Marijuana vs Prescription Meds for Bipolar: Time to End the Double Standard?

John McManamy Health Guide
  • Last week, I posted, Marijuana for Bipolar: Treatment or Self-Medication?, which took its lead from MerelyMe’s piece on marijuana for treating anxiety. This post is a response to your responses to my response to MerelyMe. Gotta love these conversations ...


    Tabby spoke for virtually all of us in stating:


    I’m not for pot over psych meds nor psych meds over pot. There is abuse of anything good or harmful. Yet for many, if something helps them ... whether that be pot, Seroquel, Klonopin, eating certain foods, or SAM-e, then why seriously knock it?


    MerelyMe added:


    Is the use of marijuana addictive or harmful to some?  Perhaps. Yet one can say this about some of the pharma products people use on a daily basis. In some cases there may be benefits of medicinal marijuana for certain patients and this is where more research is necessary. 

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    If I am interpreting Tabby and MerelyMe and others correctly, we should be judging marijuana by the same standard we judge prescription meds, namely any substance we take into our body: 1) may be extremely beneficial 2) may help somewhat 3) may be problematic 4) may be extremely dangerous 5) may have no effect.


    As Lenny notes: “I have yet to come across any medication that works the same for everyone, so it's probably the same for marijuana.”


    Denny adds the twist that when he was young, “it would ease my mood imbalance and give my brain a rest from constantly turning.” Now that he is older, “it makes me feel like I am going out of my mind at an accelerated speed.”


    I think we’re all on the same page with this. Our meds hold out the promise of leading rewarding lives, but they often fall short, there are complications, and for many they are a complete disaster. “Pill roulette” is the game we all find ourselves playing, often involving years of heartbreak and frustration. Eventually, we hit upon something that we can live with, but rarely to our complete satisfaction. Then, no sooner do we seem to be doing okay than something changes in the brain and back to another round of pill roulette we go.


    How could medical marijuana be worse than that? Indeed, I strongly urge you to read Robert Whitaker’s 2010 “Anatomy of an Epidemic,” which makes a very strong case that our meds make us worse, rather than better. I gave the book considerable play on my personal blog, Knowledge is Necessity, and look forward to giving it the treatment it deserves in the near future, here on HealthCentral.


    One of the startling points that Whitaker raises is that continued antipsychotic use may, in certain cases, result in psychosis. There is support for “supersensitivity psychosis” in the scientific literature, though you won’t see this on any warning labels. Far less novel is Whitaker’s point that antidepressants raise a high level of mania risk in those living with bipolar - a point brought home many times here on HealthCentral.


    So - whether talking about psychiatric meds or medical marijuana - we hear very similar injunctions: risk of psychosis, risk of mania. We also hear about people who benefit. This leads to the $64,000 question: Is it high time we abandoned the double standard? 


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    Another way of phrasing it: Whether we are talking about prescription meds or medical marijuana - or, for that matter nutrients and supplements - should we exercise the same skeptical regard?


    Funny you should ask. This week, on my blog Knowledge is Necessity, I published a reader poll that found that more than 50 percent of you think that more than 50 percent of psychiatrists are incompetent. One inference to draw from this is that there is a very strong likelihood our doctors will overstate the benefits of prescription meds to us and downplay the risks.


    In other words, the reliability of information we receive on prescription meds may be no better - even worse - than the reliability of information we receive concerning marijuana. Add to that the corrupting influence of Pharma on the practice of psychiatry - at long last recognized as a major problem by the American Psychiatric Association and in editorials in leading medical journals - and we can chalk one up in favor of abandoning the double-standard.


    This has been a week of coincidences. At the same time as I was writing on medical marijuana and psychiatric incompetence, I was updating an article on mcmanweb on dual diagnosis/co-occurring disorder. This stemmed from a dinner conversation I had several months before with a group of NAMI parents. The discussion inevitably turned to their kids. Their problems were so severe (repeated hospitalizations, homelessness, run-ins with the law) that at first I assumed they were talking about schizophrenia. Then one parent mentioned bipolar, then another, then another. As I reported in my updated piece:


    You guessed it. It wasn't "just bipolar" I was hearing about. Thanks to drug and alcohol abuse in the equation, life's degree of difficulty for all parties concerned went from "challenging" to "just about impossible." The stories that night jibed with other accounts I had heard over the years from parents and loved ones, plus no end of conversations I have had with individuals experiencing the condition.


    How bad is it? Recall, at first I thought these parents were talking about schizophrenia. That's how bad it is.


    Let’s be very clear about this: In no way do we want self-medicating to lead to drug abuse that in turn brings on a dual-diagnosis condition. Marijuana can be abused. So can certain classes of prescription meds. We are not talking certainty - of one thing automatically leading to another. Rather, we are talking about risk. Every decision we make carries risk. Think carefully, decide for yourself ...




    As always, you - patients and loved ones - are the true experts. Please feel free to contribute your wisdom and insight. You are in a safe place. Comments below ...  

Published On: January 22, 2012