some patients. This would be in conjunction with proper guidance and use by an experienced cannabis physician, especially if other treatments and medications have failed.
One must also consider the side effects of traditional drug therapy, looking at one of the newest bipolar drugs on the market - Vraylar (cariprazine). This is a drug that is an atypical antipsychotic used in the treatment of schizophrenia, and in the acute treatment of manic or mixed episodes associated with bipolar 1 disorder. While designed to help those with bipolar, unfortunately, there are a multitude of negative side effects that may prevent its use. These include muscle spasms, tremor, jerking, agitation, indigestion, nausea, vomiting, sleepiness, weight gain, headache, insomnia, abdominal pain, constipation, toothache, anxiety, diarrhea, back pain, dizziness, cough, suicidal thoughts and behaviors, stroke, tardive dyskinesia, leukopenia, syncope, seizures, dysphagia, and metabolic changes. Other side effects are also possible.
In light of these facts, there is an inherent difficulty when determining how to best treat this disease using cannabis. On one hand, perhaps may have cannabis played a role in the development of bipolar according to some theories in predisposed individuals. On the other hand, due to the adverse side effects of traditional drug therapy, and since many bipolar patients use/abuse cannabis to treat their symptoms, the possibility of a positive benefit is feasible. Due to the large number of compounds in the cannabis plant (ie. terpenes, cannabinoids, flavonoids, polysaccharides, phytosterols, etc..) it may be hard to ascertain the proper elements and concentrations of these elements to best treat this disease. For this reason, caution must be applied, and a skilled cannabis physician may be required to determine the best use, dosage, and method of administration. Also, because the disease fluctuates with two opposing moods, several types of cannabis may be required at different times during the course of symptoms.
Research is ongoing as cannabis has been shown to have a benefit in many mental and psychiatric conditions, including anxiety, depression, insomnia, seizure disorders, among others. However, individual responses to cannabis are widespread and varied. Its use in bipolar disease is not contra-indicated, but must be used with caution and expertise for a benefit to be observed. Other modes of therapy should also be employed, and those using cannabis must be under constant supervision and monitoring to achieve positive results.
Dr. Stanley R. Manstof
12201 Greenridge Drive
Boyds, Md. 20841
*MMCC Certified Provider
*American Academy of Cannabis Physicians
*Member Americans for Safe Access
*Technical Writer and Editor
*Member Society of Cannabis Clinicians
*International Cannabinoid Research Society
*Certified Patient Caregiver
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