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Marijuana Makes It Worse: Severe Mental Illnesses

Allan Schwartz, LCSW, Ph.D. Updated: Nov 1st 2008

On October 11, 2000 Dr. Dombeck responded to an E. Mail question from someone who stated he has a Bipolar Disorder and is taking a number of medications to control the symptoms of the disorder. The "Ask Dr. Dombeck" question and response can be found at the link below."

Click Here

Since that initial posting a number of people have responded during the past few months stating that they are angry and outraged about Dr. Dombeck's rejection of marijuana for those who are Bipolar. I believe it is incumbent upon me to respond to the concerns expressed.

Neither Dr. Dombeck, nor myself, wish to add to anyone's distress. Each of you who has responded to this posting is reporting your individual experience with both the disorder and marijuana. In fact, there is some evidence that marijuana eases some of the anxiety and agitation that comes with Bipolar Disorder. In contrast to that, there is a lot of evidence that chronic marijuana usage causes relapse, re-hospitalization and longer term recovery. In fact, this is why those with a severe mental illness and who use drugs are considered to have a "Dual Diagnosis."

However, let's put aside "findings, research and surveys and look at my experiences working in psychiatric hospitals and agencies with patients who suffer severe mental illnesses including Bipolar Disorder. Also, let's do this in the spirit of understanding and learning rather than quarreling.

I have directly witnessed the tragedy of patients going off of their medications for Bipolar Disorder, using marijuana and ending up re-hospitalized in worse shape than any time prior to the relapse. In fact, it has been my experience that many of these unfortunate patients experienced multiple relapses and were caught in an endless cycle of hospitalizations marked by periods of instability in between.

It is important to keep in mind that there are many intensities of this disorder. There are those people who experience rapid cycling while others rarely become manic. However, when they become symptomatic, they experience Major Depression. Also, there are those who experience Auditory and Visual Hallucinations while others do not. It is possible to have hallucinations at either end of the spectrum: major depression or mania. Then too, there are cases where the illness is so severe that is considered in the realm of schizophrenia and is called Schizoaffective Disorder. It has been my experience with the patients I knew who suffered from severe bipolar disorder and with those who fell into the Schizoaffective domain, that they were not helped by marijuana and were made much worse through its use.

Leaving aside anxiety, those who experience severe depression and who use marijuana end up feeling much more depressed, at least that is what I have witnessed.

There is a lot of denial around the problems of not only marijuana but other drugs of abuse and severe mental illness. In order to break through some of this denial I was, at times, able to get patients to agree to stop their marijuana use for a few weeks just so they could determine whether there was or was not an improvement in mood. These individual were surprised but were willing to admit that they felt real improvement in mood and functioning.

Lastly, there is no question that medications have side effects. That is why, depending on the medication, blood and urine tests must be done on a regular basis in order to be certain patients are not toxic from their doses. When taking some of these medications there is a constant struggle to balance variables such as weight changes, diet, coffee and tea consumption, and even water intake, with the dosage of the medication. There is also the matter of handling stress and levels of pressure in ways that will not promote relapse. The bottom line on this is that if the medications are working by allowing you to function in your personal relationships, at work and in the family then the side effects are a worthwhile trade off. It seems logical to me that even though medications side effects are miserable, hospitalizations are more miserable.

I do not wish to appear like a "party pooper" by taking the fun or relief away. But, when you have witnessed the amount of tragedy through multiple hospitalizations, family anguish, suicide attempts and general suffering, this discussion becomes one that is more than whether marijuana is good or bad. It becomes a matter of life and death for many people.

Your comments are welcome.

Allan N. Schwartz, PhD




Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at for details.

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