Can Marijuana Cause Psychosis?

Psychosis is a symptom that involves a disconnection from reality. When people experience psychosis, they may have symptoms such as delusions, hallucinations, and disordered thinking. It is a symptom of a number of mental health conditions and may have a variety of causes, including marijuana use.

This article discusses the ways marijuana is associated with the risk of developing psychosis. It also covers some of the treatments for marijuana-induced psychosis.

Can Marijuana Cause Psychosis?

A variety of substances and medications can cause a condition known as substance/medication-induced psychotic disorder. After taking a drug or medicine, some people may experience psychosis within a month of using the substance or when they are withdrawing from the drug. 

Other substances and medications that can trigger psychosis include alcohol, hallucinogens, sedatives, stimulants, amphetamines, antidepressants, and steroids.

Research suggests that people who have a co-occurring mental health disorder along with a substance use disorder are at a higher risk of developing psychosis associated with the substance or medication use. This may suggest that substances such as marijuana may trigger the onset of a psychotic episode in people who have a predisposed risk for psychosis.

Marijuana and Psychiatric Disorders

Marijuana use has also been linked to an increased risk for developing a number of psychiatric conditions, including schizophrenia, depression, and substance use disorders.

However, researchers are still not sure if marijuana can cause psychiatric conditions such as schizophrenia or bipolar disorder in healthy individuals. Instead, marijuana use may trigger the onset of certain psychiatric conditions in people with a predisposition for those disorders.

While the underlying mechanisms are not well understood, cannabis is a known risk factor for the onset of schizophrenia. Studies have found that cannabis use is involved in 50% of schizophrenia, psychosis, and schizophreniform psychosis cases.

In this study, high potency marijuana was defined as products containing more than 10% tetrahydrocannabinol (THC), the compound in cannabis that is responsible for the drug's psychoactive effects.

One reason marijuana psychosis may be more of a concern today is that these high-potency products are much more readily available than they were in the past.

Symptoms of Psychosis

When people experience psychosis as a result of marijuana use, they may experience a number of different symptoms associated with a break from reality. Symptoms of marijuana-induced psychosis include:

• Hallucinations: These are characterized by sensory experiences that are not real including seeing, hearing, or feeling things that don't exist in reality.
• Paranoia: This is a type of thinking that causes people to feel suspicious and distrustful of other people. 
• Feelings of being persecuted: This is an aspect of paranoia in which people believe that other people are trying to harm or sabotage them.
• Depersonalization: This happens when a person feels detached from their own thoughts, identity, feelings, emotions, and memories. 
• Derealization: This symptom is characterized by feeling separated from the environment and the feeling that things are not happening in real-time.
• Grandiosity: This involves having an exaggerated sense of power and importance. People experiencing grandiosity may feel that they are superior to others or invulnerable to harm.

People may also experience other symptoms during a psychotic episode including irritability, anxiety, or racing thoughts.

When psychosis is triggered by using a substance such as marijuana, these symptoms are acute rather than persistent. They typically resolve once the substance leaves the body. 

Risk Factors

There are a number of factors that may make a person more likely to experience psychosis after using marijuana. 

• Heavy marijuana use
• Chronic, long-term use
• Age
• Existing vulnerability to psychosis

Use During Adolescence

Teens who use marijuana have a higher risk of experiencing psychosis. Some researchers have suggested that this might be due to the emotional challenges that sometimes contribute to marijuana use.

Regular marijuana use by teens can also affect the brain in a variety of ways and may impact cognition, learning, and development.

Gene Variations

Research has found that people who use marijuana and have a certain variation of the AKT1 gene, which is responsible for coding for an enzyme affecting dopamine signaling in a specific region of the brain called the striatum, are at a greater risk for experiencing psychosis.

Studies have also found another gene variant of the catechol-O-methyltransferase (COMT) enzyme can play a role in increasing the risk of developing psychosis in adults who used marijuana as teens. COMT is involved in inactivating neurotransmitters such as dopamine and norepinephrine.

Treatment

People who are having an acute psychotic episode may need to be hospitalized until their condition has been stabilized. Treatment for psychosis linked to marijuana use involves antipsychotic medication. In some cases, the use of sedative antipsychotics or benzodiazepines may be needed in order to manage some behaviors. 

After the immediate symptoms have been addressed, the individual will be further evaluated to determine the cause of the psychosis and to diagnose any other co-occurring conditions that may be contributing to symptoms. 

Depending on the cause of the psychosis, a doctor or mental health professional may recommend additional treatments including antipsychotic medications, antidepressants, psychotherapy, and lifestyle modifications. Psychotherapy and mutual support groups can also be beneficial for people who have a cannabis use disorder.

CBD and Psychosis

Some research suggests that cannabidiol (CBD), another compound found in marijuana, may be helpful for reducing the risk of psychosis associated with marijuana.

CBD has a number of purported mental health benefits, although a comprehensive review of the existing research concluded that there is not enough evidence to support using CBD to relieve symptoms of mental health conditions. However, some research suggests that CBD could potentially counteract some of the negative psychological effects associated with THC such as anxiety.

The impact of CBD on psychosis is not fully understood, but some evidence suggests it may be helpful:

• Reduced psychotic symptoms: One 2017 randomized-controlled trial looked at the use of CBD as an adjunctive treatment to antipsychotics in the treatment of schizophrenia. Compared to a placebo group, those who were treated with CBD and antipsychotics experienced decreases in their psychotic symptoms as well as improvements in their cognitive functioning.
• Decreased risk of marijuana-induced psychosis: Studies have also shown that people who smoke cannabis with a higher CBD-to-THC ratio tend to have a lower risk of developing cannabis-related psychosis.
• Fewer side effects: One clinical trial comparing CBD to the antipsychotic drug amisulpride found that while both led to similar outcomes, those treated with CBD showed greater reductions in negative symptoms and fewer side effects than the antipsychotic medication.