Cannabis and Mental Illness

Cannabis. People say it calms them down, helps them sleep and soothes their pain, both emotional and physical. Well, so does the glass of wine I drink each night, the meditation I teach, my neighbor’s cigarettes and my friend’s kitten.

Cannabis and products derived from it, like CBD, have a strong political constituency. There are moves to make it legal with few restrictions in most states (36 allow medical marijuana; 15 have already legalized cannabis for recreational use). An awful lot of people think it’s safe to use and efficacious in treating any number of medical conditions.

The only reasonable response to these claims is “who knows?” There are no FDA approved indications for medical marijuana. What is researched and peer reviewed is that cannabis use is very dangerous for people with bipolar disorder.

In studies researchers have found that people with bipolar disorder who use cannabis have more manic episodes, more mixed episodes and less compliance with prescribed treatment.

Quality of life on almost all measures is lower, with fewer cannabis users with bipolar disorder holding jobs and living in a relationship.

Cannabis is a psychoactive drug, and some people who use it have psychotic episodes like hallucinations or debilitating paranoia. Of those who have had such episodes, 47% develop bipolar disorder or schizophrenia over the next 4 years.

CBD oil, or cannabinol, doesn’t fare much better. While there’s no evidence it causes bipolar disorder or increases or aggravates episodes of mania, there’s absolutely no peer reviewed research that it helps, either.

Snake oil salesmen have been colorful characters in our myths and history. Add to their ranks the people at your local dispensary and the people pushing CBD.

Don’t try to tell any of this to anyone lobbying for the greater use of cannabis. Few substances are loaded with so many positive claims backed up by so little conclusive research. When you buy it, even legally, you can’t be sure exactly what you’re getting, how much of it you should use, or what it will do to or for you.

You can be sure, if you have bipolar disorder, that you are making a foolish choice, despite how you think it makes you feel in the short term.

Of course supporters of cannabis use will disagree with me. If you’re one of them, please have a look at some of this:

1. Henquet C, Krabbendam L, de Graaf R, et al. Cannabis use and expression of mania in the general population. J Affect Disord. 2006;95:103-110.

2. Zorrilla I, Aguado J, Jaro JM, et al. Cannabis and bipolar disorder: does quitting cannabis use during manic/mixed episodes improve clinical/functional outcomes? Acta Psychiatrica Scand. 2015;131:100-110.
3. Mammen G, Rueda S, Roerecke M, et al. Association of cannabis with long-term clinical symptoms in anxiety and mood disorders: a systematic review of prospective studies. J Clin Psychiatry. 2018;79:17r11839.

4. Starzer MSK, Nordentoft M, Hjorthoj C. Rates and predictors of conversion to schizophrenia or bipolar disorder following substance-induced psychosis. Am J Psychiatry. 2018;175:343-350.
5. Radhakrishnan R, Ranganathan M, D’Souza DC. Medical marijuana: what physicians need to know. J Clin Psychiatry. 2019;80:45-47.

6. Hill JH. Medical use of cannabis in 2019. JAMA. 2019;322:974-975.

7. Humphreys K, Saitz R. Should physicians recommend replacing opioids with cannabis? JAMA 2019; 321(7): 639-640.

Thanks to the Psychiatric Times for the research citations.

Getting Older With Bipolar

Every Thursday evening at 7:00p EST a group of us meet on Zoom to discuss the challenges of aging and mental illness, and to share ways to live successfully with mental illness. We meditate a bit. Please join us. Find the link here.


I’ve written on Christian, Buddhist and Islamic meditation. Judaism, too, has a long tradition of contemplative practices. This video by Gutman Locks considers Jewish meditation. What is striking is that nearly every tradition uses essentially the same techniques of focused attention to achieve very different ends. Whether you seek simple relaxation or deep spiritual insight, sitting quietly and placing your mind on a point of focus, possibly your breath or a letter from Hebrew, and returning your mind to that point of focus when it wanders, over and over again, can work wonders. Here Rabi Locks explains how to keep meditation spiritual: