Bad Effects of Cannabis on BPD Patients Could be Gene Mutation
Studies show that, overall, BPD patients benefit from medical cannabis. And that it does NOT contribute to cognitive decline.
Bipolar disorder (BPD) is one of the leading forms of psychiatric illnesses, and it creates a significant burden on patients and caregivers. Patients with BPD are at a greater risk of substance abuse, which can make it even more difficult to achieve effective treatment.
Many BPD patients resort to alcohol or drugs for symptom relief; this includes cannabis. There is, therefore, a grey area over the potential benefits and harms of medical cannabis for BPD patients as other substances are often in the mix. Indeed, a long-standing debate exists in the literature about whether symptom relief can be achieved with medical cannabis in BPD patients, and even if that is the case, whether the cost of presumed further cognitive impairment is worth it.
Despite the absence of consensus on benefits of medical cannabis in BPD, there is also no concrete evidence to dispute its assistance. In fact, clinical studies are emerging with research designs that are more rigorous and geared towards answering this question directly.
Two studies reported positive association between neuropsychological functioning in medical cannabis BPD users. They found that cognitive domains, such as psychomotor function, speed, attention, working memory, executive functioning and verbal learning all improved in BPD patients using medical cannabis compared to those who did not.
Another study was conducted to further investigate this potential beneficial impact, which enrolled both patients with and without BPD. This study repeated the results of positive associations of medical cannabis and BPD patients. Namely, they observed significantly lower bouts of anger, depression, and tension and higher amount of vigor. The authors observed no negative cognitive effects resulting from cannabis use in BPD patients.
Previous studies reported that despite the positive effects observed in BPD patients using cannabis, an increase in manic and depressive episodes was also observed. It is likely that positive and negative cognitive effects of cannabis are dependent on many different factors, such as dose, disease severity, mode of administration, and individual differences. Furthermore, different chemovars of cannabis, with varying THC and CBD content, are likely to exert differential effects.
For example, CBD is known for its anxiolytic (anti-anxiety) and antipsychotic properties, and therefore chemovars with higher CBD content may be more beneficial in relieving symptomology in BPD patients. Another aspect of cannabinoid medicine is at the level of receptors, and perhaps the varying effects may arise due to differences in receptor expression. While to date, there is no known indication of CB1 receptor level changes in individuals with BPD, a mutation in CB2 receptor gene has been discovered to occur more frequently in individuals with BPD.
This change encompasses only a single letter of the DNA alphabet, called a single nucleotide polymorphism, that changes an amino acid in the CB2 receptor protein, making it more stable. It is thus tempting to speculate that individuals who carry this polymorphism are more likely to benefit from cannabis, and of chemovars richer in CBD, given that their CB2 receptor is more stable. However, there are no studies to support this yet.
It is important to note that cognitive performance declines in BP, irrespective of cannabis use. With that in mind, therapeutic strategies to alleviate symptomology should be considered, and likely on an individual basis. Cannabis may be most beneficial when content of CBD is higher compared to THC. Also, it remains to be addressed as to whether different cannabis preparations (oil, vape, medibles) would be cognitively therapeutic.
Taken together, recent studies suggest that cannabis use in BPD patients provides at least short-term cognitive benefits and as importantly, does not result in cognitive decline additive to the disorder.