Bipolar I disorder and cannabis

[crOOk]

So what is the news on this one? Countless bipolar I patients seem to consider it a good idea to level themselves out with cannabis. I have never been able to find a single publication that would support such claims though. With no causal relationship between cannabis use and bipolar I disorder, but countless articles stating a worse prognosis in individuals who do use cannabis over those who do not and an improved prognosis for those who stop cannabis use after their first manic episode, I just don't know what to believe.

I am bipolar I myself and the way I see it, cannabis does have some mood stabilizing effects as long as the dosage isn't changed on a daily basis. Larger dosages bring on symptoms of depression, smaller dosages than usual tend to make me hypomanic. What's funny is that the same applies to my neuroleptics... I wonder what an impact it would have if I took 1 pill on monday, 4 on tuesday, 2 on wednesday etc. Surely this would not stabilize me either. In fact, I have a feeling such behaviour would lead to my hospitalization very quickly.
I therefore feel cannabis is not done justice since in it's naturally occuring, non-standardized form it simply cannot be looked at as anything else but a drug of abuse, surely not as a psychopharmaceutical.

I'd really like to see some good information on this. Maybe I just want to hear what according to all articles I have found is simply not the case because I'm so severely addicted to this substance (15 years of daily use). One of my psychiatrists tended to agree and never saw a problem in my cannabis use, most others strongly discourage it.

 

[jpgrdnr]

^^ In broad terms I think marijuana use with mental disorders is a bad idea. Its a depressant, and depression is common with people with mental health issues (??? I don't mean to have a bias - everyone is at risk), so its either compounding the depression or masking the overall sense that one is depressed.

BUT Mental Health is extremely complex and very much person based. Its case by case. I could make the case that personally I was more functional smoking marijuana in terms of holding down a job than not smoking marijuana. But I drank alcohol and at the time would have consumed other drugs, and did at the drop of a hat. Many people self-medicate with marijuana and are highly functional. Then again I've seen people smoke marijuana in people with MDD, major depression and be thrown off the rails. I've witnessed people becoming very aggressive to the point of fighting on marijuana. To people with schizophrenia where any sort of stability they might have had become destroyed.

So the byline that its a cool, and chill....everyone should relax and smoke a doobie is obviously not the case. In obviously throws a wrench into the whole legalize movement.

----There could be a use for marinol or some sort of THC synthetic. Marinol is used medically in palliative care, etc. I think its a question of promoting it as maintenance therapy as opposed to a street drug that isn't regulated. There's a conflict with taking a measured dose VS smoking a large joint of AK47 or some powerful strain that would send anyone to the moon and back. I have no knowledge of varied doses of Marinol and its effects. I would assume it resembles a mild sedative. I would also assume that in terms of inpatient therapy there is probably the tendency to "go for what works."

 

[bloodshed344]

^^ In broad terms I think marijuana use with mental disorders is a bad idea. Its a depressant,

What does this even mean? and whatever it means, it has nothing to do with depression. But yeah, regular marijuana use can cause depression. I personally feel manic sometimes and depressed sometimes, happy sometimes and sad sometimes. No rhyme or reason. Weed makes me feel just a bit more normal.

 

[velmwend]

I've always envied people who enjoy a long, fruitful relationship with cannabis. Unfortunately, I'm one of those people (and they are out there) who suffered some serious long term mental issues after only a short period smoking cannabis. I could *never* smoke it while depressed...ouch - that would be a mental nightmare ride, probably with longer lasting scars.

 

[jpgrdnr]

What does this even mean? and whatever it means, it has nothing to do with depression. But yeah, regular marijuana use can cause depression. I personally feel manic sometimes and depressed sometimes, happy sometimes and sad sometimes. No rhyme or reason. Weed makes me feel just a bit more normal.

From the wiki, depressants:

Although Cannabis or Marijuana is often considered either in its own unique category or as a mild psychedelic, the drug, notably the chemical compound Cannabidiol in it, still does nevertheless have many depressant effects such as muscle relaxation, sedation, decreased alertness, and tiredness.

A depressant is simply a class of drug that

lowers or depresses arousal levels and reduces excitability.

Marijuana does not cause depression. It is, like alcohol, something that should be taken in moderation if you suffer from depression.

 

[AlphaMethylPhenyl]

A depressant reduces transmission of other peptides/proteins; that doesn't necessarily make people depressed. See literature on aps for depression.

 

[Buddy Catva]

I am bipolar I myself and the way I see it, cannabis does have some mood stabilizing effects as long as the dosage isn't changed on a daily basis. Larger dosages bring on symptoms of depression, smaller dosages than usual tend to make me hypomanic. What's funny is that the same applies to my neuroleptics... I wonder what an impact it would have if I took 1 pill on monday, 4 on tuesday, 2 on wednesday etc. Surely this would not stabilize me either. In fact, I have a feeling such behaviour would lead to my hospitalization very quickly.
I therefore feel cannabis is not done justice since in it's naturally occuring, non-standardized form it simply cannot be looked at as anything else but a drug of abuse, surely not as a psychopharmaceutical.

The difficulty with keeping the dose constant is a legal issue. Prohibition prevents you from buying a standard brand or growing a seed line you're familiar with. In its naturally occurring form it is a plant bigger than one day's dose. With any new supply containing many doses you can produce constant doses by stirring it up. If you had a constant dose for one month, and then a new supply that was constant for another month, how many days would it take for you to know if there's a difference in strength? With legal supply you could stir a year's worth, so you would have no sudden changes in dosage for a year.

The facts you cite that make random dose cannabis problematic as a psychopharmaceutical are due to it appearing in the UNnaturally occurring form of a black market. If prohibitionists allow dealers to use the police and courts to settle brand infringements, contracts, etc, the naturally occurring markets will solve the dose problem, among others.

There are a couple of more dose-related issues for cannabis that are made worse by prohibition and attempts at pharmaceutical profits. In the quest for a standard dose Marinol was suggested by jpgrdnr above; that is a very expensive substitute for stirring your cannabis. You can't split a marinol pill, can you? And you can't know quickly how the dose will affect you.

It is easier to get the precise dose you need by vaporizing cannabis. If you take a whole marinol pill you get the full dose. You can't stop in the middle as you can with a vaporizer. I think a "10 mg" pill contains about as much THC as your grandfather's joint -- but none of the moderating cannabinoids, which the joint had. The fact that marinol is available in pills with smaller concentrations is a smokescreen because there is such a long delay between ingesting a pill and realizing it was not enough or too much. Finding a standard dose is MORE difficult with THC synthetics packaged by big pharma than with whole mixed cannabis in a vaporizer. The dose you get in a vaporizer is quickly recognizable. The dose you get in pills is not.

Except for promoting cannabis prohibition, there is no reason to ignore the advantage for finding the best dose quickly with whole cannabis, mixed and vaporized, compared to the slow metabolic process of guessing how many pills to swallow how often. For some medical uses, the difficulty of swallowing pills and keeping them down is also ignored by pharmaceutical packaging. Vaporizing or even smoking is a better dosing method then when you can't be sure how much of the pill you're going to throw up.

I guess many people are not vulnerable to bad effects when the strength of their new supply is much different from their old supply; they simply change the dose, making the decision within minutes. If I understand the summary of this small study, marinol doses were changed from 80 mg to 480 mg per day, but the subjects adjusted without dramatic reactions.

Tolerance to Effects of High-Dose Oral D9-Tetrahydrocannabinol and Plasma Cannabinoid Concentrations in Male Daily Cannabis Smokers

http://www.ncbi.nlm.nih.gov/pubmed/23074216

And while extracts or synthetics are more profitable, the pharmaceutical chemists may be guessing wrong about how to approximate whole cannabis.

----------
http://norml.org/component/zoo/category/marinol-vs-natural-cannabis

Patients prescribed Marinol frequently report that its psychoactive effects are far greater than those of natural cannabis.

Marinol passes through the liver where a significant proportion of the drug is metabolized into other chemicals. One of these chemicals, 11-hydroxy-THC, may be four to five times more potent than natural THC, and is produced in greater quantities. Thus, patients administered Marinol experience the psychoactive effects of both THC and 11-hydroxy-THC, greatly increasing the likelihood that they will suffer from an adverse psychological reaction. By comparison, only minute quantities of 11-hydroxy-THC are produced when cannabis is inhaled. Moreover, Marinol lacks the compound cannabidiol, which possesses anxiolytic activity and likely modifies and/or diminishes much of THC's psychoactivity in natural cannabis

Marinol avoids the potential risks of smoking, it has significant drawbacks. Because of synthetic THC's poor bioavailability, only 5-20 percent of an oral dose ever reaches the bloodstream and the drug may not achieve peak effect until four hours after dosing.
---------------

I guess the desire to prohibit cannabis and promote Big Pharma profits is the best reason to get worked up over unpredictable strength. It is just too easy to adjust your dose with whole cannabis. Few people are so shortsighted that they buy medicine one dose at a time, each time trying a different brand.

 

[Reverend Random]

It's an interesting question, CrOOk, and from what I've been told, while cannabis is able to stabilize many people with mood disorders in the short run, in the long run it's usually seen as contributing to instability. I'm afraid I'm not an expert from a medical point of view nor from personal experience, so you may discount what I'm writing here.

My suspicion would be that it's hard for people with bipolar to moderate their intake - when manic one might get overexcited and use more than a possibly therapeutic dose and when down, cannabis could reinforce feelings of depression. So I would infer that most physicians believe that cannabis mostly destabilizes the condition.

If you're interested in how cannabis affects your condition, crOOk, have you considered quitting for a period (dunno, a month or two) to see what it does when you're off cannabis? You might expect some withdrawal symptoms at first (for quite some time actually, since you've been using for a long time), but it could be a way to assess how your use relates to your bipolarity.

It would be interesting to see how different strains affect people with bipolar disorder. I know that in the Netherlands the one company that's allowed to cultivate medicinal cannabis have different strains that are prescribed for different afflictions.

Anyway, don't have anything scientific of value to add, just think it's an interesting discussion.

 

[endotropic]

A depressant reduces transmission of other peptides/proteins; that doesn't necessarily make people depressed. See literature on aps for depression.

By that definition any antagonist of any receptor is a depressant (caffeine reduces transmission of adenosine = depressant?). I don't think that's a standard usage of "depressant".

 

[AlphaMethylPhenyl]

I'm talking about a net effect in neuro-transmission. Caffeine works to antagonize adenosine, but the overall effect is increased catecholaminic activity.

No one would assume amphetamine is a depressant just because it decreases striatal gabaergic transmission.

http://www.nature.com/npp/journal/v26/n2/abs/1395742a.html

 

[paranoid android]

Well i have bipolar disorder NOS and Cannabis certainly helps to even out my moods and it makes the highs and lows less intense. Indica strains work the best for me in regards to calming me the fuck down or making me less depressed. It even helps mixed states as it seems to help me stop and think about wtf i am doing instead of being a moron and just doing whatever self destructive thing that pops into my head. My doctor has even said that if i helps then why stop using it? When i don't smoke Cannabis my moods can get wacky to say the least

 

[any major dude]

its a complex issue to say the least. BPD, either type, can be a very serious illness and cannabis is a complex drug.

Cannabis contains a litany of different substances. Depending on what you read between 70-85 different cannabinoids, of which a mostly unknown number are centrally active. There are quite possibly some other active chemicals as well, but i'm frankly unsure of how well that has been looked into. Anyway, of the known cannabinoids, at least one may well be helpful in the treatment of BPD, SCHZ, and possibly a few other disorders of which psychosis is a component. I'm speaking of cannabidiol, or CBD. It may well have a modulatory effect on THC's action as well. It has been postulated that CBD may well be an effective antipsychotic, and/or might be a lead compound in a new class of antipsychotics with less side effects than the current typical & atypical antipsychotics which are quite side effect laden, to say the least. I believe an Israeli research team has successful bred a strain of cannabis that contains a higher percentage of CBD, and almost no THC. though i'd have to check to see if it's being used in any human trials.

THC on the other hand, may actually be harmful to people with BPD, as it is most definitely harmful to SCHZ spectrum patients. Even in healthy volunteers a sufficient dose of THC alone will more likely than not cause transient psychosis. As we've seen with the proliferation of synthetic cannabinoids, such as the JWH series and others in Spice type products, the more potent, selective CB1 agonists are more likely to induce panic reactions and/or transient psychosis. Potent & selective full agonists (THC is a partial agonist) seem to be the worst offenders in this regard, JWH-018 was particularly notorious. I'm personally aware of a number of hospital admissions due to synthetic cannabinoids (much less for cannabis, but with psychosis spectrum patients it does happen) and the symptoms, IME, are very similar to typical bipolar or schizophrenic symptoms.

There are also issues with psychiatric diagnoses in this regard as well, but that's too complex a subject to get into here. Suffice it to say that people with SCHZ & BPD do have some similar genetic markers, but how those two broad categories will be divided up into more specific diseases once the neuroscience, genetics, & epigenetic fields yield some accurate physiological bases for treatment is currently unknown. This will certainly shed more light on who is helped by what chemical in cannabis & why, hopefully the science will be there in 5-10yrs.

I do know that some dispensaries have their products analyzed & percentages given for THC & CBD, some maybe with cannabichromeme as well. Though how the alkaloidal content varies over time may be an issue there as well. I am hopeful that private companies that arise as a result of the changing cannabis laws across the U.S. put some real effort into product testing & research as it appears public monies for such research will likely be limited for a while.

*interesting random fact: Cannabidiol is legal in the U.S. & if extracted from hemp oil is perfectly legal to produce or possess. There's at least one cannabidiol product currently available, and i imagine more.

 

[crOOk]

Thanks a lot for your input, Reverend Random, paranoid android and any major dude!

@any major dude
Do you know any articles that actually observed the effects of CBD on bipolar disorder in humans?

Personally, I've lowered my dosage massively and am now down to less than .1g at night of a weak indica strain. If I withdraw abruptly I will go batshit within 24-48h with absolute certainty. Even when lowering the dose gradually like I am now, I am often overwhelmed by emotions, aggression and sadness mostly. I've always been very impatient and physically aggressive during my youth until I started smoking cannabis and I am 100% certain that it helped me a lot in that respect.
On the flipside I have experienced very intense and short cycles while on a higher dose, with a switch to hypomania during daytime and a switch to depression during nighttime almost every single day in the past months. This has become less of an issue now that I have lowered my dosage (and abstain from caffeine!!), but I feel very emotionally volatile instead, like a bomb that could go off any minute, like I am about to do something stupid without much consideration.

I still feel there's a lot of potential in cannabis in this respect, potential I cannot access due to the content of active substances (whichever they are) not being standardized. Reading what any major dude wrote, it would actually make a lot of sense that some substances in cannabis destabilize me while others are actually beneficial. I know I am heavily addicted to cannabis after 15 years of daily use, but I also know that I never maintain habits of substances that actually worsen my overall state of well-being. I'm still very torn, but will have to see how it works out without cannabis for 2 months at least (something I've never ever managed to do before).

 

[any major dude]

I'm only aware of a couple specifically looking at BPD & cannabidiol, and they aren't terribly encouraging, but they were extremely low n studies, 2-3 patients i think, so i'm not willing to draw any definite conclusions about the effects in a wider population. Those were also with oral doses, which could differ from inhalation in some ways as well. And it's also possible it's a combination of CBD & other less known cannabinoids that may be helpful. There is still a lot we don't know & much work to be done!

 

[The Dr]

I have bipolar disorder, I used to smoke pot, but quit about 3 months ago or more. I would definitely say without a doubt that depending upon each person IT CAN HELP SIGNIFICANTLY. This is without a doubt. It's a natural thing that grows from the ground and a lot of these new drugs coming out to help treat bipolar disorder don't work for some people. Cannabis has been researched and documented longer than any of these new mood stabilizers released.

Now I will say that it is not a permanent fix for people suffering from bipolar disorder, however I do think it is a handy tool when trying to find the right medication. Some people react to the medication they are put on in very negative ways. Cannabis could be effectively used to help combat the negative effects while trying to find the right medication. From my experiences all other drugs (especially alcohol) have a extremely negative effect on people with bipolar disorder. Also not to mention, you could use a Benzo, but who wants to go that route? Sadly enough I am going that route because pot is illegal and for some people they can't use it.

Having a nice edible, indica, or stativa depending upon mood swing (high manic, low depressive) is common sense to me that it would be a excellent temporary fix. For high manic episodes you could have a Indica strain to help relax your body, an edible would work wonders due to the relaxation it gives. For a low depressive state a stativa could also work wonders. With increased energy and mental focus. Also if you do happen to get that "stoned" feeling and need a boost, just drink some coffee. This is common sense people just need to use the proper professional approach. Hope you guys read this.

There's more I could add, just waiting for responses..

 

[crOOk]

I have bipolar disorder, I used to smoke pot, but quit about 3 months ago or more. I would definitely say without a doubt that depending upon each person IT CAN HELP SIGNIFICANTLY. This is without a doubt. It's a natural thing that grows from the ground and a lot of these new drugs coming out to help treat bipolar disorder don't work for some people. Cannabis has been researched and documented longer than any of these new mood stabilizers released.

Now I will say that it is not a permanent fix for people suffering from bipolar disorder, however I do think it is a handy tool when trying to find the right medication. Some people react to the medication they are put on in very negative ways. Cannabis could be effectively used to help combat the negative effects while trying to find the right medication. From my experiences all other drugs (especially alcohol) have a extremely negative effect on people with bipolar disorder. Also not to mention, you could use a Benzo, but who wants to go that route? Sadly enough I am going that route because pot is illegal and for some people they can't use it.

Having a nice edible, indica, or stativa depending upon mood swing (high manic, low depressive) is common sense to me that it would be a excellent temporary fix. For high manic episodes you could have a Indica strain to help relax your body, an edible would work wonders due to the relaxation it gives. For a low depressive state a stativa could also work wonders. With increased energy and mental focus. Also if you do happen to get that "stoned" feeling and need a boost, just drink some coffee. This is common sense people just need to use the proper professional approach. Hope you guys read this.

There's more I could add, just waiting for responses..

Caffeine seems to be just about the worst drug I can take when it comes to trying to find affective stability. My violent daily cycling has pretty much stopped since I abstain from it. My caffeine intake reached a peak right before my nervous breakdown. I abused amphetamine for 2 years daily which made me hypomanic at best, but as soon as I started throwing daily caffeine into the mix the delusions started developing.

That being said, I appreciate the input. I've been down to ~.05g or so at night for a bit now and my psychotherapist actually recommended against abstaining from cannabis altogether for a while. She surely isn't an expert on psychopharmacology, but works solely with bipolar 1 and schizophrenic patients, so she has some experience on the subject.

I'm only aware of a couple specifically looking at BPD & cannabidiol, and they aren't terribly encouraging, but they were extremely low n studies, 2-3 patients i think, so i'm not willing to draw any definite conclusions about the effects in a wider population. Those were also with oral doses, which could differ from inhalation in some ways as well. And it's also possible it's a combination of CBD & other less known cannabinoids that may be helpful. There is still a lot we don't know & much work to be done!

Could you link me to those? I cannot finy any... :/

 

[The Dr]

Caffeine seems to be just about the worst drug I can take when it comes to trying to find affective stability. My violent daily cycling has pretty much stopped since I abstain from it. My caffeine intake reached a peak right before my nervous breakdown. I abused amphetamine for 2 years daily which made me hypomanic at best, but as soon as I started throwing daily caffeine into the mix the delusions started developing.

That being said, I appreciate the input. I've been down to ~.05g or so at night for a bit now and my psychotherapist actually recommended against abstaining from cannabis altogether for a while. She surely isn't an expert on psychopharmacology, but works solely with bipolar 1 and schizophrenic patients, so she has some experience on the subject.

No problem man. Also with the caffeine part, I only mean if you become tired in a state or frame of mind. It should only be used when needed too. You see I know my body very well and the limits it has. If something doesn't need to go into it, or if I'm in a depressive state/ manic state, I know. So I use everything accordingly. My psychiatrist is an experiment in psychopharmacology and is for marijuana. Like I said though, you have to use it in the correct way! It's not a cure. Think of it as a way to cope while not on the right medications. People may shoot me down for saying using marijuana as a coping skill, but if you don't suffer from bipolar disorder then you don't have to deal with the mood swings. Also only a temporary coping method.

 

[crOOk]

The thing with caffeine, the more I have the more crushed I'll be when i switch to depression during nighttime. I build a tolerance almost instantly and there only would be a very small dosage range that can even me out which size strongly depends on the current affective state, with too much pushing that affective state upwards to unphysiological levels. That's what makes using it "as needed" very difficult for me. As with all stimulants, the effects on my mood often kick in with a massive delay of up to 3h which reduces their usefuleness further. I then tend to cycle very very often 2 times per day (to depression at night and over to hypomania during daytime even with neuroleptics) when I'm not in a major episode. After having abused far over 100 psychoactive substances in the past 15 years I've become extremely sensitive to almost all classes except dissociatives when having no acute tolerance. Abstaining from all with a tiny bit of cannabis seems to always have worked the best. Unfortunately my self-medication with cannabis is hard to control with the unreliable strength between dosages and the stuff tasting so damn good (being addicted lol)!!

 

[paranoid android]

For what it's worth a psychiatrist i once saw (the only good one i did see) said that Nabilone or better yet Sativex wouldn't be a bad choice for me given the fact that i have Trigeminal neuralgia along with bipolar disorder. But of course neither are covered under my insurance and there is no way i could afford either out of pocket. The only Cannabinoid that is covered for me is Marinol which i have not heard much good about at all. She said she has given both Sativex and Nabilone to people with bipolar who smoke Cannabis anyway and respond favorably to it. My chronic pain doctor also recommended Sativex to me to treat both conditions if i ever get better insurance. So apparently it's not all that uncommon in Canada atleast to give prescription Cannabinoids to patients with mood disorders who already smoke Cannabis and are known to respond well to it especially those with chronic pain disorders as well.

Considering horrible typical anti-psychotic drugs like Haldol or worse by miles Zuclopenthixol (clopixol) are given everyday to bipolar patients in Canada i don't think Cannabis is that bad at all.

 

[crOOk]

For what it's worth a psychiatrist i once saw (the only good one i did see) said that Nabilone or better yet Sativex wouldn't be a bad choice for me given the fact that i have Trigeminal neuralgia along with bipolar disorder. But of course neither are covered under my insurance and there is no way i could afford either out of pocket. The only Cannabinoid that is covered for me is Marinol which i have not heard much good about at all. She said she has given both Sativex and Nabilone to people with bipolar who smoke Cannabis anyway and respond favorably to it. My chronic pain doctor also recommended Sativex to me to treat both conditions if i ever get better insurance. So apparently it's not all that uncommon in Canada atleast to give prescription Cannabinoids to patients with mood disorders who already smoke Cannabis and are known to respond well to it especially those with chronic pain disorders as well.

Considering horrible typical anti-psychotic drugs like Haldol or worse by miles Zuclopenthixol (clopixol) are given everyday to bipolar patients in Canada i don't think Cannabis is that bad at all.

Thanks a lot for that post. That's the first account I've heard of a psychiatrist recommending cannabis preparations for treatment of bipolar illness. Could you please give me the name of that psychiatrist and where he is located (maybe via pm)? I would like to ask him whether any systematic studies on the subject are known to him. It is absolutely impossible to navigate through the jungle of crappy meta-studies that try to find a causal link between "psychosis" and "cannabis abuse" on ncbi.

I reduced my dosage to a miniscule amount of a weak indica strain as I said earlier. This most definitely eliminated the worst depressive symptoms, most prominently suicidal thoughts. The other day a friend came through with his pure powerplant bio grow and gave me a handful of bud at night. I had already smoked said miniscule amount that night, but swept all worries aside and smoked about the same amount as I had already smoked.
The next day I finally got through a huge heap of paper trash that had accumulated on my desk and shelf over the course of the past year. I cleaned out four stuffed grocery bags. I got shit done which just hasn't happened in a healthy fashion ever since I'm on neuroleptics. I felt stable during the entire day, most definitely not hypomanic.

Now I stuck to the dosage of that last night smoking the new bud instead of the old. After dropping off my daughter today I found myself in the situation of having another 4 hours to kill until I'm gonna attend a concert (Patti Smith yay). Usually there would've been severe anhedonia and I would've just hit the bed for the duration. Used to this procedure I tried to lay down but just couldn't find sleep which to me is a very good sign I'm becoming stable, 5h naps during the daytime just cannot be healthy. Instead I managed to clean all the doors in my appartment, non-obsessively so. It just had to get done.

I'm still fully aware that high amounts of cannabis cause severe depression in me, but there's something going on that I just cannot put my finger on. Some reason that goes past "addiction" why I have been consuming cannabis for the past 15 years. Sigh I wish there were standardized extracts available so that I could at least observe the effects without so many factors modulating what ends up in my blood. :/