Can CBD be helpful for bipolar disorder?

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Any person can have a different state of mind from day to day, depending on circumstances. The question is, when would it be considered a bipolar disorder? When diagnosed with bipolar disorder, one experiences periods of agitation and depression, and there can be healthy periods in between. The different stages of moods are called hypomanic, manic, and depressive phases. There are various combinations of mood modes that are categorised into different types of bipolar disorder. Bipolar disorder can be caused by external factors, stress, and general irritants, and manifest itself during adolescence. The disorder can stay with the person for a lifetime. The lifetime risk of contracting bipolar disorder is one to two per cent and is equally prevalent throughout the world. It affects males and females equally.

Prevalence data fluctuate significantly depending on whether the researchers estimate type I BAD or both types of BAD together, so the numbers vary slightly. It is believed that bipolar I disorder affects between 0.5% and 2% of the population, and bipolar II disorder affects up to 5%.

Known causes of bipolar disorder

Neurotransmitters imbalance in the brain

Neurotransmitters such as serotonin, dopamine, GABA, glutamate, and others all fluctuate and interact throughout the day to regulate our moods.

Genetic predisposition

Hereditary factors play a significant role in the risk of developing bipolar disorder (formerly known as manic-depressive psychosis). Also, we need to consider the presence of environmental factors, starting with intrauterine and perinatal conditions to different psychological characteristics of an individual.

Scientists have previously shown that bipolar disorder is associated with early growth response (EGR) proteins, which translate environmental influences (such as sleep disturbances, stress, etc.) on long-term changes in the brain. Some studies have also pointed to another protein encoded by the brain-derived neurotrophic factor (BDNF) gene, the low content of which contributes to developing bipolar disorder. Besides, scientists have found that one protein's production rate is closely related to the second production. A kind of vicious circle is formed: a low EGR content leads to a decrease in the BDNF level, which causes a reduction in the EGR level.

Alcohol and drug abuse

According to DSM-IV, the use of cocaine-containing substances and amphetamines and the abrupt termination of this process can lead to persistent disorders of the affective sphere, including bipolar disorder. Alcohol also interferes with the normal functioning of neurotransmitters by inhibiting the supply of tryptophan to the brain, which reduces serotonin production. It can cause depression and insomnia. Also, regular consumption of alcohol and caffeine-containing products provokes hypoglycemia and nutritional deficiencies, especially B vitamins, vitamin C, folic acid, potassium, and magnesium.

Chemical toxicity

The current level of chemical pollution of the environment suggests an unprecedented impact of many unusual chemicals on the human body. At least 250 chemical pollutants can be found in the fat depots of any person's body (even those living at a sufficient distance from pollution sources). According to Sherry A. Rogers, MD, "the chemicals we encounter can have the ability to influence the metabolism of neurotransmitters, including the "happiness hormones," in a myriad of ways. They interfere with their synthesis and metabolism, affect receptor sites, poison enzymes, and do much more."

Heavy metals

Over the years, medical observations have shown a correlation between exposure to metals such as mercury, copper, lead, aluminium, and their derivatives and mood disorders. Many of these substances, recognised as neurotoxins, are also bioaccumulative; that is, they cannot decompose, getting inside the human body and can remain in it for years, having a destructive effect on it. For example, in a study of the condition of 762 patients after replacing their dentures made of mercury amalgam with non-toxic dentures made of composite materials, it was recorded that of 23.5% of respondents who complained of signs of depression (fatigue, loss of strength, irritability, inability to concentrate) to replacement of prostheses, 100% reported the disappearance of these symptoms after replacement of prostheses.

Hormonal imbalance

Among the hormones that have the most noticeable effect on mood swings and disorders of the affective sphere, researchers include hormones produced by the thyroid gland, adrenal glands (cortisol, dehydroepiandrosterone (DHEA), adrenaline, and norepinephrine), and reproductive hormones (estrogen, progesterone).

Main types of bipolar disorders

There are several types of bipolar disorders. These can include mania, hypomania, and depression. Symptoms can lead to unpredictable mood and behaviour changes, leading to significant stress and difficulties in life.

Bipolar disorder I

 At least one mania episode that may be preceded or accompanied by hypomanic or major depressive episodes. In some cases, mania can cause a break with reality (psychosis).

Bipolar II disorder

At least one major depressive episode and at least one hypomanic episode, without an episode of mania.

Cyclothymic disorder or cyclothymia

At least one or two years of hypomanic symptoms and periods of depression (although less severe than major depression).

Other types

If a person does not meet the criteria for bipolar I, II, or cyclothymia, but still experiences periods of clinically significantly abnormal mood elevation. For example, bipolar and related disorders are caused by certain drugs or alcohol, or health conditions like Cushing's disease, multiple sclerosis, or stroke.

What are mania and hypomania?

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Mania and hypomania can lead to a loss of judgment, affecting relationships, work, and finances. For example, one can start several projects, be in a euphoric mood, lead an excessive social life, and do things that lead to more or less severe consequences. People with mania are often very active and need very few hours of sleep. To name a few examples that could serve as indicators: when one's self-esteem is significantly higher than usual, and he or she can be annoyed if someone questions their ideas, partner, social life, and/or their work.

Mania is more intense than hypomania. It makes a person more excited and can easily lead to loss of reality perception or have psychoses. With hypomania, one doesn't lose his/her perception of reality and is less intense. After periods of mania and hypomania, people often suffer from depression. The depression can be so deep that one can have suicidal thoughts and plan to commit suicide. Sometimes, the anxiety is so much to handle that one may try to commit suicide.

Symptoms of mania, hypomania

  • Pathologically high sociability, sometimes flowing into increased aggressiveness without obvious provoking reasons;
  • Excessive mindless activity, absenteeism from school or work without a good reason, experiencing apathy for various activities;
  • Euphoric, exciting feelings that elevate their own self over other members of society, as well as excessive self-confidence, an inflated sense of self-esteem;
  • Provocative behaviour and other symptoms are associated with the increased or decreased psychological activity of a person. Also, engaging in risky behaviour;
  • Increased libido;
  • Denying or not realising that something is wrong;
  • Some bipolar disorder people may spend a lot of money, use recreational drugs, consume alcohol, and participate in dangerous and inappropriate activities.

Symptoms of the depression phase

  • Depressed mood, such as feelings of emptiness, hopelessness, or tearfulness (in children and adolescents, depressed mood can manifest as irritability);
  • A pronounced loss of interest or pleasure in most or all activities;
  • Significant fluctuations in weight (in the absence of diet), weight gain, or a decrease or increase in appetite (in children, inability to gain weight as expected may be a sign of depression);
  • Excess sleep or insomnia;
  • Anxiousness or delayed reactions;
  • Loss of energy or fatigue;
  • Feelings of emptiness or irrational guilt;
  • Impaired ability to think and concentrate, or indecisiveness;
  • Contemplating, planning, or attempting suicide;

The National Institute of Mental Health (NIMH) explains that to receive a bipolar I disorder diagnosis, a person needs to have symptoms for at least seven days, or at least two weeks of depressive episodes. To receive a bipolar II, a person must experience at least one cycle of hypomania and depression. In case of severe symptoms, it is necessary to visit a hospital. A doctor may conduct a physical check and some diagnostic tests, including blood and urine tests, to exclude other causes. Sometimes, it can be quite challenging for a doctor to diagnose bipolar disorder, as people are more likely to ask for help in a low, depressed mood, rather than in a high mood. Hence, as a result, it can be tricky to distinguish it from actual depression.

Bipolar disorder treatment

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Bipolar disorder is treatable. Simultaneously, eliminating the problem is not limited to drug exposure but requires a comprehensive restoration of the psychological state, including professional psychologists' work. Cognitive-behavioural therapy (CBT) is the most effective type of treatment in particular bipolar mood swings. It teaches a patient to:

  • Recognise and manage key stress factors;
  • Focus on aspects which help to stabilise the mood;
  • Engage family members and rebuild communication with them.

Such psychological treatment aims to reduce the incidence of depressive and manic episodes, comprehensively reduce the symptoms manifested, and return a person to everyday life in a social environment.

Another option in fighting bipolar swings is specific drug treatment. It helps to stabilise mood and manage a few symptoms. Usually, a doctor will prescribe a combination of:

The most extensive research project to assess what treatment methods work for bipolar disorder people is the Systematic Treatment Enhancement for Bipolar Disorder, otherwise known as Step-BD.

Side effects of current treatment

Lithium

Breakthroughs are likely to develop with lithium or other normotimics, especially in patients with mixed conditions, rapid episodes of bipolar disorder (usually defined as more than four episodes per year), comorbid anxiety, substance abuse, or neurological disease. Lithium can also cause sedation and cognitive impairment, tremors, fasciculations, nausea, diarrhoea, polyuria, polydipsia, and weight gain (due to the consumption of high-calorie drinks). The following symptoms manifest acute lithium intoxication: tremor, increased tendon reflexes, persistent headache, vomiting, confusion up to stupor, convulsions, and arrhythmias.

Anticonvulsants

The exact mechanism of action of anticonvulsants in bipolar disorder is not fully understood. Their primary advantages over lithium include a wider therapeutic margin and a lack of nephrotoxicity. However, some Side effects are still possible, such as nausea, dizziness, sedation, and unstable mood.

Antidepressants

An antidepressant's effect in reducing depressive symptoms usually occurs after 2-6 weeks of treatment, but side effects often happen from the start of treatment, generally in the first week.

It is important not to stop taking your medication abruptly. A sudden stop can lead to digestive problems (nausea, diarrhoea), sleep disturbances (nightmares, insomnia), headache, dizziness, and sometimes seizures.

Antipsychotics side effects

  • Delayed side effects include weight gain and metabolic syndrome (including increased adipose tissue mass, insulin resistance);
  • Uncomfortable restlessness (akathisia);
  • Sleepiness and dizziness;
  • Lips, jaw, and tongue involuntary movements (tardive dyskinesia);
  • Sexual problems due to сhanges at the hormonal level;
  • Possible interaction between antipsychotics and other medications.

In hyperactive psychotic patients with impaired food and water intake, it makes sense to prescribe antipsychotic drugs intramuscularly against the background of maintenance therapy, except for lithium or anticonvulsants.

Sedatives

Most hypnotics at therapeutic doses suppress the REM sleep, which regulates personality adaptation. If the sleeping pill is cancelled, the recoil phenomenon is possible - a compensatory increase in REM sleep with an abundance of dreams and nightmares.

The disadvantage of many sleeping pills is also relatively rapid (sometimes after 2-4 weeks) development of tolerance, leading to the need to increase the dose or change the drug.

Abrupt withdrawal of the drug in such cases leads to the development of withdrawal symptoms, manifested by a feeling of anxiety, fear, psychomotor agitation, sometimes the occurrence of hallucinations, profuse sweat, headaches, gastrointestinal disorders, small-amplitude tremor, decreased blood pressure, vomiting, and convulsions. Withdrawal symptoms occur 1-10 days after abrupt discontinuation of treatment and last for several weeks. In rare cases, detoxification therapy is indicated.

What is CBD

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There are various strains of marijuana (such as Indica, Sativa, and hybrids). Some of them bring more energy, and some are calming and sedating, depending on the different cannabinoids' balance. The Cannabis sativa plant contains over 100 chemical compounds, but the two most popular and well-known marijuana compounds are:

  • Cannabidiol (CBD) is non-psychoactive, meaning it doesn't cause you to feel "high."
  • Tetrahydrocannabinol (THC) can lead to intoxication and feeling of being "high."

So how does CBD work?

One of the leading hypotheses suggests that the endocannabinoid system is responsible for maintaining homeostasis. In the brain, activation of this system modulates excitatory and inhibitory neurotransmitters and cytokines from glial cells. In most of the cases of alleviated mood and related disorders is ECS dysfunctionality. Post mortem and other studies show ECS system abnormalities in schizophrenia and even suicide cases. The ECS is also strongly associated with affective disturbances such as anxiety and depression.

It was also reported that abnormalities in the cannabinoid-1 receptor (CNR1) gene that codes for cannabinoid-1 (CB1) receptors are reported in psychiatric disorders.

The body contains two types of endocannabinoid receptors, called CB1 and CB2. They fit in a "lock and key" model to cannabinoids produced within the body, like anandamide and 2-AG, to create a wide range of physiological effects. When the body doesn't have enough of 2-AG, which can be due to various reasons, an external source of cannabinoids is needed. While THC binds to CB1 receptors directly to produce physiological and psychoactive effects, CBD can also bind to the serotonin 5-HT1A receptors responsible for anxiety-inducing behaviour. CBD works in tandem with an increased amount of anandamide (often referred to as the "bliss molecule"), which interferes with the brain's system of pleasure and motivation.

So the key players on the stage are anandamide, tetrahydrocannabinol (THC), and cannabidiol (CBD). All of these compounds provide an excellent substitute for antidepressants, analgesics, antipsychotics, and anticonvulsant drugs, suggesting a therapeutic potential in mood and related disorders.

So what can CBD do?

Mood enhancement

A 2015 Trusted Source study found that marijuana use in some bipolar disorder people enhanced their mood and promoted a more positive outlook. It is essential to keep in mind that the research surrounding the beneficial effects of marijuana use in bipolar disorder is very preliminary.

Anxiety

Anxiety is our body's natural response to stress and causes discomfort every once in a while. According to an article in Dialogues of Clinical Neuroscience, anxiety disorders are the most prevalent causes of psychiatric conditions, increasing this problem worldwide.

A 2015 study review by Blessing EM. et al. showed that 49 studies found evidence for CBD as a treatment for generalised anxiety disorder, panic attacks, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder (PTSD). Again, the CBD effect is related to its cooperation with the ECS and binding affinity to serotonin receptors. As we know, serotonin is a "happiness" molecule, which is mainly responsible for the well-being, sleep, and behaviour. That's why most antidepressants work for serotonin activation.

Sleep regulation

CBD interacts with our inner Endocannabinoid system, which, in response, maintains circadian rhythms. Additionally, CBD also reduces anxiety and pain perception, which can aid restful sleep.

A study published in The Permanente Journal tested 72 adults with anxiety and poor sleep complaints. In the beginning, participants completed anxiety and sleep assessments. Then, they were given 25mg of CBD in capsule form. The ones who predominantly had sleep complaints took the dose in the evening. Participants with the main anxiety complaint took CBD in the morning.

After the first month, anxiety showed a decrease in 79 per cent of the examined people. Sleep scores improved by 66 per cent, which indicated less trouble sleeping. The results suggest that CBD decreased sleep difficulties in many of the participants. But while the decrease in anxiety symptoms remained steady for the study duration, the sleep scores fluctuated over time.

Depression

Authors of a review from 2018 also noted that many studies had shown the anti-stress and antidepressant activity of CBD in animal models. Even more, researchers have even studied CBD's potential to help reduce cravings in people with opioid use disorder, showing positive results.

Can CBD worsen symptoms?

A review published in 2015 showed that marijuana consumption could make manic episodes worse in bipolar disorder. Moreover, in some patients, marijuana use could trigger manic symptoms. However, it was explained that strains with high THC concentrations were responsible for such a result because, as was mentioned previously, THC acquires a "specific" effect on the human brain. Despite high expectations of finding a new cure for bipolar disorder, another study in 2015 also found that it worsened manic or depressive symptoms in some people. However, it is worth taking into account that individual reactions to cannabis differ from person to person.

While marijuana may help some bipolar disorder people, these studies show that it could also cause problems with other conditions.

Ways to use CBD

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CBD is most commonly used in four ways:

  • Inhalation (vaping)

If you are looking for the fastest onset of effects, you should use a vaping device filled with CBD e-liquid. You can feel the impact almost instantly - in about 4 minutes because the active ingredients will go directly into the bloodstream as you inhale the vapour. It offers an excellent choice for bipolar patients, as vaping offers fast relief.

  • Sublingually (under the tongue)

A sublingual application involves putting a few drops of CBD oil under your tongue and holding it for 60 seconds in your mouth before swallowing. This method of application is considered the second fastest way to deliver CBD effects. The sublingual administration is probably the most popular method of using CBD. CBD oil products come in forms of drops or sprays, and the effect can be expected in 20-40 minutes, which lasts about 4-6 hours.

  • Topically (applying on the skin)

Although liniments are not very useful in bipolar disorder treatments, they can still be a great supplement for one’s wellness. Generally, CBD creams and other topical products are widely used against problems such as eczema or acne, as well as muscle pain relief. Please note that when used topically, CBD doesn’t reach the bloodstream, so it should only be used to target localised inflammation.

  • Orally (ingestion of CBD-infused food and beverages, CBD capsules)

This method of use includes ingesting CBD that needs to be digested before it takes effect. CBD products that are used orally include capsules and foods such as chocolate or gummy bears, and beverages such as CBD tea, coffee, and even CBD water. Despite the convenience, such consumption is considered to have the slowest onset time. For a person with a healthy digestive tract, it may take 20 minutes to 1-2 hours before the user can feel the effects of CBD. However, in people with a malfunctioning digestive system, the desired effects may take over an hour. The result can be expected to last about four to six hours.

CBD dosage usually varies with the severity of bipolar disorder symptoms:

  • Low-strength CBD is used for mild depression and anxiety.
  • Medium-strength CBD is used for moderate symptoms, high stress, and insomnia.
  • High-strength CBD is used for severe anxiety.

Potential side effects of CBD

Using CBD oil in moderate amounts does not cause serious side effects. However, depending on individual factors, metabolism, and severity of bipolar disorders, some adverse reactions may occur, such as nausea, vomiting, drowsiness, dry mouth, dizziness, diarrhoea, increase or decrease in appetite.

Things to remember

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  1. In most cases, bipolar disorder is treated with potent antipsychotic drugs, which change neurotransmitters level and expression in the brain. This means that when treating this condition, one needs to be careful when taking supplements such as CBD oil because it can be challenging to predict how they interact with prescribed medications.
  2. Always consult your doctor before drug-CBD interaction.
  3. Suppose you are one of the bipolar disorder patients. In that case, it's critical to purchase a cannabis product that contains CBD and low levels of THC to avoid any recurrent manic episodes, or even worse, psychosis. The legal amount of THC in the UK and most European countries includes up to 0.2% THC in a product.
  4. Once your doctor has approved CBD to alleviate bipolar disorder symptoms, you need to find the right product and determine an optimal dose. Choose only high-quality, third-party lab tested products.

To date, an active study of various aspects of bipolar disorder continues. Numerous neuroscience studies are underway: scientists are looking for objective biological markers that could help clinical diagnosis identify the risk of disease before it manifests itself.

More in-depth research on drugs is necessary since even with the existing fairly vast arsenal of drugs, not all patients can achieve full remission. The search and adaptation of the most effective psychotherapy and rehabilitation methods are carried out, taking into account patients' specific needs with this disease. Although research on CBD and bipolar disorder treatment are still in the early stage, it sounds very promising and may become one of the best options in the near future.

Verified by a Healthcare Professional

Anastasiia Myronenko

Anastasiia Myronenko

Anastasiia Myronenko is a Medical Physicist actively practicing in one of the leading cancer centers in Kyiv, Ukraine. She received her master’s degree in Medical Physics at Karazin Kharkiv National University and completed Biological Physics internship at GSI Helmholtz Centre for Heavy Ion Research, Germany. Anastasiia Myronenko specializes in radiation therapy and is a fellow of Ukrainian Association of Medical Physicists.