In bipolar or manic-depressive disorder, the inconsolable misery of major depression alternates with mania or uncontrolled elation. In the manic phase people with bipolar disorder are cheerful, gregarious, talkative, energetic, and hyperactive. Their spending is often extravagant and their behavior reckless. They may imagine that they have extraordinary talents and are or soon will be rich and powerful. This reckless, restless cheerfulness and expansiveness can suddenly turn into incoherent agitation, irritability, rage, paranoia, or grandiose delusions.
Antidepressants alone are not a good treatment for bipolar disorder and may even make it worse. Lithium carbonate, introduced into medicine at about the same time as tricyclics, has revolutionized the treatment of bipolar disorder. It prevents mania and to a lesser extent bipolar depression. Although lithium takes several weeks to start working, its success rate is about 70 percent and 20 percent of patients are completely freed of their symptoms. Patients generally require long-term maintenance treatment, and because lithium can be toxic it must be used carefully. Chronic use may endanger the heart, kidneys, and thyroid gland. Usually the dose is gradually increased until the drug begins to work and then periodically readjusted according to the patient’s age, medical condition, and psychiatric symptoms. The amount of lithium in the blood must be checked regularly because it is ineffective if too low and risky if too high. Some side effects are weight gain, hand tremors, drowsiness, and excessive thirst or urination. Patients often cannot tolerate lithium either because of the side effects or because it takes some of the joy from their lives along with the manic episodes. It has been described as a “loose-fitting emotional straitjacket.” Only 20 percent of patients with bipolar disorder take lithium alone. Other drugs used in the treatment of bipolar disorder are the anticonvulsants carbamazepine (Tegretol) and valproic acid (Depakote), which may be used either alone or in combination with lithium.
John Frederick Wilson is a forty-two-year-old man who suffers from rapid cycling bipolar disorder. He has been hospitalized several times during manic episodes and has been treated with many conventional medicines:
There is a history of mental illness in my family. My parents and most of my relatives suffer from various mood disorders, and I myself have had manic-depressive disorder for more than twenty-five years. My symptoms are dynamic and occur in clusters of changing intensity. Sometimes mania dominates, sometimes depression, and I have no way of knowing which it will be or for how long.
In my manic periods, I feel as though I am flying, gliding effortlessly through the day with an ever-increasing sense of wonderment and delight. My body feels charged with energy. I talk rapidly and forcefully without finishing my sentences, and I constantly interrupt others. Colors appear brighter. Time seems to go by twice as fast as usual. I lose my appetite and can’t sleep more than two hours a night. Sometimes I go three days without sleeping, and when I do sleep, I awaken like a rocket leaving the pad— instantly alert, feeling as though I have had no rest at all. The situation is especially unbearable when I am recuperating from fever and physical illness while unable to sit still or stop talking.
Soon I lose control of my moods and sensations. My skin becomes highly sensitive to touch, and my clothing is a constant source of irritation. Taste and smell become so acute that odors I usually enjoy seem offensive and may trigger a headache. I hear imaginary muffled voices and tunes. Tears may flow regardless of how I feel. As my thoughts continue to race, I lose my ability to concentrate and become extremely anxious—an anxiety that may turn into either elation or rage. I feel all-powerful at one moment and suicidal the next. I make plans and promises that I will not even remember at the end of the day. I spend money on things I do not need and give away substantial sums to total strangers. I feel compelled to telephone old friends, running up hundreds of dollars in phone bills. Strangers are often drawn to me because my contagious enthusiasm, but I may unexpectedly lose patience with them and verbally assault them. At one moment I may be speeding through traffic, cutting other drivers off and running red lights; a few minutes later I feel calm and at a loss to explain my reckless behavior. At times my libido goes off the scale and I have intercourse with several women on the same day.
Eventually depression takes over. I become so physically ill that I am too weak to function. I have no appetite and lose 25 pounds. My skin is dry; I ache all over. The world seems drab and dull. I want nothing to do with other people, and I feel as though my presence is a burden to them. I do not even want to answer the phone or go to the door. I cannot carry on a conversation, because everything people say to me seems like a cruel attack. Activities that usually bring pleasure seem foreign to me. I am overwhelmingly anxious and feel as though I have never done anything right in my life. I am also extremely indecisive; a simple task like brushing my teeth takes all morning to plan and complete. Just when I think the agony cannot possibly get worse, it does. It seems as though it is never going to end. It is as if there is no future, no present, and no past—an eternal void. I contemplate suicide.
My mind and body are ravished by these constant shifts in mood. I have been treated with individual counseling, group therapy, and twenty-five prescription drugs. They have all been ineffective. At age forty I decided that conventional medication was doing more to compromise my health than restore it. In May of 1995, at the suggestion of a psychologist who has known me for many years, I decided to quit my other medications and rely on cannabis to treat my disorder.
It was not the first time I had tried marihuana. I first used it at age fifteen, and I was impressed by its effect on my symptoms even then. As a child and adolescent, I had suffered from constant anxiety, headaches, nausea, nosebleeds, uncontrollable weeping, and recurrent nightmares. I was extremely sensitive and easily upset, but I also was capable of sleeping so deeply that once I did not stir when an Air Force jet crashed and exploded within a mile of my house. Most of the time I was shy and withdrawn, with a sense of impending doom, but on rare occasions I would suddenly feel euphoric and out of control. Perhaps worst of all were my destructive rages, in which minor irritation would quickly become uncontrollable and I would destroy my belongings. These rages were extremely unpleasant, both mentally and physically, and left me exhausted when they subsided. >From the beginning, I regarded the supposed euphoria produced by marihuana as overrated. I was more struck by the improved mood that endured long after the so-called “high.” I soon began seeking a wide variety of friends, and my life-long sense of anxiety disappeared. I gradually overcame my shyness and began to develop a better understanding of people. My tendency to overreact diminished. The bedwetting ceased, and the headaches became less frequent and intense. My uncontrollable crying stopped, and my tendency to rage was curbed. I was not the poster boy for mental health, but I was much more productive than I had been.
Unfortunately, like most people at the time I allowed the scare tactics of the day to affect me. I stopped using marihuana at seventeen, and within weeks I was in a private hospital being treated for major depression and thinking about suicide. After six weeks of therapy with little progress, I obtained some marihuana on a home visit, and immediately thoughts of suicide were replaced with plans for the future. Several days later I was released and told the doctor that I had decided to use marihuana to treat my symptoms. He agreed that it was effective but refused to document the finding. A pattern emerged in the next twenty-three years as I repeatedly quit using marihuana and started again. I stopped using it and dropped out of high school. When I started again, I graduated and received awards. I stopped using marihuana and dropped out of college, then started again and earned my degree. When I stopped using marihuana I was fired, and when I started again I got a new job. Then a random drug screen detected it, and I was suspended. Since resuming my therapeutic use of cannabis permanently two years ago, I have no longer had to endure the disastrous consequences of improper treatment. My manic episodes are much milder; I am simply energetic, focused, and productive. Even more remarkably, I have not had any episodes of major depression in the last two years. It is refreshing to experience normal sadness without becoming suicidal. Cannabis calms me and focuses my attention. It makes me more patient with people. I can eat and sleep more regularly.
There is no drug-induced euphoria, and I do not look or act incapacitated. Family members, friends, neighbors, and health care professionals often comment on how much I have improved. I still have some difficulty getting enough sleep, but I do not feel tired all the time. I am enjoying an emotional stability and productivity I never knew to be possible before. If I do not use cannabis, all my symptoms return. My condition becomes unbearable for me and everyone near me. Many physicians have recommended that I continue to use it.
When I began to use cannabis therapeutically, I smoked two to four puffs every four to six hours. But I am concerned about the effect on my lungs, and I do not want to worry about the odor or about finding a safe place to inhale. Now I smoke rarely—only when I need an immediate effect because of one of my unpredictable mood changes, or when I have to stop myself from obsessing about an unpleasant past experience and concentrate on the present instead.
Most of the time eating cannabis works better for me, and I think it is healthier. Two to three grams taken in the morning last me all day. I put the crushed cannabis in an empty frying pan, apply medium heat, and stir it until a wisp of smoke appears. Then I reduce the heat to low and add a tablespoon of butter and sometimes a pinch of salt or sugar. I tilt the frying pan before adding the butter to keep the mixture concentrated. I sauté the cannabis for eight to ten minutes, remove it from heat, and immerse the bottom of the pan in an inch of cold water in my kitchen sink, adding several ice cubes. Five minutes later I have a cool green paste which I roll into a ball and eat. I have found that in my therapeutic use of cannabis, potency is not as important as variety. I would rather have two or more varieties of moderate potency than one of high potency. The indicas are very effective in controlling my mania, partly because they have a very relaxing effect on my body. The sativas also curb my mania, and they are the most effective medication I have ever used for depression.
Wilson’s mother, Polly Wilmoth, confirms his account:
John has worked hard over the years to survive his life-threatening disease. I have suffered through it with him, and I have seen the devastation that conventional medication brings. Year after year we were told that a safe new drug would soon be out. Year after year we were told that it was just a matter of adjusting the dose. And year after year we were told that what works for one patient does not necessarily work for another. That last statement, at least, could not be more true as it applies to my son and the use of cannabis. I am very proud of the progress he has made in the last two years and believe that he should have legal access to cannabis therapy.
John Frederick Wilson