An effective treatment for the extreme ups and downs of bipolar disorder has long eluded conventional medicine. | Flickr CC user versionz

An effective treatment for the extreme ups and downs of bipolar disorder has long eluded conventional medicine. | Flickr CC user versionz

Earlier this year, a contributor to the United Patients Group blog wrote about his son’s struggle to find an effective treatment for bipolar disorder. After four years of nearly annual hospitalization, cannabis was the only option that seemed to help. “From his first puff I could see immediate mood improvements,” the father wrote. But interestingly, he also felt that his son’s habit of smoking “street pot” had increased his psychosis, even provoking manic episodes.

How is it that the same plant could both agitate and alleviate his son’s symptoms? The key to effective treatment, the father argued, was in the chemical makeup of one particular cannabis strain they’d found—it had high amounts of cannabidiol (CBD), one of the principal cannabinoids in marijuana.

The Connection Between Cannabis and Bipolar Disorder     

Research into the relationship between cannabis and bipolar disorder has resulted in contradictory results: some studies say using cannabis improves cognitive functions, with patients reporting that it works better than conventional drugs to treat their mania and depression. But other studies suggest it increases depressive symptoms and that continued use of cannabis is associated with a higher occurrence of manic episodes. And there’s the risk, too, of dependence and drug abuse—research has found that people with bipolar disorder are 6.8 times more likely to have a history of illicit marijuana use than the rest of the population.

Despite all this, the father from the United Patients Group may have been onto something. While case studies on cannabis’ effects have been mixed, there’s a lot of evidence that CBD has the same antipsychotic and anticonvulsive properties as conventional bipolar disorder treatments. In other words, the chemical makeup of the strain you use does seem to matter, especially the balance of cannabis’ two most famous ingredients: tetrahydrocannabinol (THC) and cannabidiol (CBD).

The Difference Between THC and CBD

Of the 113 known compounds in marijuana, THC and CBD are the two principal active cannabinoids. Both interact with the endocannabinoid system in your body, the system that affects mood, appetite, pain sensation, and memory (this system is also known to play a role in mental disorders when it doesn’t function properly). The amount of THC and CBD in your cannabis—plus the way these compounds interact with each other—results in the different “highs” you get from various strains.

The health effects of the principal cannabinoids in marijuana. | Image Source: Wikimedia user Subvertc

The health effects of the principal cannabinoids in marijuana. | Image Source: Wikimedia user Subvertc

So, how do these two compounds differ? It’s a surprisingly long list. THC is psychoactive and has properties that relieve pain, reduce vomiting, and reduce muscle spasms. It also has a relaxing effect on most people, which can give you that classic “stoned” feeling. And while marijuana doesn’t cause psychotic disorders (contrary to familiar old-school propaganda), research shows that it can mimic symptoms—and this effect also comes from THC.  

CBD also relieves pain, and it has additional properties that are anti-anxiety, anti-inflammatory, and neuroprotective. But even more interesting are CBD’s antipsychotic and anticonvulsive properties, which suggest the compound could be used to replace conventional antipsychotics and anticonvulsants, the two drug classes most commonly prescribed to people with bipolar disorder. For instance, CBD’s antipsychotic properties mean that the cannabinoid acts like an “atypical” antipsychotic—working similarly to a conventional antipsychotic medication but without the same serious, long-term side effects.

So while THC can induce psychotic reactions and impair cognitive functions, CBD’s antipsychotic properties mitigate the effects of THC. It makes sense, then, that a strain with a high CBD content would be effective against bipolar disorder, while a strain with high THC might only aggravate psychotic symptoms. But unless you specifically seek out a high-CBD marijuana, it’s likely you’ll wind up with a strain that’s much higher in THC. In a study from the University of Mississippi that assessed the THC/CBD content of illegal marijuana confiscated between 1994 and 2014, researchers found that THC content increased from 4% to 12% over the years, while CBD decreased. There used to be about 14 times more THC than CBD in marijuana—now there’s 80 times more.

Whole Cannabis vs Isolated CBD: Which Is Better?

If THC could induce psychosis in some people with mental disorders, is it better to just use pure CBD? The father from the United Patients Group reported his son had great results with cannabis strains that had a CBD:THC ratio of 20:1, but he also said they had even better results with isolated CBD in oil form. Another man claims that CBD oil was so effective he was able to quit his conventional antipsychotic prescription.

But the way that THC and CBD interact may also be important. In 2012, a man named Miles Houser wrote to a Harvard professor who was collecting case studies on cannabis, stating that after running the gamut of conventional anticonvulsants, antipsychotics, and antidepressants, high-CBD cannabis had been the only thing that worked for him. In an article for the online magazine Ladybud, marijuana legalization advocate Gradi Jordan wrote that, based on the 36 years she’d used cannabis to treat her bipolar disorder, she felt THC was an essential component to effectively managing severe symptoms.

What’s the bottom line? We still don’t know. There’s a lot of evidence that CBD—either in isolated form or in high-CBD strains of cannabis—can effectively treat both the manic and depressive symptoms of bipolar disorder. But most clinical cannabis studies don’t include the ratio of CBD:THC in the strands they use, and more research is needed to explore whether CBD oil or whole cannabis works better. Like any psychedelic, cannabis needs to be treated with caution and respect, and it shouldn’t be used as a haphazard self-medication. And as with all medicines, treatment is ultimately a matter of personal preference: the effectiveness and side effects will depend on the unique biochemistry and personality of each person. But while we’re waiting on conclusive research, it seems that CBD is providing promising relief to people who need it.