Cannabis Use Linked to Better Decision Making in Bipolar Disorder Study Finds

 

Cannabis and Bipolar Disorder A Complicated Relationship Worth Looking At

Cannabis Use Linked to Better Decision Making in Bipolar Disorder Study Finds

For years, cannabis has carried a reputation that swings between miracle remedy and cognitive wrecking ball. If you talk to psychiatrists, many will warn you that regular use can cloud judgment, dull memory, and make decision making worse. If you talk to patients, especially those living with bipolar disorder, the story often sounds different. Some say it slows their racing thoughts. Others claim it helps them feel more grounded when their mood begins to spiral upward.

A new study published in the journal Translational Psychiatry adds an unexpected twist to this conversation. It suggests that chronic cannabis use might not impair decision making in people with bipolar disorder the way it tends to in healthy individuals. In fact, moderate use was linked to better decision making compared to bipolar patients who did not use cannabis at all.

That sounds provocative. Maybe even counterintuitive. So let’s unpack it carefully.

Bipolar Disorder Beyond Mood Swings

Most people think of bipolar disorder as dramatic mood changes. High highs. Crushing lows. Periods of intense energy and confidence that can slide into agitation or recklessness, followed by stretches of depression that feel heavy and unmovable.

But the condition does not stop at emotion. It often affects cognition in subtle yet disruptive ways. Many individuals with bipolar disorder struggle with goal directed behavior. Decision making can become inconsistent. Inhibitory control, the mental brake that stops you from acting on every impulse, may weaken.

Imagine trying to manage your finances while your brain keeps nudging you toward risky choices. Or attempting to stick to a medication routine while your attention keeps drifting. These are not minor inconveniences. They shape careers, relationships, and overall stability.

Given that backdrop, it becomes easier to understand why many people with bipolar disorder experiment with cannabis. Surveys suggest that more than seventy percent have used it regularly at some point in their lives. That rate is far higher than in the general population.

Patients often describe using cannabis as a way to soften manic energy or calm intrusive thoughts. Whether that perception matches measurable cognitive outcomes is another question entirely. That is what researchers set out to explore.

Why Scientists Wanted a Closer Look

In healthy adults, chronic cannabis use is typically linked to poorer cognitive performance. Slower reaction times. Reduced attention span. Weaker executive function. So clinicians have often viewed high cannabis use in bipolar disorder with concern.

Jared W. Young from the University of California San Diego and the VA San Diego Healthcare System pointed out that bipolar disorder remains difficult to treat effectively. Standard medications help many people, but not all. Suicide attempts remain tragically common. Life expectancy is often reduced by years. The burden on families can be enormous.

Against that background, the fact that people with bipolar disorder use cannabis at roughly three times the rate of the general population raised an obvious question. Are they simply self medicating in a way that worsens cognition, or could something more nuanced be happening in this specific neurobiological context.

The research team did not assume cannabis was helpful. They also did not assume it was harmful in every case. They decided to measure.

How the Study Was Structured

The researchers recruited 87 participants between 18 and 50 years old. To make comparisons clearer, they divided them into four groups.

Two groups consisted of healthy individuals. One group used cannabis chronically, defined as at least four times per week over the previous ninety days. The other group had little lifetime exposure and no recent use.

The remaining two groups included individuals diagnosed with bipolar disorder. Again, one group were chronic cannabis users. The other were non users.

That setup allowed for a clean comparison. Healthy users versus healthy non users. Bipolar users versus bipolar non users.

The researchers were especially interested in decision making. To test it, they used something called the Iowa Gambling Task.

A Closer Look at the Gambling Task

The Iowa Gambling Task is not about casino skills. It is a computerized test designed to mimic real world decision making under uncertainty. Participants see four decks of cards. Each time they draw from a deck, they win some play money. However, some decks are deceptive.

Two decks offer high immediate rewards but also severe penalties that lead to long term losses. The other two decks provide smaller wins and smaller losses, resulting in overall gains if you stick with them.

At first, participants do not know which decks are safe. They have to learn from experience. Good performance means gradually avoiding the risky decks and favoring the safer ones.

It sounds simple. Yet it taps into impulse control and the ability to adjust strategy after negative feedback. Skills that can be compromised in bipolar disorder.

The Results That Raised Eyebrows

Among healthy participants, the pattern matched expectations. Chronic cannabis users performed worse on the gambling task than healthy non users. They were more likely to stick with risky decks, even after losing money.

That aligns with a large body of research suggesting cannabis can impair decision making in otherwise healthy individuals.

However, when researchers looked at the bipolar groups, the pattern flipped.

Bipolar participants who did not use cannabis showed clear deficits. They frequently chose risky decks and struggled to adapt after losses. Their performance reflected the cognitive challenges often associated with the disorder.

In contrast, bipolar participants who used cannabis moderately performed significantly better. Their scores were not just higher than bipolar non users. They were comparable to healthy individuals who did not use cannabis.

That finding suggests a possible normalization effect. In this sample, moderate cannabis use was associated with decision making that looked closer to baseline healthy functioning.

The Role of Frequency

The story becomes more nuanced when frequency enters the picture.

Moderate use was defined as four to twenty four times per week. Yes, that can still sound like a lot to some readers. Heavy use was defined as twenty five times per week or more.

The apparent cognitive benefit appeared mainly in the moderate range. Heavy use was associated with worse performance, even among people with bipolar disorder.

That detail matters. It suggests that if there is a beneficial effect, it may depend heavily on dose. Too little might not move the needle. Too much may tip the balance in the opposite direction.

Young himself emphasized this point, noting that only moderate cannabis use was linked to improved functioning, while heavier use worsened outcomes.

Real World Skills Beyond a Computer Test

The researchers did not stop at the gambling task. They also measured functional capacity using the UCSD Performance Based Skills Assessment. In particular, they examined medication management.

Participants were asked to organize a complex medication schedule involving multiple prescriptions. Anyone who has ever tried to manage even two daily medications knows how easy it is to make mistakes. Add mood instability and cognitive fog to that, and it becomes more challenging.

Bipolar non users struggled more with this task. Bipolar cannabis users performed better, again reaching levels similar to healthy participants.

That is intriguing. Decision making on a computer is one thing. Planning and adhering to medication schedules in a simulated real world scenario feels more tangible.

Still, we should tread carefully.

A Possible Biological Explanation

The researchers proposed a hypothesis involving dopamine.

Bipolar disorder has been linked to elevated dopamine transmission in certain brain circuits, particularly during manic phases. Excess dopamine can contribute to impulsivity and risky behavior.

Chronic cannabis use, on the other hand, has been associated with reductions in dopamine transmission over time.

So one speculative explanation is that moderate cannabis use might dampen dopamine activity enough to counterbalance the excess seen in bipolar disorder. In healthy individuals, reducing dopamine might push them below optimal levels, impairing cognition. In bipolar disorder, it might move levels closer to equilibrium.

That is an elegant hypothesis. But it remains a hypothesis. The study did not directly measure dopamine changes in participants.

Correlation Is Not Causation

Here is where skepticism is healthy.

The study was cross sectional. It captured a snapshot in time. Researchers compared people who already used cannabis with those who did not. They did not randomly assign participants to begin using cannabis.

Therefore, we cannot say cannabis caused the improved decision making. It is possible that individuals with better cognitive functioning are more likely to use cannabis moderately. Maybe they are better at self regulating in general. Maybe they are more socially engaged, and that correlates with both cannabis use and cognitive performance.

There were also only about twenty participants in each subgroup. That limits statistical power. Small samples can produce findings that fail to replicate in larger studies.

Young himself cautioned against simplistic interpretations. He stressed the need for randomized, controlled trials before drawing firm conclusions.

The Risks Still Matter

Even if moderate cannabis use appears linked to improved decision making in this context, that does not mean it is broadly safe for people with bipolar disorder.

Cannabis has been associated with increased risk of manic episodes and psychosis in some patients. Those risks are not trivial. For someone who has experienced severe mania, the possibility of triggering another episode can carry serious consequences.

So any discussion of potential cognitive benefits must be weighed against these well documented dangers.

It would be irresponsible to interpret this study as a green light for free use. The authors themselves explicitly discourage that reading.

Where the Research Goes Next

The long term goal, according to Young and his colleagues, is to identify the biological mechanisms behind these associations. They are interested in translational studies that combine human and animal research. That approach can help isolate specific cannabinoid compounds and dosing patterns.

Not all cannabis is the same. THC, CBD, and other cannabinoids interact differently with brain receptors. Frequency of use also matters. Occasional use may have different effects than daily or near daily exposure.

The team also wants to explore whether similar patterns appear in other conditions where cannabis is commonly used for symptom management, such as HIV related cognitive changes.

Ultimately, the hope is to move toward more precise recommendations. Not broad statements that cannabis is good or bad, but nuanced guidance about who might benefit, at what dose, and under what circumstances.

A Balanced Take

If you step back, the takeaway is not that cannabis is a miracle cognitive enhancer for bipolar disorder. Nor is it that it is uniformly harmful.

The more interesting conclusion is that brain chemistry is context dependent. A substance that impairs performance in one population might have a different effect in another due to underlying neurobiology.

That does not make it harmless. It does suggest that blanket assumptions can miss important subtleties.

For people living with bipolar disorder, treatment decisions are rarely simple. Medications have side effects. Therapy takes time. Lifestyle changes require discipline. In that landscape, it is understandable that some turn to cannabis in search of relief.

Whether that relief comes with cognitive tradeoffs, benefits, or a mix of both likely depends on individual biology, dosage, and pattern of use.

This study opens a door. It does not settle the debate. More data, especially from controlled trials, will be needed before clinicians can incorporate these findings into formal treatment strategies.

Until then, the conversation should remain cautious but curious. Science advances not by clinging to assumptions, but by testing them. And sometimes the results are more complicated than we expect.

Open Your Mind !!!

Source: Psypost