Cannabis affects bipolar drugs

Bipolar Disorder: Can Patients Benefit From Cannabis As Medicine?

Mood disorders, particularly bipolar disorder, are widespread and one of the most common psychiatric illnesses. Statistics show that some people with bipolar disorder tend to use cannabis as a recreational drug, to relieve mania, or to lighten mood during a depressed phase. According to the Deutsches Ă„rzteblatt, 50 to 90 percent of cannabis users suffer from a mental disorder or another health disorder caused by the consumption of alcohol and other substances.

It is also stated that some studies suggest that there is a connection between bipolar disorder and cannabis use or the increased incidence of manic symptoms. The study situation with depressive episodes is less clear. It must be countered that studies can already show that cannabis can have an antidepressant effect.

But let's first take a closer look at the affective disorder syndrome before we look at the studies.

Symptoms of Bipolar Affective Disorder

The symptoms of a mood disorder differ depending on which mood disorder is currently present. It can be a so-called unipolar disorder (depression or mania) or a bipolar disorder (manic-depressive illness). Manic and / or depressive episodes, which can have different degrees of severity, can occur in the various forms of mood disorders. Only in rare cases do these conditions persist.

As a rule, an episode occurs in phases that are purely depressive or purely manic. The episodes can also mix or alternate during a phase. In such a case it is referred to as a mixed episode.

In addition to the changed mood, other symptoms can also occur that not only affect the behavior of the person concerned, but also the physical and mental performance. In many cases, people have impaired memory and attention. In addition, a depressive episode can reduce the ability to adapt and change or impair the way people think and behave.

Symptoms of depression

An affective disorder often manifests itself only through the symptoms of depression (unipolar depression) or through a depressive phase that occurs with manic or mixed phases.

The following symptoms may occur as part of a depressive episode:

  • Listlessness
  • indifference
  • Dejection
  • Difficulty thinking or concentrating
  • Disinterestedness

The extent of the symptoms ranges from a slightly depressed mood to melancholy and numbness (mild, moderate or severe symptoms). Often depressed sufferers show no gestures or facial expressions and speak in a low, hesitant voice. Those affected experience their environment as gray and they feel worthless or guilty.

As a result, they withdraw from their fellow human beings and can show the following additional symptoms:

  • insomnia
  • Loss of appetite
  • inner unrest
  • anxiety
  • lack of sexual interest

The risk of suicide is very high in severely depressed sufferers. 40 to 80 out of 100 people have thoughts of suicide.

Many sufferers also show what is known as dysthymia, a recurring or constant slight depressive mood. Such persistent disorders often develop in early adulthood. Nevertheless, these sufferers are usually able to cope with their everyday lives.

Symptoms of mania

In most cases, affective disorders rarely express themselves exclusively through mania. A mixed episode is much more common. The symptoms show up in the form of an inappropriately elevated or irritable mood, an increase in drive as well as accelerated thinking and overestimation of oneself.

Manic sufferers often spend money recklessly or display sexually disinhibited behavior. Accordingly, a manic phase can have serious financial and health consequences. In addition, delusional symptoms such as megalomania can develop, so that those affected may lack insight into the disease. If the mania is only mildly pronounced, doctors speak of hypomania.

Symptoms of Bipolar Affective Disorder

If pronounced manic and depressive symptoms occur, it is a bipolar affective disorder (manic-depressive illness). This typically runs in episodes. The manic and depressive symptoms alternate rapidly and both episodes rarely occur at the same time.

A bipolar affective disorder can cause different symptoms in the individual phases, which is why the disorder is characterized by the symptoms that are currently occurring, such as bipolar affective disorder with a manic episode. There are usually no symptoms between the individual phases. Nevertheless, there are cases where permanent mild symptoms occur (cyclothymia).

This is assumed if the bipolar affective disorder has persisted for at least two years. Here, too, the chronic mood disorder usually sets in in early adulthood. A typical symptom of cyclothymia is an unstable mood with many phases of slightly elevated emotions and slight depression. There are seldom times when the mood remains stable.

Causes of Bipolar Affective Disorder

The causes can be different. Hereditary predisposition plays an important role, but internal and external factors are just as crucial. Whether a drastic life event triggers a disorder depends above all on how susceptible those affected are to an affective disorder.

A mood disorder usually shows depression, although a traumatic event has usually taken place beforehand (e.g. conflict in the family or the loss of a loved one). However, these factors are probably not the sole cause of a disorder. Illnesses (e.g. epilepsy, Parkinson's, Cushing's syndrome) or medication (e.g. cortisone therapy) can also be the cause of an affective disorder.

Scientists believe that the Bornavirus can cause a mood disorder. In people with bipolar affective disorders or depression, this virus could be detected in the blood, which was only active during the acute flare-ups. In people who are prone to affective disorder, the Bornavirus could worsen the symptoms or possibly trigger the disease flare-ups. However, these theories are very controversial.

It has been proven that hereditary factors can promote the disease, as affective disorders are particularly common among first-degree relatives. So if one parent has a disorder, for example, the likelihood that the child will also become ill is between 10 and 15 percent. If both parents are sick, the probability increases to 30 to 40 percent.

Biological factors also seem to play an important role. Changes in certain chemical neurotransmitters (messenger substances) in the brain, which, among other things, are involved in the transmission of nerve stimuli, were found in those affected.

  • The messenger substances serotonin and noradrenaline are too small in those affected by depression. Therefore, drugs are given that increase the concentration of these messenger substances.
  • The messenger substances norepinephrine and dopamine are present in high concentrations in those affected with mania.

It is assumed that a disturbed balance between these messenger substances plays an important role in mood disorders. In addition, in those affected with depression, the receptors in the brain that act on these messenger substances are often changed. In addition, the activities of different areas of the brain show peculiarities in some of those affected. In people with depression, the brain structures associated with goal development are less active, while areas associated with negative emotions are very aroused.

A disturbed hormone balance can presumably also favor a mood disorder. In some depressed people, there is an excess of the hormone cortisol, which in turn is linked to a disturbed neurotransmitter balance in the brain. For example, a high concentration of cortisol can reduce the density of serotonin receptors. A sudden drop in the hormones progesterone and estrogen after giving birth can also trigger a depressive disorder (postpartum depression).

Mood disorders: diagnosis

Because symptoms vary widely, diagnosing mood disorder is not easy. A mood disorder can appear as mania, depression, or bipolar disorder. The expression can also vary in strength. The diagnosis of bipolar disorder is often very late. Those affected usually seek treatment in a depressive phase, so that unipolar depression is first diagnosed. In order to recognize bipolar disorder, however, a doctor needs information about manic symptoms, which is usually difficult because those affected rarely seek treatment during manic phases.

First and foremost, a very detailed discussion with a doctor is required first, in which the previous and existing symptoms are explained. Structured interview guidelines and questionnaires are often helpful for such a conversation in order to be able to better grasp the typical symptoms. This is not only about the patient's self-assessment, but also the information provided by relatives, which can provide crucial information for the diagnosis.

In addition, a mood disorder needs to be distinguished from a psychotic disorder. A manic or mixed episode can trigger symptoms similar to schizophrenia.

It is just as important to rule out organic causes, which is why the following examinations are usually carried out:

  • Blood test
  • Urinalysis
  • Electroencephalography (EEG)
  • Magnetic resonance imaging (MRI) or computed tomography (CT)

The doctor will also ask which medications are taken regularly, as various drugs such as cortisone, cytostatics or antidepressants can promote an affective disorder. The consumption of drugs is also asked. Cocaine, ecstasy and amphetamines can trigger manic symptoms.

Mood disorders: therapy and drug treatment

The therapy depends on various factors such as the degree of impairment, the extent of the mood disorder and the social environment. An important goal of treatment is to reduce the manic or depressive symptoms (acute treatment). Long-term therapy is about preventing further manic and / or depressive phases (phase prophylaxis).

In most cases, outpatient therapy in the form of psychotherapy and drug treatment is sufficient. In the context of psychotherapy, it can also be helpful to include the family.

It is often difficult to treat an acute manic phase because those affected do not show any insight into the disease. In the case of a severe manic phase, it may therefore be necessary to consider inpatient treatment in order to shield those affected from external stimuli.

Which drugs are used depends on whether the patient is suffering from pure depression, pure manic or bipolar disorder. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are usually prescribed for depression. In manic phases, either individual drugs (monotherapy) or different drugs (combination therapy) are used. The drug lithium is often given to an acute manic phase, which is supposed to reduce renewed manic and depressive symptoms.

Like all drugs, drugs used in mood disorders have side effects. It is particularly worth mentioning here that these drugs can lead to weight gain, which is why it is advised to check your body weight regularly.

Affective disorders: disease progression

As a rule, affective disorders have a phased course, so that manic and / or depressive phases occur in attacks that are more or less pronounced. Symptoms subside between these phases. While a manic phase often occurs within a few hours or days, a depressive phase can begin slowly. The sudden onset of a depressive phase is rather rare.

If an affective disorder is unipolar, i.e. through a manic or depressive phase, there are on average about four phases in the course of life. In contrast, bipolar disorder usually has several shorter phases. The longer the disease persists, the faster the phases follow one another. Untreated depressive or manic phases usually last three to twelve months. Here, the symptom-free time between the attacks is also shortened as the number of phases increases. The earlier treatment is given, the more favorable the prognosis.

Can medicinal cannabis have a positive effect on bipolar disorder?

Some studies have shown that the phytocannabinoids from the cannabis plant such as THC and CBD can have beneficial effects on patients with depression, anxiety, or post-traumatic stress disorder (PTSD). Unfortunately, research on how these phytocannabinoids affect patients with bipolar disorder is still limited.

In 2015, a study was carried out at Lancaster University, UK. Here, 24 patients with bipolar disorder who consumed cannabis at least three times a week were asked to keep a diary for six days and to document how the use of cannabis affected the depressive or manic phases. The problem is that most of the study participants used cannabis as a recreational drug and not for medical purposes, which is why the results are inconclusive. In addition, some study participants reported that the effects of cannabis increased the manic and depressive phases.

At Harvard Medical School in Boston, however, the researchers found five cases in 1998 in which study participants with bipolar disorder could benefit from cannabis. As a result, medicinal cannabis was found to help patients cope better with their extreme ups and downs.

A study from 2010 that was carried out at the University of Oslo is also interesting. The researchers stated that cannabis use was linked to altered neurocognitive function in severe mental disorders, but that the data were not yet clear and studies on bipolar disorder were not yet available. The aim of this study was to examine the relationship between cannabis use and neurocognition in bipolar disorder versus schizophrenia in a naturalistic setting.

A total of 133 patients with bipolar disorder and 140 patients with schizophrenia were subjected to neuropsychological examinations and clinical characterization including measurements of substance consumption. The relationships between cannabis users and neurocognitive function were examined in the two diagnostic groups.

In patients with bipolar disorder, cannabis use was associated with better neurocognitive function, while in schizophrenia patients the opposite was the case. There was a statistically significant interaction effect with focused attention, logical memory and memory learning. These differences in neurocognitive function could not be explained by putative confounding factors.

The results suggest that cannabis use is associated with improved neurocognition in bipolar disorder and impaired neurocognition in schizophrenia. However, the results need to be replicated in independent samples and may suggest different underlying disease mechanisms in the two diseases, the researchers said.

CBD: Insufficient effect in manic episodes

The pharmacological profile of cannabidiol (CBD) has several properties related to drugs known to favor bipolar affective disorders, leading to the hypothesis that CBD may have therapeutic properties. This theory was carried out by researchers at the University of Sao Paulo in 2010. As part of a study, researchers looked at the effectiveness and safety of CBD in two patients with bipolar disorder.

Both patients met the DSM IV criteria for bipolar I disorder in which a manic episode occurred with no comorbidities. The two patients initially received placebo for the first five days and then CBD from day 6 to 30 (initial oral dose of 600 mg up to 1200 mg / day). From the 6th to the 20thOn the 1st day, the first patient (a 34-year-old woman) also received olanzapine (oral dose of 10-15 mg).

On day 31, the CBD treatment was discontinued and replaced with placebo for 5 days. The first patient showed an improvement in symptoms with olanzapine plus CBD, but showed no additional improvement during the CBD monotherapy. The second patient (a 36-year-old woman) did not experience any improvement in symptoms with a dose of CBD during the study. Both patients tolerated CBD very well and no side effects were reported. These preliminary data suggest that CBD may not be effective for the manic episode.

In 2017, researchers at the Federal University of Minas Gerais in Brazil investigated whether CBD was useful and safe for treating psychiatric disorders. The aim was to create a systematic overview of the benefits and side effects of CBD in the treatment of schizophrenia, psychotic disorders, anxiety disorders, depression, bipolar disorder, and substance use disorders. The result was that the evidence regarding the efficacy and safety of CBD in psychiatry is still low. To study the effects of CBD on psychiatric illness, more larger, well-designed randomized controlled trials are needed.

Medicinal cannabis for depressive episodes

Although pharmaceutical cannabis does not seem to be sufficiently effective in a manic episode, cannabis has been used against depression for centuries. In numerous studies, the mood-enhancing effect is repeatedly pointed out, which we have already reported in detail in various articles. The non-psychoactive cannabinoid CBD also appears to have potential for alleviating symptoms of depression.

Two studies are worth mentioning here. Spanish researchers from the Universidad de Cantabria stated that CBD docks with the 5-HT1A receptors (serotonin receptors) and can thus develop antidepressant effects. Brazilian researchers from the University of Rio de Janeiro found the same thing, suggesting that CBD may have antidepressant and anxiolytic effects.

 

 

Note: In this article we report on prescription CBD or cannabidiol. This article makes no suggestion as to the possible purpose. Promises of use are left to the pharmacists.

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