CBD oil can help stabilize our mood & emotions. Here are the best CBD oils for bipolar & how they can help. CBD has been touted to help a number of mental health conditions. Learn if there is any evidence of CBD helping people with bipolar disorder. Bipolar patients and pioneering doctors report life changing benefits from CBD, including mood stabilization, the holy grail in bipolar disorder symptom management.
CBD Oil for Bipolar Disorder: Does It Help, Dosage, & How to Use
Bipolar disorder is a condition involving unusual shifts in mood, focus, and energy.
There’s some evidence that CBD can help, but there are a few cautions to be aware of too.
Bipolar disorder affects between 0.4% and 1.6% of the world’s population, according to recent reports. This means roughly 70 million people around the planet suffer from bipolar disorder to some degree.
There are treatment options available — however, they often come with a myriad of negative side-effects, and often don’t work at all.
Cannabidiol (CBD), has been shown to protect the brain from damage and support healthy neurotransmitter function. Through these effects, it’s believed to reduce the severity of the bipolar disorder and help those affected to maintain a more stable mood throughout the day.
Here, we’ll explore the role CBD plays in maintaining mood, how to use CBD for bipolar disorder, and when to avoid it.
Let’s get started.
MEDICALLY REVIEWED BY
Updated on October 20, 2021
Table of Contents
$49 – $229
Royal CBD Oil 30 mL
5 / 5
|Total CBD:||500 – 2500 mg|
|Potency:||16.6 – 83.3 mg/mL|
|Cost per mg CBD:||$0.12 – $0.18|
The Benefits of CBD Oil For Bipolar Disorder
Using CBD for bipolar disorder isn’t a new concept, and there’s currently one phase II clinical trial underway comparing the long-term effects of CBD with the effects of a placebo in patients diagnosed with bipolar disorder.
In order to get to this stage of research, CBD needed to pass similar tests with flying colors. If it failed any of the studies prior to this phase II clinical trial, it wouldn’t have been approved for use in the study.
Previous studies found that CBD offers a clear benefit to mood disorders with little to no side-effects.
The benefits of CBD for bipolar disorder include:
- Relieves common side effects such as anxiety or insomnia
- Helps stabilize mood & alleviates depression
- Regulates the endocannabinoid system (involved with the cause of bipolar disorder)
Although there are clear benefits to using CBD with bipolar disorder, there are some important cautions to be aware of before deciding if it’s right for you or not.
Best CBD Products For Bipolar Disorder
Caution #1: The Type of CBD Product You Use Matters
Some cannabinoids in the cannabis plant, including THC, can actually make bipolar disorder significantly worse. Therefore, it’s critical that the CBD product you purchase contains low levels of THC to avoid this.
For bipolar disorder, it’s recommended that only a high-grade, full-spectrum extract with third-party lab testing to confirm the cannabinoid profiles of the product is used.
The other option is to use a CBD isolate — which contains nothing but active CBD.
Caution #2. Other Medications Need to Be Considered
Bipolar disorder is usually treated with powerful antipsychotic drugs. These medications alter neurotransmitters in the brain. Users need to be cautious when taking other supplements, including herbs and nutritional supplements such as CBD oil because it can be difficult to predict how they interact with prescription medications.
Always consult your doctor before trying CBD for bipolar symptoms to check for drug-herb interactions.
What is Bipolar Disorder?
Bipolar disorder is characterized by dramatic changes in mood, behavior, and energy levels.
The root of the condition is the balance of neurotransmitters in the brain. Neurotransmitters such as serotonin, dopamine, GABA, glutamate, and others all fluctuate and interact throughout the day to regulate our moods.
Everybody’s mood fluctuates to some extent — we have periods of feeling joy and periods of discomfort and irritability. This is normal — however, in bipolar patients, these fluctuations are far more severe, often making it difficult to perform daily activities such as complete work or socially interact.
The specific neurotransmitters responsible for bipolar symptoms can vary, and in many cases, the exact cause is never truly identified.
This makes the condition hard to treat, and much of the treatment in a hospital is done through trial and error — patients try a drug and wait to see if it produces results. If not, they try the next one in line until they find something that relieves their symptoms.
Bipolar disorder causes episodes of extreme emotion that can last anywhere from a few minutes to a few weeks at a time. Episodes can range from mild to extreme.
There are three primary types of episodes experienced by those with bipolar disorder.
1. Manic Episodes
The brain is in a state of hyperactivation, which can make people seem intense or overly happy. During manic episodes, those affected tend to have a lot of energy. They can seem highly motivated and euphoric and tend to develop side-effects such as anxiety and insomnia.
Manic episodes can become dangerous as they can make people reckless and may bring negative side-effects such as paranoia, psychosis, or delusions.
2. Hypomanic Episodes
A hypomanic episode is similar to a manic episode — but tends to be less extreme. It’s often considered a halfway point between mania and depression.
People experiencing hypomania are often able to continue their normal responsibilities, but find it more challenging to avoid distraction or bursts of anxiety.
3. Major Depressive Episodes
Major depressive episodes are the opposite of manic episodes. It causes those affected to have low motivation. They may feel tired and sluggish and can feel severely depressed. They often go through periods of social isolation, and some experience thoughts of suicide or death.
The Causes of Bipolar Disorder
There’s no single cause of bipolar disorder. It’s a combination of many factors ranging from genetic inheritance to environmental and social influences.
Some of the Known Causes of Bipolar Disorder Include:
Are There Any Treatment Options For Bipolar Disorder?
Treating bipolar disorder is difficult because the cause is hard to determine.
The best treatment for the condition comes in the form of psychiatric therapy to determine potential triggers and underlying causes such as a history of abuse or mental stresses.
Other causes, such as hormone imbalances, should also be tested for and treated as necessary.
In terms of symptomatic support, there are a few pharmaceutical medications effective for treating bipolar disorder.
Medications Used to Control Bipolar Symptoms
- Mood stabilizers (lithium, valproic acid, carbamazepine)
- Antipsychotics (Abilify, Zyprexa, Latuda)
- Antidepressants (Sertraline)
- Antidepressant-antipsychotics (Symbyax)
- Anticonvulsants (Depakote, Tegretol)
Other Treatments for Bipolar Disorder
- Hospitalization during extreme episodes of mania or depression
- Nutritional support
- CBD supplementation
- Herbal medicine
- Removal of mental stresses
- Sensory deprivation
- Support groups
How to Use CBD for Bipolar Disorder Safely
CBD alleviates many of the common symptoms of bipolar disorder. However, there are also reports of people who had their symptoms magnified due to cannabis use. This is mainly due to the THC content in marijuana, which is neuro-stimulating and can aggravate symptoms.
For this reason, it’s not safe for people with bipolar disorder to consume marijuana that has a high THC content.
To use this supplement safely, it’s important to find CBD oils, capsules, or edibles confirmed to be low in THC and high in therapeutic CBD.
It’s also crucial that you speak with your doctor before taking CBD for bipolar disorder to make sure the compound won’t interact negatively with the medications you’re taking.
Once your doctor has approved you to start taking CBD to alleviate symptoms of bipolar disorder, you need to find the right product to use and determine the best dose of CBD.
There are many different ways you can take CBD. Here, we’ll discuss the most common options in detail and how they can be used alongside a bipolar diagnosis.
1. CBD Oils & Tinctures
CBD oils and tinctures are the most common forms of CBD supplementation because it allows for simple and precise dosing.
They’re made by mixing a CBD extract with oil. CBD oils easier to consume because pure CBD or cannabis resin comes as tiny crystals or a sticky, oily, resin — both of which make it difficult to measure the dose accurately.
As an oil, the dose is measured by counting the number of drops using the provided dropper.
CBD oils and tinctures come in a variety of potencies. It’s recommended that you choose a potency that best matches the dose you aim to take. Use our CBD oil dosage calculator to find your approximate dosage.
2. CBD Capsules
CBD capsules provide another popular method of consuming CBD. They take away a lot of the guesswork when it comes to dosing and make it easy to take your CBD on the go.
CBD capsules also come in both low-potency and high-potency options.
Many people who take a variety of capsules throughout the day with their other medications or supplements find this form the easiest to integrate into their daily routines.
3. CBD Edibles
CBD edibles are a great option for people who don’t like the taste of the oils or tinctures and want to avoid swallowing capsules.
They come in all different forms — from CBD-infused honey to CBD chocolates.
The only downside to edibles is that the amount of CBD they contain is often unreliable, making dosing inconsistent.
For a condition such as bipolar disorder, it’s important to be consistent with your CBD use — something that edibles aren’t always able to provide.
4. CBD E-Liquids & Vape Oils
CBD vape pens & vape oils provide the most efficient form of dosing because bioavailability through the lungs is much higher than it is through the digestive tract.
Vaping is a good option for people with bipolar disorder because it offers fast relief from symptoms. It’s also one of the most portable methods of taking CBD.
What’s The Dose of CBD Oil For Bipolar Disorder?
Deciding on the right dose of CBD can take some trial and error. Everybody responds to this compound differently, so a little bit of self-testing is needed to find the right dose. This is also the case with most of the pharmaceutical bipolar medications used.
It’s best to start with a low dosage and build up gradually over time until you find relief from your symptoms.
In most cases, people with bipolar disorder won’t start to experience benefits until they reach the medium- or high-strength doses. Some people even require doses outside the listed range. The only way to find out your optimal dose is to test it.
With that said, you can use our dosage calculator below to find the approximate dose based on your weight and desired strength.
General Dosage Ranges for Psychological Disorders
|Low-Strength CBD||Medium-Strength CBD||High-Strength CBD|
|• Mild depression or anxiety
• Periods of higher-than-average stress
• Daily maintenance dose for asymptomatic bipolar disorder
|• Moderate bipolar symptoms
• High stress
|• Severe bipolar symptoms
• Severe insomnia
Most bipolar patients take a medium- or high-strength dose of CBD — however, this can vary from one person to the next.
CBD for Bipolar Disorder: Does It Help?
Laura Dorwart is a health journalist with expertise in disability rights, mental health, and pregnancy-related conditions. She has written for publications like SELF, The New York Times, VICE, and The Guardian.
Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more.
Erika Prouty, PharmD, is a professional community pharmacist who aids patients in medication management and pharmacy services in North Adams, Massachusetts.
Bipolar disorder refers to a group of mental health disorders that cause extreme highs and lows in mood. According to the National Institute of Mental Health (NIMS), 4.4% of adults in the United States experience bipolar disorder at some point in their lives.
A person with bipolar disorder, previously known as manic depression, experiences disruptive mood fluctuations that interfere with their daily functioning in relationships, work, school, and family life. These mood fluctuations usually include both “high highs,” such as mania and hypomania, and “low lows” in the form of depressive episodes.
Cannabidiol, or CBD, has been touted as a possible way of treating the symptoms of bipolar disorder. While there’s some evidence that CBD oil can help people with bipolar disorder, there hasn’t been enough research to establish its long-term safety and effectiveness.
Learn more about CBD for bipolar disorder, including its safety, effectiveness, drawbacks, and alternatives.
Catherine Falls Commercial / Moment / Getty Images
What Is CBD?
CBD is one of the active ingredients in the Cannabis sativa plant (marijuana). Although it’s a chemical derived from marijuana, CBD doesn’t have psychoactive properties like tetrahydrocannabinol (THC). In other words, CBD won’t get you “high” like THC.
CBD is believed to act on the body’s central nervous system to produce a calming, relaxing effect that could help with anxiety and other mental health conditions, such as bipolar disorder. Some evidence suggests that it also might have pain-relieving and anti-inflammatory properties.
Is CBD Addictive?
According to the World Health Organization (WHO), there’s no evidence of any risk of chemical dependency or addiction when it comes to CBD.
And while CBD’s legal restrictions vary from state to state, the Food and Drug Administration (FDA) has legalized its use for clinical trials. One product containing CBD—Epidiolex—was FDA approved in 2018 for use in the treatment of seizures in certain rare childhood epileptic disorders.
You can take CBD in various forms, including:
- Tinctures (plant extracts dissolved in an alcohol solvent)
- Tablets and capsules
- Edibles, such as gummies
- Topicals, such as lotions and creams
Because CBD’s legal status varies so widely across the United States, it’s always wise to check your local and state laws before purchasing any product containing CBD.
The Science Behind CBD
CBD oil isn’t yet established as an evidence-based treatment for bipolar disorder. Research is ongoing, with many clinical trials underway.
However, it’s believed that CBD works by acting on the body’s endocannabinoid system (ECS). The endocannabinoid system isn’t yet entirely understood by researchers, but some believe it plays a role in many important functions, such as pain and mood regulation as well as inflammation.
Early research indicates that CBD might serve as a mood stabilizer for people with bipolar disorder.
One 2020 review argues that CBD might be helpful in the treatment of depressive episodes associated with bipolar disorder due to its calming, antidepressant effects.
A 2020 clinical trial suggests that CBD could be beneficial as an “adjunctive,” or supplemental, treatment for bipolar depression.
CBD has also been shown to have an anxiety-reducing effect and shows therapeutic potential in the treatment of addictions. This could be beneficial to people with bipolar disorder because many people with mood disorders also have comorbid mental health conditions, such as anxiety disorders and substance use disorder.
CBD and Its Potential Benefits
CBD is being investigated for use in the treatment of a number of mental health disorders and neurological conditions. These include schizophrenia, post-traumatic stress disorder (PTSD), anxiety disorders, depression, addiction, and Alzheimer’s disease.
There are certain drawbacks to taking CBD for bipolar disorder. People who use CBD products might experience a range of side effects, including:
CBD can also interact with other medications, such as blood thinners, and it can affect your liver enzymes.
If you take CBD, it’s important to let your healthcare provider know so they can warn you about any potential drug interactions or negative effects on your liver function. You also shouldn’t drink alcohol if you’re using CBD, as the interaction between the two substances could enhance their sedative effects.
There’s limited evidence in initial animal studies that the male reproductive system could be affected by CBD use. So if you’re trying to conceive, you might want to hold off on using CBD or ask your healthcare provider if CBD is safe to use.
Also, most products containing CBD aren’t regulated or approved by the FDA. This means that you can’t guarantee that what you buy is safe, pure, or high-quality. A CBD product could contain THC or even contaminants like pesticides, so choose carefully.
There are many evidence-based alternatives to using CBD for bipolar disorder symptoms. Here are some of the many available alternative treatments for bipolar disorder:
- Medication: There are a number of prescription medications available to treat the symptoms of bipolar disorder. Mood stabilizers such as lithium, as well as anticonvulsants and antipsychotic drugs, may be prescribed by a psychiatrist to help regulate your moods.
- Psychotherapy:Talk therapy with a trusted psychotherapist, as well as support groups led by qualified mental health counselors, can help you work through the emotional and social challenges of living with bipolar disorder.
- Exercise: Regular exercise can help people with bipolar disorder by releasing endorphins that improve their sense of well-being.
- Relaxation and mindfulness techniques: Relaxation techniques such as breathing exercises, and mindfulness techniques such as yoga and meditation, can have a calming effect and help you regulate your emotions in times of stress.
- Sleep hygiene:Insomnia and chronic sleep deprivation can worsen the effects of bipolar disorder. Practicing good sleep habits, such as going to bed at the same time every night, can go a long way in curbing bipolar disorder symptoms.
Some researchers believe that CBD, a chemical compound derived from marijuana, could be helpful in treating some of the symptoms of bipolar disorder and other mental health conditions.
Early evidence suggests that CBD oil could play a role in regulating mood and alleviating depression. Drawbacks can include mild to moderate side effects like nausea and fatigue, as well as potential drug interactions and negative effects on liver function.
Alternative treatments for bipolar disorder include prescription drugs, psychotherapy, mindfulness techniques, and lifestyle changes.
A Word From Verywell
CBD is widely believed to be safe and potentially effective in the treatment of various mental health conditions, including bipolar disorder. However, it’s not FDA approved as a treatment for bipolar disorder, and research into its benefits and long-term side effects is still ongoing.
If you decide to take CBD for bipolar disorder, make sure to let your healthcare provider know so they can warn you about any potential side effects or drug interactions.
Frequently Asked Questions
Research on CBD and its potential interactions with other drugs is ongoing. There is some preliminary evidence that CBD could interact with lithium, which is frequently prescribed to people with bipolar disorder as a mood stabilizer. This interaction could potentially cause lithium toxicity, a serious condition.
CBD, or cannabidiol, is one of the chemical compounds (called “cannabinoids”) found in the Cannabis sativa plant. Cannabis also contains tetrahydrocannabinol (THC), the main active component of marijuana. Unlike THC, CBD doesn’t have psychoactive properties; in other words, it won’t give you a “high.”
The only FDA-approved product containing CBD is a pharmaceutical-grade CBD oil called Epidiolex, which is used to prevent seizures in people with two different childhood epileptic disorders. Because most CBD products aren’t regulated by the FDA, it’s important to check the product labels yourself.
Always check your CBD product’s certificate of analysis (COA) to see if it’s been tested for THC and contaminants. Also, CBD derived from hemp grown in the U.S. rather than overseas might be a safer bet in terms of the federal and local testing requirements.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Institute of Mental Health. Bipolar disorder.
Blessing EM, Steenkamp MM, Manzanares J, Marmar CR. Cannabidiol as a potential treatment for anxiety disorders. Neurotherapeutics. 2015;12(4):825-836. doi:10.1007/s13311-015-0387-1
Khan R, Naveed S, Mian N, et al. The therapeutic role of cannabidiol in mental health: a systematic review. J Cannabis Res. 2020;2(2). doi:10.1186/s4438-019-0012-y
Oberbarnscheidt T, Miller NS. The impact of cannabidiol on psychiatric and medical conditions. J Clin Med Res. 2020;12(7):393-403. doi:10.14740/jocmr4159
Singh RK, Dillon B, Tatum DA, et al. Drug-drug interactions between cannabidiol and lithium. Child Neurol Open. 2020;7. doi:10.1177/2329048X20947896
CBD & Bipolar Disorder
It’s long been accepted that mental health conditions are greatly underserved by current medications and treatments. And none more so than bipolar disorder ( BD ), a debilitating condition in which patients’ moods swing uncontrollably between manic episodes and deep depression. For many, simply existing becomes intolerable, with between 25-60% attempting suicide at some point in their lives. 1
Most BD patients are prescribed a cocktail of drugs that include mood stabilizers like lithium, antidepressants, antipsychotics, anti-anxiety medication, anticonvulsants, and sleeping tablets, often leaving them so medicated they’re unable to function. Eighty-nine percent of BD sufferers report experiencing serious impairment due to their condition (and undoubtedly their medication), more so than any other mental health disorder. 2
As such, self-medication with cannabis and/or alcohol is common, although universally discouraged by health professionals. 3 Indeed, of the clinicians who regularly prescribe cannabis for other health conditions such as anxiety and depression, most give the cannabis plant a wide berth when it comes to bipolar disorder, citing the risk of worsening manic episodes and its link with increasing the risk of psychosis. 4
And yet, anecdotal evidence both from patients and the few pioneering doctors are reporting some life changing benefits from CBD -rich cannabis, including mood stabilization, the holy grail in bipolar disorder symptom management.
What Is Bipolar Disorder?
Bipolar disorder, formerly called manic depression, often manifests in adolescence, although it can come on at any time, and affects almost 3% of the US population.
On average, it can take 8 years to get an official diagnosis 5 after a first episode, with younger patients sometimes misdiagnosed with ADHD . 6 However, when the diagnosis eventually comes it’s usually classified as either bipolar I disorder, where one manic episode is preceded or followed by hypomanic or major depressive episodes, including in some cases, psychosis; or bipolar II disorder when patients have had one major depressive episode and at least one hypomanic episode, but never a full-on manic episode.
Because of bipolar disorder’s complex nature, patients are prescribed multiple pharmaceuticals, some of which can actually make certain symptoms worse and leave them feeling like zombies.
Bipolar Disorder, Dopamine, & the Endocannabinoid System
Why BD develops is not completely understood. However, one commonly held theory suggests an imbalance in the dopaminergic system may play a role, 7 with excessive dopamine transmission contributing to the manic phase and increased dopamine transporter levels leading to reduced dopaminergic function and depression. Dopamine is a class of neurotransmitter that plays a role in pleasure, motivation, and learning.
CB2 receptors that modulate immune function may be a therapeutic target for managing bipolar disorder symptoms.
It’s commonly accepted among scientists that the endocannabinoid system acts as a master regulator, maintaining homeostasis in neurological activity and throughout the body. This includes acting as an ‘important filter’ to incoming inputs acting locally in the midbrain and shaping how information is passed onto dopamine neurons. 8
While it’s not clear whether some kind dysregulation within the endocannabinoid system has a causal relationship with BD , authors of the paper, “Endocannabinoid Modulation of Dopamine Neurotransmission” suggest “endocannabinoid-based therapies as valuable treatments for disorders associated with aberrant DA function.” As an aside, CBD is a partial agonist [activator] of the dopamine D2 receptors, which researchers suggest may partly account for its antipsychotic effect. 9
A further line of study, outlined in the 2019 paper ‘Bipolar Disorder and the Endocannabinoid System’, 10 is based on the premise that inflammation plays a role in many mood disorders including BD , and suggests CB2 cannabinoid receptors, considered to have an immunomodulating effect, 11 may be a therapeutic target for managing BD symptoms.
Studies show elevated levels of certain inflammatory pro-cytokines are present in the manic phase and depressive phases of BD and normalise when patients have returned back to a neutral phase. 12
Thus, the researchers posit that reducing inflammation by targeting the CB2 receptors and using selective CB1 receptor antagonists, “may lead to remarkable advances pertaining to pharmacotherapy of BD based on modulation of the ECS , and this approach offers a brand-new treatment strategy to broaden the arsenal available to pharmacologically mange BD .”
A Patient’s Story
Diane Green, 62, from Rocklin, California, first started showing symptoms of bipolar disorder when she was 15. However, it would take over twenty years until she eventually got an accurate diagnosis.
Most of what Diane has held dear in life has been destroyed by BD ; her education, her relationship with her family, her marriages, and her career as a nurse.
“The one thing that I know is being bipolar and being on meds,” she shares. “It touches every part of life… it takes everything away.”
Being bipolar and being on meds touches every part of life. It takes everything away.
Before she got her diagnosis at 38, Diane self-medicated with alcohol and occasionally cannabis to calm her agitation. However, her violent outbursts, agitation, and depression continued unabated, leaving Diane desperate for help.
“Once I called the cops,” she recalls. “They came over and I’m begging him, ‘Please take me to the mental institution.’ He asked me if I was drinking, and I said yes. And he said, ‘Well, they won’t take you, and I remember I went and got in his car anyway.”
While finally getting a bipolar disorder diagnosis was a relief in many ways, it heralded a new phase of her life: coping with the side effects of the various pharmaceuticals she was prescribed.
“The medication is its own nightmare of a journey,” says Diane, “the side effects were shockingly terrible. The fog I was in, it was horrible.”
In fact, according to Diane, rather than improving her depressive episodes, the medication actually made them worse.
“Once they put me on meds is when the depression got to where I could hardly get out of bed at all,” she remembers. “It never stopped the episodes… But it helped take the edge off. So, I still had to go through the cycles, manic depression and rapid cycling.”
CBD to the Rescue
It was in one of her desperate lows that Diane decided to try CBD oil.
“About 45 minutes later, I just noticed I’m calmer,” says Diane. “I’m more relaxed. Something felt better I think because I wasn’t depressed.”
Delighted with the results, Diane started taking CBD everyday, eventually over time carefully coming off her meds (a process best undertaken with the guidance of a health professional). Free from their debilitating side effects, Diane could finally begin to enjoy her life again.
“I just remember the amazement of the mornings with a clear mind and going for walks and just feeling the air and looking at nature,” she recalls fondly. “And that just became so precious to me having a clear mind… I feel like it just balances it out, so that I really don’t have symptoms. Sometimes I forget I’m bipolar.”
It’s taken a bit of experimentation with different CBD products for Diane to find her therapeutic sweet spot. But interestingly, for her at least, rather than whole plant CBD -rich cannabis, it’s actually been 33 mg of CBD isolate taken twice a day that has worked best at managing her symptoms.
After a life dominated by her bipolar disorder, Diane wishes she’d found CBD earlier.
“I think about those hopes and dreams because I wanted a career, I was excited about life in college and getting married someday and having the perfect kids in the perfect house… And all that just gets taken away slowly. It just does… I don’t think with CBD I would have ever had to have gone on disability.”
A Clinician’s Experience
Holistic physician Deborah Malka MD has seen a number of patients with bipolar disorder over the years. Indeed, she is one of only a few clinicians worldwide willing to recommend medicinal cannabis to help manage bipolar disorder symptoms.
In her book ‘Medicinal Cannabis: Pearls for Clinical Practice,’ Malka shares a number of case studies of bipolar patients who have responded favorably to CBD -rich cannabis, and in a conversation with Project CBD she reveals why treating bipolar disorder with cannabis isn’t just about alternating between CBD and THC to manage the manic and depressive cycling.
“I had about 10 patients with bipolar disorder,” says Malka, “and what I found is that most of them responded best to being on some kind of CBD as an ongoing mood stabiliser, to actually prevent the ups and downs.
According to Dr. Malka, because CBD has proven anticonvulsant effects, and anticonvulsants are commonly prescribed for bipolar disorder to complement drugs like Lithium, it’s not so shocking that CBD has mood stabilizing effects.
“I believe that [ CBD ’s] anticonvulsant properties are actually inherently affecting the lability of probably the serotonin, probably of dopamine, and actually smoothing out the bipolar disorder patients into a more moderate range.”
But for Malka, CBD isn’t the end of the story. She feels it’s important to highlight how compounds within the cannabis plant hold multiple therapeutic keys for the complex bipolar symptoms that a multitude of pharmaceutical drugs fail to manage – without the horrendous side effects.
In Malka’s experience, terpenes play a key role in managing cycling episodes and she favors myrcene to promote calmness and improve sleep during manic phases and alpha pinene and/or limonene for invigorating patients when they fall into depression.
Caution With THC
She will turn to THC chemovars containing myrcene to regulate sleep, which is often disrupted in bipolar disorder, but does not recommend THC when patients are manic or experiencing suicidal ideations.
Bipolar patients should seek help from an experienced physician before trying cannabis to manage their mood fluctuations.
“If somebody uses too much stimulating THC -rich cannabis because that’s what you’d want to use if you’re suicidal and in a very low mood,” explains Malka, “it alters your perception to a place where you skip reasoning and you just get disoriented, especially if you’re not used to cannabis. Too much THC can actually induce a psychotic experience. So, we don’t want that.”
To avoid any worsening of symptoms, Malka recommends bipolar patients seek professional help from an experienced physician before trying cannabis to manage their mood fluctuations.
“It’s really not safe if you’re a naive patient,” she stresses. “Too much THC is not safe, especially when you have a mood disorder. Please don’t do that. Get professional help.”
Preliminary Clinical Studies
With the buzz surrounding the therapeutic application of CBD in a number of mood disorders, including as an antipsychotic treatment in schizophrenia, 13 it’s not a surprise that a preliminary clinical trial is examining whether the compound could also be effective in bipolar disorder. This despite some earlier reviews 14 finding only weak evidence that CBD was effective for BD . 15
So far, unfortunately, there are no definitive results to report. One small Brazilian study, 16 which was terminated prematurely due to COVID , gave 36 bipolar patients 150-300 mg of CBD or a placebo over twelve weeks, to assess whether their depression and anxiety symptoms improved, as well as measuring inflammatory biomarkers. However, despite ending the study early, the researchers have been able to submit the results to a journal, which is awaiting review and hopefully a future publication.
Another clinical trial 17 currently recruiting in San Diego, will compare the administration of a one-time 600mg dose of Epidiolex (pharmaceutical CBD ) with 5mg of dronabinol (synthetic THC ) and a placebo on 144 bipolar participants in order to assess 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 measuring anandamide, an endocannabinoid and homovanillic acid, a marker of dopamine activity in the brain.
However, the study’s objective appears to be less about cannabinoids as potential treatment for bipolar disorder and more geared towards understanding why many patients with BD also suffer from substance abuse.
It appears then that the stigma against cannabis and bipolar disorder among health professionals remains ingrained, and more clinical trials are needed before prescribing CBD -rich cannabis or just plain old CBD will be readily accepted by mental health clinicians and psychiatrists.
Mary Biles, a UK -based journalist, educator, and Project CBD contributing writer, is the author of The CBD Book (Harper Collins, UK ).
Copyright, Project CBD . May not be reprinted without permission.