Bipolar disorder may be one of the world’s oldest known illnesses with records of its existence dating back thousands of years.
But today, doctors are faced with a greater challenge when it comes to treating the condition. The challenge is drug abuse; a problem that affects only 6% of the general population yet plagues more than 50% of all patients with bipolar disorder.
Interestingly, cannabis appears to be the drug of choice for these patients, which has led many to question its role in the treatment of this age-old disorder.
What is Bipolar Disorder?
Bipolar disorder (also known as bipolar affective disorder) causes dramatic mood swings in patients, alternating between states of depression and mania. Mania can range from moderate levels of energy and excitement to symptoms of psychosis, such as erratic and delusional behaviors.
Experts say that approximately 4% of the population will fit the criteria of bipolar disorder at some point in their lives. And while the underlying cause has yet to be identified, there are a variety of treatment options available for patients.
The first-line of treatment is lithium which acts to reverse symptoms of mania, but other mood-stabilizers (anticonvulsants) and antipsychotics are commonly used as well.
On the other hand, current pharmaceutical therapies subject patients to a wide range of side-effects, which can sometimes outweigh the benefits of the treatments themselves. As a result, some are beginning to turn to medical marijuana – a sparsely recommended treatment option that is gradually becoming more noticed as research progresses.
How Can Marijuana Help?
Medical marijuana acts on the endocannabinoid system – a homeostatic regulator that is present in all humans. Interestingly, research suggests that certain cannabinoids found in marijuana (i.e. THC and CBD) may have significant mood-stabilizing properties that could be beneficial for patients with the disorder.
Studies have shown that THC, under certain conditions, can have anti-anxiety, hypnotic and antidepressant effects, resulting in improvements in mood and overall well-being in normal subjects as well as in patients suffering from pain, multiple sclerosis or cancer. CBD seems to counter the psychoactive effects produced by high doses of THC and may also possess anti-anxiety, hypnotic and anticonvulsant properties of its own.
Researchers have also identified a link between marijuana use and cognitive improvements in patients with schizophrenia – a finding could explain evidence of similar improvements in bipolar disorder.
What Studies Say
A number of recent studies have set out to determine the effects of marijuana use on patients with bipolar disorder and have provided some thought-provoking findings.
In 2010, researchers at the University of Oslo in Norway published the results of a study conducted on 133 bipolar patients. What they found was that patients who used cannabis regularly actually performed better than non-users on tests of verbal fluency and learning, although improvements in learning were not statistically significant.
In another study, published in 2012 by researchers at the Zucker Hillside Hospital in New York, regular marijuana use was linked to higher levels of attention, processing speed and memory among the 200 bipolar patients that the researchers followed over a 9 year span.
On the other hand, while these results suggest that marijuana use might improve cognitive function in cases of bipolar disorder, a study published in 2009 found that bipolar patients who used cannabis exhibited less treatment compliance as well as higher levels of illness severity, mania and psychosis, although data was only collected over a 12 month period.
Interestingly, the study also found that while cannabis users were less likely to have a relationship and were less satisfied with life in general, they were still more engaged in social activities than non-users. Furthermore, the study identified no significant differences between cannabis use and independent living or work impairments.
Despite the overall lack of clinical research available on cannabis use and bipolar outcomes, case reports provide an abundance of evidence that seem to support its usefulness.
A study published in 1998 by Harvard professors Dr. Lester Grinspoon and James B. Bakalar documented 5 cases in which patients obtained significant relief from their bipolar-related symptoms through the use of medical marijuana.
One of these patients, a 47-year-old woman, found cannabis to be more effective than other drugs in controlling her manic episodes.
“A few puffs of this herb and I can be calm… this drug seems harmless compared to other drugs I have tried, including tranquillisers and lithium.”
In another case, the husband of a bipolar sufferer told of numerous ways that cannabis seemed to help his wife in dealing with the disorder.
“My wife functions much better when she uses marijuana. When she is hypomanic, it relaxes her, helps her sleep, and slows her speech down. When she is depressed and would otherwise lie in bed all day, the marijuana makes her more active… Lithium is also effective, but it doesn’t always keep her in control.”
These cases were also cited alongside others in a review study conducted by a team of British researchers. The review, published in 2005 in the Journal of Psychopharmacology, presented evidence from a 1996 report that described 5 cases in which marijuana seemed to have a direct effect in countering depression. The researchers also cited 2 surveys conducted in 2003 which found that 15-27% of medical marijuana patients in California were prescribed the drug for various mood disorders, including depression, bipolar disorder, PTSD and ADHD.