The literature search revealed no systematic studies of the therapeutic
use of cannabis or cannabinoids in BAD, although there are
several anecdotal reports. Grinspoon and Bakalar (199
described
five cases in which cannabis appeared to alleviate mania. For
example, one woman with BAD quoted in their report chose
cannabis over alcohol to control her manic behaviour: A few puffs
of this herb and I can be calm
this drug seems harmless
compared to other drugs I have tried, including tranquillisers and
lithium. A husband, describing his wife with BAD said: My wife
functions much better when she uses marijuana. When she is hypomanic,
it relaxes her, helps her sleep, and slows her speech down.
When she is depressed and would otherwise lie in bed all day, the
marijuana makes her more active
Lithium is also effective, but
it doesnt always keep her in control.
Personal observation of a patient attending the local outpatients
also indicated an apparent antimanic effect of cannabis. The patient
was a 39-year-old male who had been diagnosed 10 years previously
as having BAD. His illness mainly took the form of manic
episodes for which he had a history of five hospital admissions.
These episodes were difficult to control because the patient was
intolerant of antipsychotic drugs, including quetiapine and risperidone,
and non-compliant with lithium and sodium valproate.
Diazepam controlled his symptoms but he often used up his
2-week prescription for 30 mg daily in 1 week.
A recent manic episode was associated with a severe behaviour
disturbance involving a further possible detention order. The psychiatrist
was called for a home visit, which he made some hours
later. To his surprise, he found the patient calm, almost serene,
sitting tranquilly in an armchair smoking a cannabis spliff. (He
offered the psychiatrist one of the same, which was declined). It
was clear that the cannabis was responsible for the rapid change in
the patients behaviour. He maintained that, over the years, he had
taken mainly cannabis, sometimes moderate amounts of alcohol,
occasionally street benzodiazepines, and infrequently heroin to
regulate his mood.
Gruber