Does Smoking Cannabis Cause Psychosis in Bipolar II Disorder?

Yes, undoubtedly, but not universally. I have encountered patients in my clinical practice whose manic episodes seemed directly correlated with their use of cannabis. In one notable case, an individual's chronic paranoid state fully remitted when he ceased using cannabis. For many patients, substance use is just one of many factors contributing to their struggles, and establishing clear causation is often challenging.

Psychotropic Drugs as Psychosis Triggers

Psychotropic drugs, including cannabis, are a potential trigger for individuals with a history of psychotic reactions. While not everyone is equally affected by the same drugs, and some individuals may not find any drugs problematic, cannabis is frequently cited as a trigger. For some users, it is not the intoxicating high that poses a problem, but rather the specific effects of THC, which can push someone over the edge. Some experience cannabis to intensify or newly trigger experiences classified as 'psychosis' a day or three after single-time use. The effects of psychotropic drugs are not limited to the initial hours after dosing.

Understanding Psychiatric Diagnoses

It's important to note that psychiatric diagnoses like 'bipolar disorder' are not medical conditions in the traditional sense. They are labels for experiences that have occurred but do not provide an explanation for why these experiences happened or when they may recur. Proper psychiatric diagnoses require that the experiences are not due to any physical medical problem or the effects of drug use. Each patient's underlying physical and psychological causes and dynamics are unique, meaning that there is no 'bipolar' to 'have' that interacts with drug use.

Causes and Triggers

The reasons for experiencing psychosis can be a critical factor in determining whether cannabis use is a trigger. While a psychiatric diagnosis, medical illness, or a history of experiences are common, a drug can contribute to or trigger psychosis even in the absence of these factors. However, many drugs are more likely to cause psychosis than cannabis. A disadvantage of cannabis is that responsible drug management is less researched, discussed, and standardized. Myths about drug risks prevail, and this is no less true of prescription pharmaceuticals, which are also often mishandled.

Precautions and Best Practices

For individuals unsure about the impact of cannabis use, the best first step is often avoidance. For those who wish to experiment, using strains that are much higher in CBD and much lower in THC, starting with a very small dose that won't produce a proper high, and choosing a route of administration that can be easily adjusted (e.g., vaporization or leaf rather than edibles) can help reduce the risks of a surprise bad reaction. It's also crucial to understand that cannabis use can interact with any current or recent use of other drugs, and the ramifications of drug use are not limited to the hours and days directly after the last dose taken. Always be educated, responsible, and wise in managing your risk.