The research into bipolar disorder (BD) has largely been focused on trying to prove that cannabis is dangerous, that the question of any potential beneficial effects have been ignored. Although there is no scientific evidence that medicinal cannabis is effective to treat clinical depression or mania in BD, it may still be of value in bringing relief to the anxiety that often comes with the condition.
Bipolar disorder can be found in about two to three percent of people worldwide, equally distributed across gender and race. The recurrent episodes of mania and depression of BD are categorized by psychiatry into types I (episodes of full mania, usually with loss of connection to reality) and II (major depression and minor episodes of mania called hypomania). Depression is a significantly more common symptom compared to mania for both types: 3:1 in type I, and 39:1 in type II.  Anxiety is a main feature in BD, especially in type I.  For more information, see our health articles on depression, schizophrenia, and anxiety.
People with bipolar disorder note that medicinal cannabis can help to alleviate hyperactivity typical of hypomanic or manic episodes, and lift their mood during periods of depression.   In saying that, genetic research along with one study of CB1 receptor densities were negative, meaning, there isn’t a likely plausible basic science hypothesis that would link the endocannabinoid system (ECS) and BD.   Conversely, no cerebrospinal fluid (CSF) elevations of anandamide were found, as was the discovery for schizophrenia.  However, In a 2015 study review of the best available literature on cannabinoids and BD, researchers uncovered an earlier age of onset for those using cannabis, as well as a worsening of prognostic outcome.  Meaning, for those predisposed to developing bipolar, cannabis use can result in an earlier onset of the condition.
“Therefore, as of now, no available data can substantiate the potential utility of endocannabinoid modulators for the treatment of bipolar disorder. The strongest findings point to an association between cannabis use and an earlier age of onset increased severity and frequency of mood episodes, particularly mania, and increased numbers of comorbid Axis I and II disorders, as well as more severe deficits in psychosocial functioning. Taken together, findings indicate that cannabis use may be associated with worse prognostic outcomes in patients with both disorders.”
A 2015 study used the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), which started with 43,093 participants. Their results were not what they expected in a study designed to study cannabis abuse: The baseline presence of major depressive disorder was associated with future use of cannabis, indicating self-medication; there was no causative association between BD and cannabis use. 
Traditional western medical treatments of bipolar disorder primarily focus on relieving the symptoms of mania and depression, and on preventing cycling between these two states. Although BD can almost always be controlled to some degree, like schizophrenia, it cannot be cured and needs lifelong medical management. The possibility of drug interactions between medical cannabis and atypical antipsychotic or antidepressant medications is largely unexplored, and should be considered (under the supervision of a doctor), if changes in efficacy of traditional medications are being considered. 
Highly respected academic psychiatrists experienced with cannabis research, Asthon et al, reviewed potential reasons for, and benefits of, the use of medical cannabis in BD  stating that, “BD is often poorly controlled by existing drugs and often involves a polypharmacological medley, including lithium, anticonvulsants, antidepressants, antipsychotics, and benzodiazepines. Many patients take street drugs in addition. Some claim that such self-medication is superior to the drugs prescribed by psychiatrists. There are good pharmacological reasons for believing that the prescription of synthetic cannabinoids or standardized plant extracts may have a therapeutic potential in BD.”
Because of the fragile nature of BD states and the conflicting evidence, caution is advised when trying any cannabinoid-containing products. Due to the lack of evidence supporting the efficacy of cannabis as a treatment for BD, a high-CBD product is likely the safest to experiment with to balance mood. High-THC products should be avoided, given the possibility of triggering paranoia or anxiety if too high a dose is taken.
It is important to understand that this article is designed for informational purposes only and does not constitute medical advice. Prior to making changes to your treatment plan or lifestyle, consult with a licenced medical professional. These statements have not been evaluated by the food and drug administration.
Cannabidiol products that contain only CBD have a dosing range for anxiety between 2.5 and 10 mg. CBD is typically well tolerated in very large doses without problems or any notable side effects. Generally, a CBD isolate or cannabis product with a 20:1 ratio of CBD to THC or higher is ideal. A high CBD to THC ratio may provide relief from anxiety with minimal, if any, psychoactivity.. Begin with 5 mg CBD, three times daily, with the last dose taken before 5 pm (any later, and the CBD may be wake-promoting).
A 1:1 CBD:THC oral extract or spray may be of value,  but expect some potential psychoactivity from the presence of THC. Start with 2.5 mg of each cannabinoid, moving to 5 mg only if the lower dose is well-tolerated.
Tetrahydrocannabinol (THC) is not recommended to manage the symptoms of BD. If treating the symptoms of BD is the goal, medical cannabis with a high CBD to THC ratio such as a 20:1 or higher is likely the most reasonable and safest approach. 
Oral cannabis products such as in the case of sprays, sublingual tinctures, or edibles take longer to take effect (30-60 minutes) but last longer (6-8 hours), whereas inhaled products take effect immediately but only last 2-3 hours. Such as in the case of smoking or vaporizing, is often the first choice for those wanting more immediate relief for anxiety or a shift in mood, but caution must be advised when monitoring the dose. High CBD strains are recommended, while THC varieties should be avoided.
Search for a full spectrum cannabis product containing whole plant compounds such as terpenes and other plant phytonutrients to take advantage of the “entourage effect” , which boosts the synergy, efficiency, and potency of the cannabinoids inside the body. A terpene content high in limonene may have an uplifting effect. The role of terpenes in psychosis is relatively unexplored, but linalool, present in some cannabis strains, can have a calming effect.  High-CBD strains such as ACDC and deadlights, may be helpful if medical cannabis is being used for the calming of hypomanic symptoms. Cannabis strains with the monoterpene myrcene, as is found in most CBD-dominant cultivars, may also have a strongly sedative effect. For more information, see our articles on Full Spectrum Extracts, the Entourage Effect, and our Ultimate Guide to Terpenes.
For more information, see our other article on bipolar.
The benefits of using CBD products derived from the cannabis plant alongside prescription medications for mental health related disorders such as bipolar still require additional studies to be completed. Using medical marijuana and CBD oil to treat brain imbalance and dysfunction must be carefully approached using caution, as the long term effects are not well known.
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