Cannabis and Mental Health: Schizophrenia

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About 1.1 percent of the worldwide population is diagnosed with schizophrenia. According to the Schizophrenia and Related Disorders Alliance of America, schizophrenia is one of the leading causes of disability in the United States, affecting 3.5 million people. 

The mental health condition can erase people’s memories of their days, past and even their reality. The SRDAA states that person must have at least two of the following symptoms to be diagnosed with schizophrenia, with one of the first three listed being one a person is suffering form:

  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Disorganized or catatonic behavior
  5. Negative symptoms

Cannabis consumption tends to be a debated topic surrounding most mental health conditions today. This is particularly true with schizophrenia. Some believe that cannabis can lead to increased psychosis, a common symptom in schizophrenia. Meanwhile, others believe that may not be the case just yet. 

Dr. Alex Dimitriu is a double board-certified in Psychiatry and Sleep Medicine and founder of Menlo Park Psychiatry & Sleep Medicine. In response to this article, Dr. Dimitriu explained what the effects of psychosis are like on a person. “Psychosis is defined as having false beliefs (often called delusions) and seeing or hearing things that are not real (hallucinations). In a psychotic state, people may appear disorganized, confused, paranoid, almost as if they were tripping on something (like LSD, or magic mushrooms).”

He also expanded on how THC is a mild hallucinogen that can lead to short-term schizophrenia but should not be long-lasting. “Believe it or not, to some degree or other many users of cannabis have experienced the “psychotic” like effects of the drug. Fortunately, this is short-lived, usually lasting hours. Most commonly, this is seen as the paranoia – thoughts like “are people watching me?” “am I going to get in trouble with the authorities?” or, “I think I’m having a panic attack and should maybe go to the ER?”

Dr. Amy Baxter, CEO of Pain Care Labs, felt differently about cannabis use and its potential to affect people. She wrote that while cannabis can be useful in a myriad of conditions from cancer to PTSD, the dopamine pain receptors targeted can lead to mania and psychosis when overstimulated. Dr. Baxter elaborated, “In fact, 10-15% of people get paranoia and hallucinations (psychosis symptoms). With certain genetic backgrounds, even a single use of cannabis can lead to a 10x greater risk of lifelong schizophrenia.”

She also recommended a 2017 review of cannabis through the centuries, noting its recommendation for more research. 

Dr. Jordan Tishler is a Harvard graduate and doctor with his own practice and research and works with CannabisMD. He noted that cannabis use is used at higher rates by people with schizophrenia and other psychotic disorders. Dr. Tishler added, “This has lead to the association of cannabis use with development or worsening of these illnesses. It’s entirely unclear whether cannabis is causing these problems or the problems lead to cannabis use. Obviously these are very different situations. Studies that try to solve this riddle are very mixed, some appear to show causation, others do not.”

Unlike other articles in this series, no patients came forward to share their experience with High Times. That said, many testimonies online detail individual experiences. From the medical professional perspective, while often short-lived, Dr. Dimitriu noted that come symptoms can worsen when using cannabis. He recalled a patient in their 20s who experienced paranoid thoughts, didn’t go to school and slept on the floor to avoid electromagnetic waves. He also noted a 50-something-year-old patient who started hearing voices after smoking a potent strain. 

Dr. Tishler also offered up an example they encountered. In this case, a 65-year-old patient suffered from severe and constant physical pain and unresponsive to traditional medicine. The patient also had suffered from 40 years of mental health issues, dating back to her 20s. He explained how they came to a suitable treatment plan using cannabis.

“Ideally, we’d avoid cannabis for her, but her pain is debilitating, unresponsive to prior treatment, and her acute psychosis was long ago. In this case, I was able to devise a care plan with her vast mental health team to monitor her daily (as they were already doing) such that if cannabis made her worse, we’d know rapidly.” 

He said that he “did lose sleep over her case,” but the issue worked out in this case. He also offered a counterexample. “I’ve had cases where, despite careful consideration, they did poorly and were thankfully noticed quickly.”

With such varying outcomes and the severity of the condition, Dr. Tishler recognized that cannabis could be the cause of psychosis, or increase the illness. Therefore, it is wise to avoid using cannabis if there are any signs of any such symptoms. He also addressed the problem with this solution. “The problem, of course, is that it is hard to foresee these illnesses until they strike. Since these illnesses tend to occur in late teens and early young adults, this is part of the reason for suggesting that these people avoid cannabis.”

The other responding physicians agreed with this approach. Dr. Baxter called using cannabis with this mental health condition “extremely risky.” Meanwhile, Dr. Dimitriu expanded on other substances people with schizophrenia and other conditions may want to consider avoiding. 

“Certainly true with uppers – whether it is amphetamines like Adderall, or methylphenidate – Ritalin, even caffeine and energy drinks – these meds can increase levels of dopamine which can worsen agitation, and the symptoms of psychosis. Classic psychedelics should be definitely avoided – like LSD, psilocybin (magic mushrooms), DMT, and so on.”

While THC appears to be a cannabinoid medical professionals would not recommend in most schizophrenia patients, some are discussing the positive benefits of CBD

Dr. Bill Code is a cannabis expert concerning mental conditions, including schizophrenia. His book, Solving the Brain Puzzle, addresses cannabis use. He explained how CBD led to “considerable benefit” with psychosis and schizophrenia. He came to a decision after reading a French study of high potency CBD and its equivalence to modern antipsychotics “without the rough side effects.”  

Dr. Dimitriu expanded on why CBD may prove to be an effective anti-psychotic. “CBD has been shown to have numerous medicinal benefits – as a pain reducer, an anti-convulsant (anti-seizure), a sleep inducer, and has been shown to lower anxiety levels,” he said while adding that additional studies are required. He mentioned a 2012 investigation of the effects of CBD as an antipsychotic for further reading.

In the end, just with any condition, the choice falls on the patient as long as they are of a sound mind to do so. “This is not always an easy decision…careful planning and monitoring is essential to being able to avoid problems or [react] quickly if they do arise,” said Dr. Tishler.

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