Cannabis as a Mood Stabilizer in Bipolar Disorder

The Use of Cannabis as a Mood Stabilizer in Bipolar Disorder:

Anecdotal Evidence and the Need for Clinical Research

Lester Grinspoon, M.D. & James B. Bakalar

Published in Journal of Psychoactive Drugs, Volume 30 (2), April - June 1998, pp. 171-177.

Abstract- The authors present case histories indicating that a number of patients find cannabis (marihuana) useful in the treatment of their bipolar disorder. Some used it to treat mania, depression, or both. They stated that it was more effective than conventional drugs, or helped relieve the side effects of those drugs. One woman found that cannabis curbed her manic rages; she and her husband have worked to make it legally available as a medicine. Others described the use of cannabis as a supplement to lithium (allowing reduced consumption) or for relief of lithium's side effects. Another case illustrates the fact that medical cannabis users are in danger of arrest, especially when children are encouraged to inform on parents by some drug prevention programs. An analogy is drawn between the status of cannabis today and that of lithium in the early 1950s, when its effect on mania had been discovered but there were no controlled studies. In the case of cannabis, the law has made such studies almost impossible, and the only available evidence is anecdotal. The potential for cannabis as a treatment for bipolar disorder unfortunately cannot be fully explored in the present social circumstances.

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[EDITOR'S NOTE: The following article is based in part on materials that appear in the revised and expanded edition of the authors' book, Marihuana, The Forbidden Medicine, republished in 1997 by Yale University Press, Newhaven and London. While the interviews have previously appeared in print, they provide a reference point for the authors' discussion of cannabis’ potential role in the treatment of bipolar disorder as it appears in this theme issue. In their revised and expanded book, Grinspoon and Bakalar discuss a wide range of what they refer to as "Common Medical Uses" and” Less Common Medical Uses" for cannabis. The former include treatment for the nausea and vomiting of cancer chemotherapy, glaucoma, epilepsy, the muscle spasms of multiple sclerosis, paraplegia and quadriplegia, the weight loss syndrome of AIDS, chronic pain, migraine, rheumatic diseases, pruritus, PMS, menstrual cramps and labour pains, depression and other mood disorders. The latter include treatment for asthma, insomnia, antimicrobial effects, topical anaesthetic effects, anti-tumour effects, dystonias, adult ADD, schizophrenia, systemic sclerosis, Crohn's disease, diabetic gastro paresis, pseudo tumour cerebri, tinnitus, violence, PTSD, phantom limb pain, alcoholism and other addictions, terminal illness and aging.]

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In bipolar or manic-depressive disorder, major depression alternates with uncontrollable elation, or mania. Symptoms of depression include loss of interest and pleasure in life, sadness, irrational guilt, inability to concentrate, appetite loss, lethargy and chronic fatigue. Manic symptoms include sleeplessness, tirelessness (until exhaustion leads to a breakdown), and recklessly gregarious and expansive behaviour, which sometimes turns to irritability, rage and paranoid delusions. Bipolar disorder is treated mainly with lithium salts and anti-convulsant drugs, which can have serious side effects. Thirty percent to 40% of patients with bipolar disorder are not consistently helped by or cannot tolerate standard medications. In the course of the authors' studies of the medical uses of cannabis (Grinspoon & Bakalar 1997), a number of sufferers were discovered who believed marihuana to be more effective than conventional anti-manic drugs, or who used it to relieve the side effects of lithium.

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