Cannabis And Bipolar Disorder
Many people with bipolar disorder report that cannabis relieves both depressive and manic symptoms, that it works better than conventional medications, and that it helps relieve bothersome side effects from those drugs.13 Despite these anecdotal claims, a 2020 review that examined research on the therapeutic use of cannabis in bipolar disorder presented a more nuanced picture. 14
While researchers found that the use of medical cannabis offered short-term partial alleviation of clinical symptoms,15 another case study showed that treating two bipolar type I patients with CBD had no impact on manic symptoms.16 Yet another study cited evidence that cannabis use might actually worsen manic symptoms and increase the risk of new manic episodes.17
With these mixed results, additional clinical trials are needed to better clarify the role that marijuana might play in treating bipolar disorder. Upcoming trials include:
- A randomized clinical trial has been registered to examine CBD as an adjunctive treatment for bipolar disorder
- Another trial aimed to evaluate the cognitive and psychophysiological effects of THC in bipolar disorder has been registered but is not yet recruiting.
- A trial that examines the effects of dronabinol as well as of CBD on cognitive domains relevant to bipolar disorder, i.e., arousal, decision making, cognitive control, inhibition, and temporal perception will be evaluated in adult patients and is currently recruiting participants.
Choose Natural Products With Care
People sometimes use St. Johns wort to treat depressive symptoms, but they may and interfere with antidepressants.
People with bipolar disorder should not use St. Johns wort.
Always speak to a doctor before trying any natural or alternative therapy. Some can interact with other drugs, and they may have adverse effects.
The FDA does not officially regulate supplements and herbal products, so people may not know exactly what they are buying.
Find New Ways To Relieve Stress
Trying new things may be one of the last things you want to do when youre in a depressive episode. However, doing so can help alleviate your symptoms.
For example, if youve never gotten a massage before, consider scheduling an appointment at a local spa.
Similarly, yoga or meditation may be new to you, but they can be beneficial during depressive episodes. These activities are known for being relaxing. They can make it easier for you to cope with the stress or irritability you may be experiencing.
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How Is It Treated
Bipolar disorder is treatable. With treatment, which includes medicines and counselling, you can feel better.
You may need to try several medicines to
find the combination that works for you.
- Most people with bipolar disorder need to take a medicine called a mood stabilizer every day.
- Medicines called antipsychotics can help get a manic phase under control.
- Antidepressants are used carefully for episodes of depression, because they cause some people to move into a manic phase.
Counselling for you and your family is also an important treatment. It can help you cope with some of the work and relationship issues that the illness may cause.
You can do a few things on your own to help deal with bipolar disorder. These include regular activity, getting enough sleep, and learning to recognize early signs of highs and lows.
People often stop taking their medicines during a manic phase because they feel good. But this is a mistake. You must take your medicines regularly, even if you are feeling better.
Who Experiences Bipolar Disorder
Bipolar disorder usually begins in older teens and young adults, with at least half of all cases appearing before age 25. Children and adolescents, however, can develop this disease in more severe forms and often in combination with attention deficit hyperactivity disorder . Some studies have indicated that bipolar depression is genetically inherited, occurring more commonly within families.
While bipolar disorder occurs equally in women and men, women are more likely to meet criteria for bipolar II disorder. Women with bipolar disorder may switch moods more quickly this is called “rapid cycling.” Varying levels of sex hormones and activity of the thyroid gland in the neck, together with the tendency to be prescribed antidepressants, may contribute to the more rapid cycling seen in women. Women may also experience more periods of depression than men.
An estimated 60 percent of all people with bipolar disorder have drug or alcohol dependence. It has also been shown to occur frequently in people with seasonal depression and certain anxiety disorders, like post-traumatic stress disorder .
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Supporting Someone You Care About With Bipolar Disorder
References
What Causes Bipolar Disorder
The cause of bipolar disorder remains unclear. However, factors believed to play a role include genetics, brain chemicals, social and environmental factors, substance abuse and medical illnesses. Sometimes its onset can be linked to a stressful or traumatic life event.Genetic factors are thought to account for about 6080% of the cause of the condition. If one parent has bipolar disorder, there is a 1025% chance that his or her child will develop the illness. If both parents have bipolar disorder, the likelihood of their child developing the illness is about 1050%.
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Assessment Of Symptom Severity
The most common approach to measuring the severity of manic symptoms has been clinician-rated interviews. The Young Mania Rating Scale and Bech-Rafaelsen Mania Rating Scale are two of the most widely used clinician-rated scales for assessing symptom severity. These scales have been commonly used to track changes in symptoms over time as treatment progresses. We briefly review these two scales, as well as the Schedule for Affective Disorders and SchizophreniaâChange version mania subscale. There has been growing recognition, though, of the need to track both clinician and patient perspectives on the course of treatment, and so we discuss available symptom severity measures that rely on self-report. Some research has focused on measures useful for case conceptualization and treatment planning, but this literature is not covered in detail here: interested readers are referred to other reviews . summarizes some of the well-supported measures for assessing symptom severity in bipolar disorder.
Pregnancy And Bipolar Medicines
One of the main problems is that the risks of taking bipolar medicines during pregnancy are not well understood.
If you’re pregnant and you have bipolar disorder, a written plan for your treatment should be developed as soon as possible.
The plan should be drawn up with you, your partner, your obstetrician , midwife, GP and health visitor.
The following medicines are not routinely prescribed for pregnant women with bipolar disorder, as they may harm the baby:
- valproate
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Medication Treatment For Bipolar Disorder
Most people with bipolar disorder need medication in order to keep their symptoms under control. When medication is continued on a long-term basis, it can reduce the frequency and severity of bipolar mood episodes, and sometimes prevent them entirely. If you have been diagnosed with bipolar disorder, you and your doctor will work together to find the right drug or combination of drugs for your needs. Because everyone responds to medication differently, you may have to try several different medications before you find one that relieves your symptoms.
Check in frequently with your doctor. Its important to have regular blood tests to make sure that your medication levels are in the therapeutic range. Getting the dose right is a delicate balancing act. Close monitoring by your doctor will help keep you safe and symptom-free.
Continue taking your medication, even if your mood is stable. Dont stop taking your medication as soon as you start to feel better. Most people need to take medication long-term in order to avoid relapse.
Dont expect medication to fix all your problems. Bipolar disorder medication can help reduce the symptoms of mania and depression, but in order to feel your best, its important to lead a lifestyle that supports wellness. This includes surrounding yourself with supportive people, getting therapy, and getting plenty of rest.
Effective Personalized Strategies For Treating Bipolar Disorder
Stephen V. Sobel, MDPsychiatric Times
Effective personalized treatment recognizes bipolar disorder as a biopsychosocial disorder, but mood-stabilizing medications are the backbone of treatment. These medications fall into 3 categories: lithium, antikindling/antiepileptic agents, and second-generation antipsychotics.
Bipolar disorder causes havoc in patients lives. Even in the best of circumstances, successful treatment is challenging. Treatment targets constantly shift patients are frequently nonadherent and comorbidity is the rule, not the exception. Diagnosis of bipolar disorder is often difficult. Comorbidities need to be identified and addressed if treatment is to be effective.
The importance of an accurate diagnosis
With apologies to Charles Dickens, bipolar disorder is often experienced as the best of times and the worst of times. This polarity often causes bipolar disorder to be undiagnosed, overdiagnosed, or misdiagnosed. Bipolar disorder is associated with a significantly elevated risk of suicide. Moreover, bipolar patients often use highly lethal means for suicide.1 Contributing factors include early age at disease onset, the high number of depressive episodes, comorbid alcohol abuse, a history of antidepressant-induced mania, and traits of hostility and impulsivity.
A moving target needs moving treatment
TABLE
Factors that suggest bipolar depression rather than unipolar depression
The best treatment is prevention
The best mood stabilizer
Drug interactions
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Convincing A Person With Bipolar Disorder To See A Doctor
Aside from offering emotional support, the best way to help your loved one with bipolar disorder is by encouraging and supporting treatment. Often, that can be more of a challenge than it sounds. Since people with bipolar disorder tend to lack insight into their condition, its not always easy to get them to a doctor. When your loved one is manic, they feel great and dont realize theres a problem. When your loved one is depressed, they may recognize somethings wrong, but often lack the energy to seek help.
If your loved one wont acknowledge the possibility of bipolar disorder, dont argue about it. The idea may be frightening to them, so be sensitive. Suggest a routine medical checkup instead, or a doctors visit for a specific symptom, such as insomnia, irritability, or fatiguethen privately call ahead to tell the doctor of your concerns about bipolar disorder.
Things you can say that might help:
- Bipolar disorder is a real illness, like diabetes. It requires medical treatment.
- Youre not to blame for bipolar disorder. You didnt cause it. Its not your fault.
- You can feel better. There are many treatments that can help.
- When bipolar disorder isnt treated, it usually gets worse.
What Does It Mean To Be Bipolar
Once called manic depression, bipolar disorder is a mental health condition characterized by unusual shifts in mood, energy, activity levels, concentration and an inability to carry out daily tasks. Moods can range from highs where you feel extremely energized, elated or unusually irritable to lows which can lead to sadness, indifference, or hopelessness.1
Although bipolar disorder is a lifelong condition, its possible to manage mood swings and other symptoms by following a treatment plan that, in most cases, includes medications and psychotherapy.
In general, bipolar disorder is much better controlled if treatment is continuous and tailored to each person since different people respond to treatment in different ways, says Diana Samuel, MD, assistant professor of clinical psychiatry at the Columbia University Medical Center. The combination of psychotherapy and medications together tends to be more effective, providing improvement in symptoms sooner.
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Be Patient And Stay Optimistic
Bipolar disorder is a long-term condition, so the symptoms will come and go throughout a persons life. The disorder is unpredictable, with symptom-free periods alternating with extreme mood episodes. For the sake of the person with bipolar disorder, try to stay patient and optimistic. This can help them stay on track to living a full, healthy life.
Lithiums Neurotrophic Effects In Bd: Data From Human Studies
The most replicated finding from structural neuroimaging studies is an association between lithium treatment and increased gray matter volume in brain areas implicated in emotional processing and cognitive control, such as the anterior cingulate gyrus, amygdala, and hippocampus, which suggests that lithium has considerable neurotrophic effects . One study found that patients with BD who were not treated with lithium had significantly reduced left anterior cingulate volumes compared to healthy volunteers and lithium-treated patients . Additional magnetic resonance imaging studies examined the gray and white matter volumes of 12 untreated and 17 lithium-treated patients with BD and 46 healthy controls and found that total gray matter volumes were significantly increased in lithium-treated relative to untreated patients and healthy controls . Another study found that gray matter density was significantly greater in patients with BD relative to healthy controls in diffuse cortical regions . In an MRI study of the hippocampus conducted in 33 patients with BD and 62 matched healthy controls, investigators found that total hippocampal volume was significantly greater in lithium-treated patients with BD compared with healthy controls and unmedicated patients .
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How Do The Cns Depressants Help With Bipolar Disorder Depression
Central nervous system depressants, which include the benzodiazepines, act on neurotransmitters to slow down normal brain function. CNS depressants are commonly used to treat anxiety and sleep disorders and may be an effective alternative or adjunctive therapy in some bipolar patients with acute mania.
Some commonly used benzodiazepines include clonazepam , lorazepam , alprazolam , and diazepam . These drugs all can be addictive and can cause sluggish thinking. They generally should be used only to treat agitation or sleep problems during the acute phase of the illness and not as long-term medications. They typically should be tapered off rather than stopped abruptly, in order to minimize the risk of drug withdrawal.
Living With Bipolar Disorder
Teens normally face ups and downs with school, family, work, and friends. Dealing with bipolar disorder at the same time is a very difficult challenge. One 16-year-old reader who was diagnosed with bipolar disorder at 14 wrote to us about the experience:
“I had mood swings that were the worst anyone could have ever seen. My poor parents thought I hated them, but really I was sick and didn’t even realize it. But now I am on medications for my disorder and I live a pretty normal life. My family and friends support me, and they, along with my therapist, have helped me get to the point where I am today. I just want other teens to know that even though it is hard at times to be bipolar, things will get better.”
If you’ve been diagnosed with bipolar disorder, taking your medications as prescribed, reporting any changes in how you feel or function, and participating in therapy will be key to living a successful life. In addition to treatment, making a few lifestyle changes, such as reducing stress, eating well, and getting enough sleep and exercise can help someone who is living with the condition. And many teens find it helps to join a support network such as a local support group for people with bipolar disorder.
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What Treatment Could I Get To Manage A Current Episode
This will usually depend on what kind of episode you’re experiencing.
During depressive episodes
- You’re likely to be offered medication this might be new medication or adjusting your current medication.
- You might also be offered a structured psychological treatment that’s proven to help with depression, such as cognitive behavioural therapy .
During manic or hypomanic episodes
- You’re likely to be offered medication this might be new medication or adjusting your current medication.
- You’re unlikely to be offered a talking treatment if you are currently experiencing a manic or hypomanic episode.
Pregnancy And Treatment For Bipolar Disorder
You should discuss any pregnancy plans with your psychiatrist. Together, you can arrange how to manage your mood during the pregnancy and for the first few months after the baby arrives. Lithium and sodium valproate should not be prescribed if you are pregnant or planning to become pregnant.
If you become are pregnant while taking lithium, it’s best to discuss with your psychiatrist whether you need to stop lithium. Although lithium is safer in pregnancy than the other mood stabilisers, there is a significant risk to the baby of heart problems. This risk will need to be weighed against the risk of you becoming depressed or manic.
The risk is greatest during the first three months of pregnancy. Lithium is safe after the 26th week of pregnancy, although you should not breastfeed your baby if you are taking lithium as it can be toxic for your baby12.
It will be worth the discussing the possibility of starting some of the psychological treatments mentioned above.
During pregnancy, everyone involved – the obstetrician, midwives, health visitors, GP, psychiatrist, and community psychiatric nurse need to keep in close touch with each other.
During a depressive episode, or in between episodes of mania and depression, psychological treatments can be helpful1 5 11. These can include:
- other options if the above choices have not helped.
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