Medical Marijuana for Bipolar: The User's Dilemma
This is a follow-up to last week’s post on medical marijuana for bipolar. In the post, I noted that a case can be made for using the product in very small doses to relieve symptoms and maintain mental health, but with some very strong provisos.
In particular, I noted:
All medications, including psychiatric meds, carry substantial risks that must be weighed against potential benefits. Marijuana is no exception.
I also pointed out:
A “medical” dose is not to be equated with a recreational dose. ... Getting high is not a sign of the efficacy of the treatment. Nor is it a legitimate side effect. The result you’re looking for is extremely subtle but profound - a brain that works.
A number of readers echoed my concerns. A pair of comments, in particular, are worth singling out. On the surface, they come across as a point/counterpoint. In actuality, they are complementary:
Gina accepts at face value user reports of anxiety relief and improved sleep and so on, but advises that other avenues need to be explored first. She points out those already suffering from cognitive deficits “owe it to themselves to strengthen brain function instead of going for temporary measures that can do long-term harm.”
She also notes that “natural” is not to be equated with “safe.”
Tabby observes that unlike most pharmaceutical meds, both marijuana and alcohol offer instant relief, though one needs to be mindful of the risks from long-term use. Having said that, she points out that “alcohol and marijuana and other recreational drugs are really no different than the pharmaceutical lab chemicals to me. It's just that pharma is prescribed by a doc.”
In effect, Tabby is saying “prescription meds” are not to be equated with “safe.” Exhibit A is the benzodiazepine class of drugs (Xanax, Ativan, etc) to treat short-term anxiety. These drugs tend to get pressed into service for long-term use, which builds up a tolerance and dependency.
Exhibit B are ADHD meds, which Tabby characterizes as “modified street speed,” which is why they are so abused.
Tabby could have added other classes of meds that are not necessarily abused but can be extremely dangerous when recklessly prescribed: Antidepressants - which can induce mania and rapid cycling - and antipsychotics, which carry a high cost of doing business.
To that we can add lithium and the mood stabilizers, where doctors tend to err on the side of overkill.
In effect, Gina and Tabby are both telling us is that no choice is risk-free. On one side, we may wrongly assume that Mother Nature is benign. On the other, we may place too much faith in our doctors.
Clinical trial evidence on marijuana for bipolar is totally lacking. But the same is true for psychiatric meds over the long haul (see, for instance, Antipsychotics in the Long Term: Zero Evidence).
This brings us to the user’s dilemma: Informed decisions depend on good data. Alas, alas - our brains can’t wait. We need to act now. That’s life in the real world.