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Why Cannabis May Cause Psychosis in Some People

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Last Updated on August 23, 2021 by Diane Ridaeus

Why Cannabis May Cause Psychosis in Some People

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD
Medically Reviewed

Terminology is key to understanding the potential risks and benefits of cannabis. Cannabis is the name of a plant that has various strains. Just like tomatoes, each strain has specific and unique characteristics. Botanists have developed hundreds of products from hybrid strains, and pharmaceutical companies have gotten themselves quite busy making synthetic (lab-created) versions of cannabis, such as an injectable synthetic version awaiting FDA approval to treat Covid-19.5

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High THC Cannabis and PsychosisThe most commonly used natural species of cannabis include cannabis sativa, cannabis indica, and cannabis ruderalis. Strains with a high level of a compound called CBD are mostly chosen as medicinal agents, as their intoxication potential is very low. Benefits of CBD products include treatment of schizophrenia, reduction of psychotic symptoms, pain relief, lowered anxiety, used for treatment-resistant epilepsy and muscular dystrophy. 3,4 Strains with a high level of another compound called THC are chosen for recreational use, as their intoxication potential is pronounced. Products containing a 5% to 10% concentration of THC can also produce analgesic effects as an alternative to pain medication, but higher THC concentrations can actually increase pain, and increase the frequency of adverse events. Studies have also shown that consumption of high concentrations (15-30%) of THC present an estimated 6-fold risk for psychiatric symptoms such as psychosis and schizophrenia. 2,6,8 THC should be avoided in persons suffering from depression according to studies, as high levels of THC can worsen depressive symptoms, especially over long term use. 7

As more and more states begin to legalize cannabis use, the popularity of both recreational and medicinal marijuana has continued to grow as well. This has led many people to either try cannabis for the first time or to try a new method of using cannabis. However, understanding the risks and benefits precisely is clearly advantageous whether your aim is safe medicinal or recreational use.

Here’s what you need to know about cannabis induced psychosis and some answers to common questions regarding the topic.

Is There a Link Between Marijuana Use and Psychiatric Disorders?

Marijuana generally refers to recreational cannabis, which is typically sought for its significant THC content, that is 15% – 30% or greater. As marijuana use continues to grow in popularity across the country, more and more research is being done to study the effects of recreational marijuana on mental and physical health. According to the National Institute on Drug Abuse recent studies found links between recreational marijuana use and an increased risk of psychiatric disorders, such as psychosis, schizophrenia and mood disorders like depression and anxiety, as well as physical risks such as cardiovascular and respiratory diseases. 6,7

Does Cannabis Cause Psychosis?

GeneticsCannabis-induced psychosis has been recognized and studied for quite some time. It is fascinating to note Manseau’s observations that the compound THC in high quantities can induce schizophrenia and psychosis, and the compound CBD can be used to mitigate (relieve) those same symptoms. 1

Another area of research suggests that certain genetic predispositions may be linked to a vulnerability to cannabis-induced psychosis. Genetics can affect how efficiently or poorly drugs are metabolized or cleared. Other combined predispositions may also exist alongside cannabis use, such as early childhood trauma and may also contribute to vulnerability in some persons who suffer drug-induced psychosis. 8

What Is THC Induced Psychosis?

THC-induced psychosis is a set of symptoms that can occur after ingesting typically high levels of THC. It’s a break with reality and is often accompanied with audio and/or visual hallucinations, paranoia, suspicion, and delusional thought. It is not at all uncommon for cannabis-induced psychosis to be misdiagnosed as schizophrenia, as the symptoms are similar. A 5 year follow-up review of patients who totally abstained after a first episode of cannabis-induced psychosis were found to never again relapse. 10

Is Cannabis Induced Psychosis Common?

The statistics on cannabis-induced psychosis have not been fully determined, but we do see that cannabis use is over-represented in the population diagnosed as schizophrenic, across the world. An interesting study by Hall and Degenhardt published in the World Psychiatry Journal concluded after a 27 year follow up, that 13% of the schizophrenia cases followed in the study could have been averted if cannabis was abstained from.11

Another clinical study out of India estimated that an astounding 50% of all schizophrenia and psychosis cases are cannabis-related. 12

What Are the Symptoms of Cannabis Induced Psychosis?

Symptoms of Cannabis Induced Psychosis

Cannabis-induced psychosis looks a lot like schizophrenia, and mimics other psychiatric disorders. If the symptoms fade away relatively quickly they are called “acute” symptoms, such as when a person can sleep it off, and wake up feeling relatively normal. THC has a “sticky” characteristic, in that it takes a long time for the body to flush out the metabolites. If the person abstains, likely the symptoms will continue to abate, and will not return. However, if the person continues to use cannabis with high concentrations of THC, it is possible that the cumulative effects may cause another psychotic episode to occur. If the symptoms are persistent, even after abstaining, then treatment is indicated. Physicians may not always identify these symptoms as drug-induced psychosis and too often, misdiagnosis can lead to the wrong treatment approach.

Some of the most common symptoms that occur during cannabis induced psychosis include:

1. Losing Touch with Reality

One of the signs that someone may be experiencing psychosis of any kind is when they seem to be losing touch with reality, meaning they cannot differentiate between what is real and what is not. Psychiatry might call this depersonalization or derealization or dissociation and similar tags. The person may start to forget things or have difficulty interacting with others or with their environment. They are out of touch with themself, their body, and their location in the real world.

2. Hallucinations

Hallucinations are a common feature of psychosis. Hallucinations are when a person senses something, but it does not actually exist. Though this frequently presents visually, people can also hallucinate sounds, smells, sensations of touch, and more.

3. Delusions

Delusions are defined as persistent beliefs that are demonstrably false. A person may experience delusions during psychosis even if there is evidence that can prove them wrong. An example of a delusion would be a person believing that a celebrity is in love with them, even though they have never met that person, or that their heart has permanently stopped beating, or that they are a famous billionaire.

4. Paranoia

Paranoia is another common symptom of psychosis. Paranoia is described as an unrealistic belief that someone or something is out to get you. It’s the feeling that you are being followed or being threatened or in some kind of danger but there is no evidence to back it up. Paranoia can also be defined as a consistent distrust of people, as you assume they will do something bad to you.

5. Anxiety

Anxiety is a feeling of nervousness or apprehension that won’t go away. It can be a general or specific overwhelming worry or fear, often exacerbated by environmental factors. When a person is experiencing anxiety it may feel like racing/chaotic or disturbing thoughts that you cannot control. A continual fear of having your car spin out of control while driving down a flat, dry, quiet, country road, could be an example.

6. Impaired Cognition/Movement

When someone is exhibiting cognitive impairment, they struggle to make basic decisions, concentrate, remember experiences, or learn new skills. During psychosis, people may not be able to make a decision at all, their thoughts being “frozen”. Conversely, some people may be jumping from one answer to another extremely fast, constantly changing their mind. Sometimes muscle movements of an individual can be similarly impaired, and they are not able to control their arms or legs or move as they normally do.

7. Disorganized and Chaotic Thoughts

Disorganized, chaotic, and even disturbing thoughts are all common features exhibited by someone experiencing psychosis. Some people are barely able to form sentences during a psychotic episode without their thoughts jumping to the next subject. They may seem as if they are tripping over their own words or talking in gibberish. Other people may be able to barely speak at all during an episode, due to how disorganized their mind has become. To someone on the outside, it may seem like the person is just speaking nonsense or uncharacteristically unable to formulate clear thoughts.

8. Difficulty or Change in the Way Emotions Are Experienced

The way a person’s emotions are expressed outwardly usually reflects congruently with their environment. Someone waves and smiles, and you wave and smile back. However, sometimes expressions of emotion can become incongruent with the situation, such as laughing hysterically at nothing. This can be a characteristic seen during an episode of psychosis. Often it is close friends and family members who can identify signs of an episode of psychosis first, due to these changes and the unusual way their loved one may be acting. For example, a person suddenly seems to be extremely irritable and argumentative but there is no observable reason for this sudden change. You might not even be able to spark a conversation without them blowing up. Or on the opposite side of the spectrum, psychosis in some people can make them seem completely unemotional, mute, withdrawn, or unable to process or express their thoughts or feelings. In some extreme cases of psychosis, people can even seem catatonic.  Since catatonia is diagnosed in up to 20% of patients who are in a psychiatric inpatient setting, it is important to realize that this neuropsychiatric condition can be drug-induced, and the chance of misdiagnosis may be significant if drug use prior to the condition was not taken into account. 15

An intense change in behavior might signal a psychotic episode. Again, close family and friends are most likely the ones who will be able to identify these changes first. A person in psychosis may swiftly change from one mood or behavior to the opposite, including inappropriate behavior that is out of character. This is because they are unable to process emotions in the same way they could before the episode.

9. Sleep Disturbances / Lack of Sleep

Many people experiencing psychosis find it hard to fall asleep or stay asleep. This is often due to the turbulent symptoms an individual may be experiencing. Their anxiety and disturbed thoughts disrupt sleep. An individual might find themselves waking up every few hours or never able to fully relax and get rested.

How Long Does THC Psychosis Last?

Some people may only experience psychosis symptoms that present when they use cannabis and then find these slowly go away as it exits their system. In other cases, symptoms can last much longer. These longer psychosis episodes may range anywhere from one day to years long, as was demonstrated in a long term comparative study published in the American Journal of Psychiatry. 13

How Is Cannabis Induced Psychosis Treated?

Is highly recommended that you arrange to see a healthcare professional who is specifically familiar with drug-induced symptoms such as cannabis-induced psychosis. This will help to ensure you get a proper diagnosis and treatment. In severe cases, medication can help dampen disturbing symptoms, and might be necessary for your own safety and to be able to comfortably rest and stabilize.

Seeking Professional Help

Seeking Professional HelpHow often the individual used cannabis can affect how long it takes their body to detox and recover. While some people are able to shed the symptoms of drug-induced psychosis after a few hours or days, others may need a much longer treatment process.

Treatment may include a temporary course of medication and rest in a quiet environment, with compassionate care including good nutrition. Often, persons exhibiting psychosis have a dysregulated gut microbiome and other deficiencies that contributed to the reaction. These can be addressed with probiotics, supplements, and a clean, nutrient-dense diet. Holistic psychiatry specializes in these types of nutrition-based interventions, preventing the need to rely primarily on antipsychotic medications. 14

Abstaining from Cannabis

Abstaining from further recreational cannabis use is highly recommended to avoid future psychotic episodes, even after recovery from an episode of drug-induced psychosis.

Taking Care of Yourself and Knowing Potential Dangers

While medical cannabis (CBD) may have a variety of health benefits, the use of THC products is connected to some severe health risks. Get yourself informed about the risks and benefits so you can stay healthy and safe. Cannabis-induced psychosis can ruin a life. But help is available.

Here at Alternative to Meds Center, we specialize in helping people fight addiction, substance abuse, withdrawals, making lifestyle changes, correcting the microbiome and diet, and more. We understand how difficult quitting a substance can be. That’s why we provide education on the topic and offer services in the Sedona area to help. For more information on help for cannabis-induced psychosis or how we can help you manage problems with substance abuse in general, contact us here.


Sources:

  1. Manseau MW, Goff DC. Cannabinoids and Schizophrenia: Risks and Therapeutic Potential. Neurotherapeutics. 2015;12(4):816-824. doi:10.1007/s13311-015-0382-6 (cited 2021 Aug 13]
  2. Andréasson S, Allebeck P, Engström A, Rydberg U. Cannabis and schizophrenia. A longitudinal study of Swedish conscripts. Lancet. 1987 Dec 26;2(8574):1483-6. doi: 10.1016/s0140-6736(87)92620-1. PMID: 2892048. [cited 2021 Aug 13]
  3. VanDolah HJ, Bauer BA, Mauck KF. Clinicians’ Guide to Cannabidiol and Hemp Oils. Mayo Clin Proc. 2019 Sep;94(9):1840-1851. doi: 10.1016/j.mayocp.2019.01.003. Epub 2019 Aug 22. PMID: 31447137. [cited 2021 Aug 13]
  4. NIH authors, “Cannabis (Marijuana) and Cannabinoids: What You Need to Know” [online] [cited 2021 Aug 13]
  5. Khodadadi H, Salles ÉL, Jarrahi A, Chibane F, Costigliola V, Yu JC, Vaibhav K, Hess DC, Dhandapani KM, Baban B. Cannabidiol Modulates Cytokine Storm in Acute Respiratory Distress Syndrome Induced by Simulated Viral Infection Using Synthetic RNA. Cannabis Cannabinoid Res. 2020 Sep 2;5(3):197-201. doi: 10.1089/can.2020.0043. PMID: 32923657; PMCID: PMC7480719. [cited 2021 Aug 13]
  6. Karila L, Roux P, Rolland B, Benyamina A, Reynaud M, Aubin HJ, Lançon C. Acute and long-term effects of cannabis use: a review. Curr Pharm Des. 2014;20(25):4112-8. doi: 10.2174/13816128113199990620. PMID: 24001294. [cited 2021 Aug 13]
  7. Sarris, J., Sinclair, J., Karamacoska, D. et al. Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review. BMC Psychiatry 20, 24 (2020). https://doi.org/10.1186/s12888-019-2409-8 [cited 2021 Aug 13]
  8. Cash MC, Cunnane K, Fan C, Romero-Sandoval EA. Mapping cannabis potency in medical and recreational programs in the United States. PLoS One. 2020;15(3):e0230167. Published 2020 Mar 26. doi:10.1371/journal.pone.0230167 [cited 2021 Aug 13]
  9. Alemany S, Arias B, Fatjó-Vilas M, Villa H, Moya J, Ibáñez MI, Ortet G, Gastó C, Fañanás L. Psychosis-inducing effects of cannabis are related to both childhood abuse and COMT genotypes. Acta Psychiatr Scand. 2014 Jan;129(1):54-62. doi: 10.1111/acps.12108. Epub 2013 Feb 28. PMID: 23445265. [cited 2021 Aug 13]
  10. Shah D, Chand P, Bandawar M, Benegal V, Murthy P. Cannabis induced psychosis and subsequent psychiatric disorders. Asian J Psychiatr. 2017 Dec;30:180-184. doi: 10.1016/j.ajp.2017.10.003. Epub 2017 Oct 16. PMID: 29096386. [cited 2021 Aug 13]
  11. Hall W, Degenhardt L. Cannabis use and the risk of developing a psychotic disorder. World Psychiatry. 2008;7(2):68-71. doi:10.1002/j.2051-5545.2008.tb00158.x [cited 2021 Aug 13]
  12. Shrivastava A, Johnston M, Terpstra K, Bureau Y. Cannabis and psychosis: Neurobiology. Indian J Psychiatry. 2014;56(1):8-16. doi:10.4103/0019-5545.124708 [cited 2021 Aug 13]
  13. Foti DJ, Kotov R, Guey LT, Bromet EJ. Cannabis use and the course of schizophrenia: 10-year follow-up after first hospitalization. Am J Psychiatry. 2010 Aug;167(8):987-93. doi: 10.1176/appi.ajp.2010.09020189. Epub 2010 May 17. PMID: 20478874; PMCID: PMC3594105. [cited 2021 Aug 13]
  14. Teasdale S, Morkl S, Muller-Stierlin A, “Nutritional Psychiatry in the Treatment of Psychotic Disorders: Current Hypotheses and Research Challenges.” Journal of Brain, Behavior and Immunity Vol 5 published May 2020 [cited 2021 Aug 13]

Why Cannabis May Cause Psychosis in Some People
Medical Disclaimer:
Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.

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