CBD for bipolar depression? The presence of therapeutic hope for a difficult problem.
It has long been acknowledged that current drugs and therapies for mental health issues are woefully inadequate. And none more so than bipolar disorder (BD), a terrible condition characterized by uncontrollable mood swings between manic episodes and severe depression. Twenty-five to sixty percent of people will try suicide at some point in their lifetimes, as merely existing becomes intolerable for many.
Most bipolar disorder (BD) patients are prescribed a combination of mood stabilizers such as lithium, antidepressants, antipsychotics, anti-anxiety medication, anticonvulsants, and sleeping pills, leaving them frequently unable to function. More than any other mental health issue, 89 percent of BD patients report having severe impairment owing to their diagnosis (and probably their treatment).
As a result, cannabis and/or alcohol self-medication is prevalent, despite being uniformly condemned by health professionals. In fact, the majority of therapists who regularly prescribe cannabis for other disorders such as anxiety and depression avoid the plant when it comes to bipolar disorder, citing the risk of aggravating manic episodes and its association with an increased risk of psychosis.
In spite of this, anecdotal data from patients and a few pioneering physicians indicates that CBD-rich cannabis has life-changing advantages, including mood stabilization, the holy grail of bipolar illness symptom therapy.
WHAT DOES BIPOLAR MEAN?
Bipolar illness, formerly known as manic depression, typically presents in adolescence, though it can occur at any age, and affects around 3 percent of the population in the United States.
After a first episode, an official diagnosis can take an average of eight years, and younger patients are occasionally misdiagnosed with ADHD. However, when the diagnosis is made, it is typically classified as either bipolar I disorder, in which one manic episode is preceded or followed by hypomanic or major depressive episodes, and in some cases psychosis; or bipolar II disorder, in which patients have experienced one major depressive episode and at least one hypomanic episode, but never a full-blown manic episode.
Due to the complexity of bipolar disorder, patients are prescribed many medicines, some of which can exacerbate symptoms and leave them feeling like zombies.
BIPOLAR DISORDER, DOPAMINE, & THE ENDOCANNABINOID SYSTEM
The cause of BD is not fully understood. One widely held idea, however, argues that an imbalance in the dopaminergic system may play a role, with excessive dopamine transmission contributing to the manic phase and high dopamine transporter levels resulting in decreased dopaminergic function and depression. Dopamine is a neurotransmitter that contributes to pleasure, motivation, and learning.
Scientists generally agree that the endocannabinoid system serves as the body’s master regulator, maintaining homeostasis in brain function and across the entire body. This includes serving as a “important filter” for incoming inputs functioning locally in the midbrain and influencing how information is sent to dopamine neurons. But let’s see if really CBD for bipolar depression can give benefits and to help.
While it is unclear whether dysregulation of the endocannabinoid system contributes to BD, the authors of “Endocannabinoid Modulation of Dopamine Neurotransmission” advocate “endocannabinoid-based therapies as effective treatments for illnesses associated with abnormal DA function.” As a side note, CBD is a partial agonist [activator] of the dopamine D2 receptors, which experts believe may contribute to its antipsychotic action.
The 2019 research titled “Bipolar Disorder and the Endocannabinoid System” proposes that CB2 cannabinoid receptors, which are believed to have an immunomodulatory function, may be a therapeutic target for the management of BD symptoms.
Studies indicate that higher levels of specific inflammatory pro-cytokines are present during the manic and depressed stages of bipolar disorder and revert to normal once the patient has reached the neutral phase.
Thus, the researchers hypothesize that reducing inflammation by targeting CB2 receptors and using selective CB1 receptor antagonists “may lead to remarkable advances in pharmacotherapy of BD based on modulation of the ECS, and this approach provides a brand-new treatment strategy to expand the arsenal available for pharmacologically managing BD.”
HERE IS A TRUE STORY
Diane Green, 62, of Rocklin, California, began exhibiting symptoms of bipolar disorder at age 15. However, it took almost two decades before she received an appropriate diagnosis.
Diane’s education, her family relationships, her marriages, and her nursing career have all been devastated by BD.
“The only thing I know is having bipolar disorder and taking medication,” she says. It touches every aspect of life and destroys everything. She never asked herself before the question – “Does CBD for bipolar depression?”
Before she was diagnosed with schizophrenia at the age of 38, Diane self-medicated with alcohol and, on sometimes, cannabis to calm her agitation. Nevertheless, her violent outbursts, anger, and depression persisted, leaving Diane yearning for assistance.
Once, she recalls, she phoned the police. “They arrived, and I begged him to commit me to a mental institution.” He inquired if I was drinking, and I replied affirmatively. And he added, “Well, they’re not taking you, but I remember getting in his car nonetheless.”
While receiving a diagnosis of bipolar disorder was in many respects a relief, it marked the beginning of a new period of her life: managing with the adverse effects of the different medications she was prescribed.
“The drug is a nightmare in and of itself,” adds Diane; “the side effects were startlingly awful.” The fog I was in was dreadful.”
According to Diane, the drug exacerbated her depression episodes rather than alleviating them.
“Once they placed me on medication, my depression became so severe that I could not get out of bed,” she recalls. It never stopped producing episodes… However, it helped alleviate tension. Thus, I continued to experience manic depression and rapid cycling.
CBD COMES TO THE SAVE
So, let’s check it out – CBD for bipolar depression? During one of her lowest points, Diane decided to try CBD oil.
Diane says, “About 45 minutes later, I’ve noticed I’m calmer.” “I’m more at ease. Something felt better because I wasn’t depressed, I believe.”
Delighted with the benefits, Diane began taking CBD daily, slowly tapering off her medications over time (a process best undertaken with the guidance of a health professional). Diane could now begin to enjoy her life once again, as she was no longer hampered by these debilitating side effects.
She recalls warmly the awe she had when she had a clear head in the mornings, went for walks, and simply took in the air and nature. “And that became so useful to me, having a clear head… I believe it simply balances it out, so that I no longer get symptoms. Sometimes I forget I’m bipolar.”
Diane has had to experiment with various CBD products before finding the optimal therapeutic dosage. Interestingly, for her, rather than CBD-rich cannabis as a complete plant, the most effective treatment for her problems has been 33 mg of CBD isolate twice day.
After a lifetime controlled by bipolar disease, Diane wishes she had discovered CBD sooner.
“I reflect on those goals and dreams because I wanted a job, I was enthusiastic about life in college and getting married someday and having the perfect children and the ideal home… And everything gradually disappears. It just does… I don’t believe CBD would have ever required me to go on disability.”
WHAT AN EXPERT SAYS
Over the years, holistic physician Deborah Malka, MD, has treated a number of individuals with bipolar disorder. In fact, she is one of only a handful of specialists globally ready to offer cannabis as a treatment for bipolar disorder.
In her book ‘Medicinal Cannabis: Pearls for Clinical Practice,’ Malka presents a number of case studies of bipolar patients who responded positively to CBD for bipolar depression with CBD-rich cannabis plants, and in an interview with Project CBD, she explains why treating bipolar disorder with cannabis involves more than simply alternating between CBD and THC to manage manic and depressive cycling.
“I had about ten patients with bipolar disorder,” says Malka, “and I discovered that the majority of them responded well to some form of CBD as an ongoing mood stabilizer, in order to prevent mood swings.”
According to Dr. Malka, the fact that CBD has proven anticonvulsant properties, and anticonvulsants are routinely recommended to supplement Lithium for bipolar disorder, it is not so surprising that CBD has mood stabilizing benefits.
“I feel that CBD’s anticonvulsant characteristics fundamentally impact the lability of certainly serotonin and possibly dopamine, so bringing bipolar illness patients into a more moderate range.”
However, CBD is not the end of the story for Malka. She believes it is crucial to highlight how cannabis plant chemicals hold several therapeutic keys for the complex bipolar symptoms that a multiplicity of pharmaceutical medications are unable to treat — without the horrifying side effects.
Terpenes play a crucial part in the management of cycle episodes, and Malka prefers myrcene to promote tranquility and better sleep during manic phases and alpha pinene and/or limonene for energizing patients when they fall into despair.
WARNING WITH THC
CBD for bipolar depression can be help helpful. But what about THC? Malka will use THC chemovars including myrcene to control sleep, which is frequently disturbed in bipolar disorder, but she will not prescribe THC to patients who are manic or have suicidal thoughts.
“If someone takes too much stimulating THC-rich cannabis, which is what you’d want to use if you’re suicidal and in a really poor mood,” explains Malka, “it distorts your perception to the point where you skip logic and become bewildered, particularly if you’re not used to cannabis. A toxic dose of THC can actually create psychosis. Therefore, we do not want it.”
Before using cannabis to control mood swings, Malka advises bipolar individuals to get professional assistance from an expert physician to prevent aggravating their symptoms.
She emphasizes, “It is not safe if you are a naive patient.” “Too much THC is dangerous, particularly if you have a mood illness. Please avoid doing so. Get expert assistance.”
PRELIMINARY CLINICAL EXAMINATIONS
Given the buzz surrounding the therapeutic application of CBD in a variety of mood disorders, including as an antipsychotic treatment for schizophrenia, it is not surprising that a pilot clinical trial is investigating if the chemical may also be effective in bipolar disorder. Despite the fact that several previous assessments found only poor evidence that CBD was beneficial for BD.
Unfortunately, there are currently no conclusive results to report. One small Brazilian trial, which was prematurely discontinued due to COVID, administered 150-300 mg of CBD or a placebo to 36 bipolar patients over a twelve-week period to examine if their depression and anxiety symptoms improved and to measure inflammatory biomarkers. Despite prematurely halting the trial, the researchers were able to submit the results to a journal for review and, presumably, future publication.
Another clinical trial currently recruiting in San Diego will compare the effects of a single 600mg dose of Epidiolex (pharmaceutical CBD) with 5mg of dronabinol (synthetic THC) and a placebo on 144 bipolar participants in order to evaluate their effects on “cognitive domains relevant to bipolar disorder, e.g., arousal, decision making, cognitive control, inhibition, and temporal perception (sense of timing)” as well as
The study appears to be less concerned with marijuana as a potential treatment for bipolar illness and more concerned with determining why so many individuals with BD also engage in substance addiction.
Accordingly, it appears that the stigma against cannabis and bipolar disorder among health professionals is entrenched, and additional clinical trials are required before prescribing CBD-rich cannabis or CBD alone will be widely accepted by mental health practitioners and psychiatrists.
