Marijuana a mood stabilizer?
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Marijuana a mood stabilizer?

Q: My son at 19 was diagnosed with bipolar. He was put on depakote and zoloft. He took this medication for about a year. He didn't like how he felt on it. Stopped taking any medication for about a year now. He and his wife say he is doing much better. Very few manic episodes and very little depression, no severe ups and downs. My concern is, he is smoking marijuana and tobacco. Is this a form of self medicating? Is the marijuana causing him to be somewhat stable? Can he continue to lead a "normal" life without his medication. What is going to happen when he stops smoking? Will that cause the symptoms to increase?

Dear Nancy --
"Very few manic episodes": that in itself is concerning, as many mood experts now seem to believe that at least for some people, any continued cycling may cause the illness to worsen over time.   On the other hand, us doc's don't get to see the people out there who have mild symptoms over time, don't get worse, and maybe "medicate" with marijuana or other things (alcohol is very common, and caffeine).  Those people don't come to see us, so how would we know how they do over time.  Point being: I couldn't say with certainty that the current "treatment plan" for your son is a bad idea.  Some people who use a lot of marijuana lose motivation over time, as though the drug made it easier to put up with bad things that might make others want to change their life so that doesn't keep happening (my clinical experience; I haven't searched that topic recently and substance use is not a specialty of mine); I am not aware of clear data implicating marijuana, used long term, in health concerns except perhaps as a lung/heart disease risk.

For people like your son I try to establish, as above, that I do not start out assuming that what they are doing is necessarily bad.  I try to make sure their "science" is good: i.e. help them keep track of how they are doing, understanding that if they are not really doing so well that will be evident if they "keep good data".  Hopefully that data itself will persuade them, if it looks bad, that they need to examine alternative treatment options -- including but not necessarily limited to mood stabilizers, for example.  This follows the strategy described by William Miller, Ph.D., a noted alcohol researcher, from his book Motivational Interviewing.  You might try to dig that up if you can see evidence that his current plan isn't working so hot: the book will give you some insight into how effective substance abuse counselors approach this situation.

Dr. Phelps

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