by
John Frederick Wilson
from http://www.rxmarihuana.com/bipolar.htm
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.
Mr. 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.
