Mental Health in Specific Populations

What Causes Bipolar Disorder?

Jim Sugel on November 12, 2024

Bipolar disorder is a mental health disorder affecting an estimated 3% of the U.S. population. While there are different types of bipolar disorder with different symptoms, bipolar disorder is primarily a lifelong or chronic disorder that can go in and out of remission for as long as you are alive. While many types of mental health disorder can go away with treatment to never return, bipolar disorder is normally chronic. This means that, for the most part, treating bipolar disorder is about managing symptoms and pushing the disorder into remission for as long as possible.

That can probably help you to understand that bipolar disorder is almost always something you’re born with. However, bipolar disorder can express itself in different ways and can be caused by different things. In this article, we’ll look at the different causes of bipolar disorder as well as triggers and what causes relapse or reoccurrence of bipolar episodes.

Causes of Biploar Disorder

Bipolar disorder is overwhelmingly caused by genetics. Some 73-91% of all instances of bipolar disorder occur when someone else in the family has bipolar disorder. In fact, bipolar disorder is about 0.71% hereditary. If a fraternal twin has bipolar disorder, there’s about a 5% chance that the other twin has it also and if those twins are identical that rises to about 41%. If you widen that spectrum to include all bipolar spectrum disorders including major depressive disorder, that rises to 67% for identical twins.

So, there’s a very strong genetic element in bipolar disorder. Here, risk factors include:

A family history of depression
A family history of bipolar disorder
A family history of mania

In some cases, you might not know about having a family history of bipolar disorder. For example, until recently, women with bipolar disorder may have been diagnosed with hysteria or borderline personality disorder. Men are much more likely to be diagnosed with a bipolar spectrum disorder, despite women experiencing bipolar disorders at similar rates to men and being almost twice as likely to experience bipolar disorder with major depression than men. Therefore, a family history of mental illnesses including borderline personality disorder, split personality disorder, narcissism, hysteria, and depression can all be indicative of a family history of bipolar disorder.

So, there’s a very strong genetic element in bipolar disorder. Here, risk factors include:

A family history of depression
A family history of bipolar disorder
A family history of mania

Are Genetics the Only Cause of Bipolar Disorder?

While genetics cause up to 91% of all instances of bipolar disorder, there are some other causes. However, it’s unclear if these are “causes” or “triggers” that caused a latent disorder to manifest.

In most cases, it’s likely that the genetic basis for bipolar disorder was there, but triggers brought it forward when it might not have appeared otherwise.

Trauma
Childhood abuse and trauma
Depression
Sleep deprivation (sleep deprivation can induce mania in most people with bipolar disorder)
Neurological injury such as stroke, brain injury, multiple sclerosis temporal lobe epilepsy, etc. However, this may be “Bipolar-like” rather than a bipolar disorder

In addition, for most people, the earlier the exposure to trauma, the more likely it is to contribute to bipolar disorder. For example, an estimated 30-50% of all persons with a bipolar disorder diagnosis report traumatic childhood experiences including trauma and abuse. In addition, children who experience physical or sexual violence are significantly more likely to engage in violence during bipolar mania episodes, with rate and severity of violent outbursts heavily linked to how young the child was at the time of abuse. This is so much the case that hospitals are increasingly using the Violence Tendency Scale to score these factors to predict violent behavior in children with diagnoses, before violent behavior manifests.

Therefore, environment can significantly shape bipolar disorder and its expressions, even if it doesn’t cause that behavior to begin with.

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What About Different Types of Bipolar Disorder?

The bipolar spectrum consists of three subtypes of bipolar disorder, as defined by the DSM-5.

These include:

Bipolar I – Bipolar I disorder is characterized by manic (extreme high energy periods with psychosis that cause social and occupational impairment) episodes, which much have occurred at least once for a diagnosis to happen. Depression is not necessary to receive this diagnosis but it may be present. Here, episodes last 3-12 weeks, with most patients experiencing a rollercoaster of mania and then depression with potentially some “normal” periods in between.
Bipolar II Disorder – Bipolar II disorder is characterized by hypomanic (high elevated mood without social and occupational impairment and without psychosis) episodes followed by periods of depression. This can look like someone having periods of high productivity followed by normal or low productivity – resulting in a lowered chance of diagnosis because depression alleviates itself often enough to seem like remission and hypomania makes people feel better. Therefore, many people who qualify for Bipolar II disorder may not have it.
Cyclothymia – Cyclothymia includes any series of hypomanic episodes and depression that don’t meet criteria for bipolar II. E.g., if episodes last a few days or weeks instead of longer, if depression isn’t strong enough to be major depression, etc.

So, you have three expressions of essentially the same disorder. Are they caused by different things? No. They’re all primarily genetically based. For example, Bipolar I is .73 heritable, Bipolar I and II is .77 heritable, and Bipolar I, II, and Cyclothymia are .71 heritable. This means that of the three, cyclothymia is the least likely to be heritable.

Eventually, all three disorders are related to the same genetic and heritability factors. In each case, triggers such as trauma, neuropathic damage, and stress or sleep deprivation can cause a latent disorder to appear. However, it’s unlikely that those factors can cause any form of bipolar disorder on their own.

A genetic basis for bipolar disorder also explains why it’s almost always chronic. Most people who are diagnosed with bipolar disorder will have periods of remission and relapse throughout their lives. That means most people with bipolar disorder will receive treatment and probably medication for the rest of their lives. However, with good management and potentially medication to reduce risks and to prevent mania with psychosis, some people can be respectively in remission for most of the rest of their lives.

Getting Help with Bipolar Disorder

Bipolar disorder effects 3 out of every 100 adults in the United States, with about equal occurrence in men and women. If you have it, chances are, someone in your family has it too, even if you aren’t familiar with it. At the same time, you don’t need active expressions of bipolar disorder in the family to have it. For example, some people have the genes, but the disorder is never triggered, which means you may have heritable bipolar disorder but no recent episodes of it in your family.

Finally, bipolar disorder is a chronic disorder. Treating the trigger for bipolar disorder may be important for improving your mental health and your quality of life. However, you won’t be able to undo that, and you will have a bipolar disorder for the rest of your life. That means choosing treatment that focuses on long-term management, symptom management, and getting your life under control so you can live as normally as possible around your disorder are the important things.

If you or a loved one are struggling with bipolar disorder, there is help. Medication, behavioral therapy, and ongoing support will help you take control back and get your quality of life back.

10 Signs of Depression in Your Young Adult

Annie Winner on November 4, 2024

Depression is a normal fact of life for many of us. In fact, today, an estimated 21.5 million people experienced a major depressive episode or depression in the last year. For most of us, the age of mental health disorder onset is between 12 and 18, with 4.5 million youth aged 12-17 also experiencing depressive episodes in the same year. But, depression is highest for young adults, aged 18-25, with 6 million individuals, or 17.5% of all people of that age category. This means that young adults are especially vulnerable to depression.

While this relates to a large number of factors including high workloads, uncertain futures, covid-19 disruption, economic uncertainty, genetics, and social pressure – our youngest adults are also our most vulnerable. If you suspect that a young adult in your life is struggling, it’s important to pay attention, to make spaces to talk, and to look into getting help together.

The following 10 signs of depression in young adults will get you started.

Persistent Sadness or Low Mood

Prolonged sadness, low mood, or apathy are a core symptom of depression and are present in almost all people with depression. This might result in a young adult experiencing prolonged low mood or being bummed out for long periods of time.

What it looks like: Feeling down or persistent low mood can be difficult to spot from the outside so often, you’ll have to talk to your loved one. They also might not have words to say, “My mood is low” or “I’m just bummed out all the time” or “I feel depressed” and might instead say things like “I just feel off” “I’m having a bad month” or “I just don’t have any energy”. Especially for men, talking about mental health tends to be translated into physical symptoms, which can make it harder to figure out what’s going on.

Loss of Interest in Activities

Anhedonia, or loss of interest in things you previously enjoyed, is one of the most common symptoms of depression. Often, this means that you’re struggling with your brain regulating the uptake of serotonin and dopamine, meaning you simply don’t experience things like you used to. For example, instead of feeling excitement and interest in doing something you just feel nothing and after doing something, you also feel nothing because you’re not getting the reward of feeling good about interactions.

What it looks like: Young adults experiencing anhedonia might withdraw and stop doing things. They might drop out of sports or chess clubs, they might spend less time with family, they might do less with partners. Instead, they’ll likely dump time into high-reward/low-energy activities like phone games, alcohol or drugs, or binging food/sugary drinks.

Sleep Disturbances

People struggling with depression are very likely to have problems with sleeping, which can mean sleeping too much or not enough. In young adults, this most frequently results in sleeping too much paired with difficulty falling asleep. Often that results from sleeping too late, being tired all day, and then staying up too late in an attempt to regain control over the day – resulting in a negative reinforcing pattern of poor sleep. In addition, poor sleep worsens depression by disrupting rhythms and disrupting the brain’s ability to heal.

What it looks like: Young adults with depression are very likely to sleep in and have trouble waking up, which can result in missed classes, being late for work, and all-day fatigue. At the same time, they are unlikely to go to bed on time and are instead more likely to take frequent naps or to fall asleep in vehicles. Still, they will be tired even if they go to bed on time and get the right amount of sleep.

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Changes in Appetite or Weight

Significant changes in appetite or weight are always a sign that something is wrong. If someone is losing or gaining a lot of weight without changing diet, it can be a symptom of both physical and mental health problems so it’s important to go to a doctor. Changes in appetite can also be a red flag, as young adults with depression may avoid food and lose too much weight because they aren’t experiencing enough reward from it or may turn to high sugar and fat foods to binge on in an attempt to feel good.

What it looks like: If a young adult is suddenly losing or gaining weight, it’s a cause for concern. Weight loss is more concerning than weight gain, because it can stress the organs and cause more problems. However, disinterest or over interest in food are both a sign that something is wrong, and you should talk to a doctor about it.

Fatigue or Lack of Energy

Chronic fatigue, even after sleeping enough, is a very normal symptom of depression. Young adults with a healthy sleeping schedule may still feel chronically fatigued and may sleep for seemingly absurd amounts of time. This is linked to the way depression disturbs the body’s inflammatory responses, meaning your young adult is experiencing the same fatigue as if they had a cold or hay fever – but all the time.

What it Looks Like: Your young adult may be lethargic, may take naps frequently, and may drop responsibilities. They might not do things like taking out the trash or helping around the house. They might start missing work or class because they’re sleeping too late. Tasks like picking up medication, doing assignments for college, or doing chores around the house might seem monumental because they are tired all the time and so simply might not happen.

Difficulty Concentrating

People struggling with depression can experience life as if they are walking around in a fog. Concentration and focus-oriented tasks can become extremely difficult. This makes sense because depression actually impairs cognitive functioning and can slow down processing and can result in actual impairments to the brain.

What it looks like: Your young adult may show symptoms of depression by having no attention span. They might not pay attention when you’re talking, they might lose focus in the middle of a conversation, they might leave tasks half-finished. Alternatively, they might struggle with making choices, experience executive dysfunction, and may lack the attention to complete longer tasks well.

Feelings of Worthlessness or Guilt

Feelings of worthlessness and guilt are hallmarks of depression. This is often a self-reinforcing cycle of feeling excessive guilt and low self-esteem coupled with fatigue and executive dysfunction. These in turn, exacerbate each other, which can be difficult to treat or to manage.

What it looks like: Young adults are not known for self-esteem, but excessive self-blame, low self-esteem, and guilt are signs that something is wrong. If your young adult jumps to “I always fail”, “People are better off without me”, “this is terrible because of me”, it’s a sign that they are struggling with self-esteem.

Irritability or Anger

Irritability and anger are extremely common symptoms of depression. Here, depression is heavily linked to both episodic and chronic irritability, where a young adult may experience spikes of being irritable or cranky or might be irritable as a common standard. This happens because of a symptom known as severe mood dysregulation, in which the person with depression loses control of and insight into their moods.

What it looks like: Your young adult might snap or be irritable at slight provocations, like being interrupted from texting to be asked if they want dinner. They might have mood swings and unpredictable outbursts or moods. They might behave as though they are cranky or annoyed as a standard.

Physical Aches and Pains

Depression heavily interacts with the immune system, which means that depression can result in physical pain including headaches, stomach issues, and general malaise. Your young adult may experience life as though they have a cold or flu all the time.

What it looks like: Your young adult may frequently have stomach pain and diarrhea. They might also complain of aches and pains. And, they are very likely to have a headache as a normal thing. Here, they might say nothing, but you’ll see increases in acetaminophen or other painkiller use, changes in how they eat, and will hear more frequent complaints.

Thoughts of Death or Suicide

Suicidal ideation is one of the most serious symptoms of depression, but it affects 12.2% of young adults. Untreated depression is also one of the most common causes of suicidal ideation, meaning that suicidal ideation is a very common symptom of depression.

What it looks like: Most people don’t talk about thinking about suicide or death. However, they might let things slip by accident, they might google ways to kill themselves, they might text with friends about it. If you see things like this, it’s important to talk about it, even if it seems like it might be a bad joke.

Young adults struggle with depression more than any other generation. If someone in your life is struggling, it’s important to make space to talk, to offer help, and to work towards going to a doctor, looking for treatment, and finding professional help. Depression impacts 17.5% of all young adults but mental health treatment and therapy will help and can improve quality of life and your future – even when depression is chronic.

PTSD Science: How Trauma Changes Your Brain

Jim Sugel on August 30, 2024

Post-Traumatic Stress Disorder or PTSD is widely known as a “veterans” disease, and many of us see it as something that primarily affects people in the military. Yet, the U.S. Department of Veterans Affairs shares that 6 out of every 10 men and 5 out of every 10 women will experience at least one traumatic event in their lifetime – and every traumatic event leads to a risk of developing PTSD.

PTSD is a risk for everyone, and that means anyone, no matter what their lifestyle, is at risk of developing complications to trauma including PTSD after a traumatic event. Trauma changes the brain in many ways and PTSD continues to do so, long after the original traumatic event is over. Understanding those changes can give you insight into what PTSD is, how it affects people over the long-term, and why treatment is so important for anyone struggling with trauma after the fact.

What is PTSD?

Post-traumatic-stress disorder is a diagnosis in which trauma continues to affect the brain and the body after the trauma. In most cases, that means the side-effects of trauma have not gone away within about 2 months of a traumatic event. Not everyone exposed to trauma will develop PTSD. Instead, personal resilience, coping strategies, genetics, environment, support, and the intensity and duration of the trauma will all impact the risk of PTSD.

PTSD itself is characterized by failure to recover from a traumatic event. That often means remaining in a psychological and biological state of heightened awareness and stress response. And, that means that treatment often requires identifying pre-exposure risk factors that led to failure to recover. That’s often significantly more important to recovery than the specific reactions of the brain in PTSD.

Heightened Fear Response and the Amygdala

One of the key symptoms of PTSD is a heightened fear response. Here, you may experience situations intensely, may be on constant alert, may respond with fear or anger out of proportion to events happening, and typically experience heightened anxiety. That can translate into outbursts, feelings of anxiety and worry, fear of situations or places, avoidance, and extreme emotions.

Much of it tracks to changes in the amygdala, the almond-shaped structure in the brain widely known as being responsible for the emotional processing of fear and anger. Individuals with PTSD show hyperactivity in the amygdala, leading to that heightened fear response, hypervigilance, and emotional outburst.

Memory, Processing, and the Hippocampus

Many people describe PTSD as though they are living in a fog, as though they have a wall between them and everything going on, and as though events that happened in the past are as real or more real than things happening now. Memories of traumatic events can be as visible and as real as events happening in the present. As a result, people with PTSD can struggle to differentiate past and current memories, struggle to see safe areas as safe, and may feel that they are still experiencing a traumatic event, even years after the fact.

That’s related to shrinkage and changes in connectivity and neurotransmitters in the hippocampus. This area of the brain is responsible for memory and contextual processing. As shrinkage gets worse, so do flashbacks and memory processing symptoms of PTSD.

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Emotional Regulation and the Prefrontal Cortex

PTSD often results in reduced connectivity, reduced neurotransmitter activity, and decreased electrical impulses in the brain. One of the areas of the brain most affected by this is the prefrontal cortex. This part of the brain is impactful in emotional regulation, impulse control, and decision-making. Reducing connectivity and activity in this part of the brain also means that individuals have more difficulty with emotional regulation and impulse control. For example, persons with PTSD are more likely to jump from one emotion to the next, to quickly go to emotional extremes, and to have difficulty regulating stress, anxiety, and fear. They may not have the ability to calm themselves down once stressed.

It also ties into how people with PTSD see threats. If something is a bit scary or threatening, they may not be able to regulate themselves to respond in measure to the amount of threat. Finally, reduced emotional regulation and impulse control means that impulsive behaviors like outbursts, spending money to quickly feel better, taking risks, and otherwise sensation seeking for temporary reward and feeling better all become more likely – because the person is less able to control impulses and think those decisions through.

Stress Response and the HPA Axis

The HPA Axis is only partially in the brain. However, it’s part of the body’s response to stress and to PTSD. This system regulates the stress and adrenaline responses including cortisol and adrenaline. IT’s the hypothalamic-pituitary-adrenal system. During PTSD, this system is often dysregulated, meaning that it over-produces stress hormones, leading to a constant state of stress and anxiety.

That can translate to elevated heart rate, being on edge, inability to sleep, hypervigilance and awareness, and irritability. That all makes sense because the body is producing hormones that should only occur when something is wrong.

Neurotransmitter Imbalances

PTSD often results in an imbalance of neurotransmitters throughout the brain. These include serotonin, dopamine, norepinephrine which allow the brain to send signals, to process signals, and to create reward for activities. For example, serotonin is largely known as being responsible for people feeling good after activities or when in love, dopamine is largely known for its role in providing motivation and feeling good around motivation. Reducing levels of these transmitters in the brain can have significant and meaningful impacts on the individual and their ability to recover. For example, over time, it leads to symptoms of anxiety, depression, and increased hypervigilance.

Getting Help

How do you get help for something that affects the way your brain functions? Does behavioral therapy help? The good news is that yes it does. The bad news is that it can take a long time for your brain to return to normal even with treatment. In most cases, treatment for PTSD involves a short-term course of medication to reduce the symptoms and flashbacks – so that you can benefit from treatment. From there, you’ll receive behavioral therapy like DBT, CBT, and counseling. Over time, these will allow you to reframe experiences, expose yourself to trauma, to reframe reactions, and to get emotional regulation under control. And, over time, your brain and body will heal and will return to normal.

PTSD significantly impacts the brain including the function and the structure of areas of the brain. Everyone with PTSD will see changes in neurotransmitter processing, connectivity, and activity across the brain. Those changes can mean that it’s difficult to tell what’s real and what’s not. But, with treatment, you can mitigate those symptoms and give the brain space to begin to heal.

If you or a loved one is still experiencing symptoms of trauma more than a few months after a traumatic event it’s important to reach out and get help. That means talking to your doctor and looking for a specialist that can build a custom treatment plan, identify the pre-risk factors of PTSD, and then work on helping you through the changes you need to make to recover. Full recovery will always take time, but it starts with taking steps to heal.

How Long Does Untreated Trauma Last?

Jim Sugel on August 7, 2024

Most people will eventually struggle with trauma. An estimated 70% of all Americans experience significant or major traumatic events at some point during their lives. And, everyone experiences traumatic events like the death of parents and grandparents. Often, that means taking time to heal and that means giving yourself time to recover from trauma.

At the same time, that trauma should heal. If your trauma doesn’t start to naturally go away on its own, it’s a sign that something deeper is wrong. For example, if you’re not seeing even slow improvement after a month, you might want to look into treatment. Left untreated, trauma that isn’t resolving on its own can turn into PTSD (post-traumatic stress disorder) which is a much more serious disorder that requires more significant treatment.

However, the path to trauma recovery varies per person. It’s important that you understand the path to trauma recovery, how untreated trauma works, and the steps you can take to get help if you don’t see improvement.

Talk to Your Doctor

If you’ve experienced a traumatic event, it’s important to talk to your doctor. That means discussing your health and mental health with someone who is both qualified to talk to you about it and who can set up next steps for you. Doing so right away means you’ll understand the options available to you and your doctor will know they might have to make next steps for you in the future. That will simplify the process if you end up needing help later.

Here, you want to discuss:

What happened
What the expected timeline should be
How you feel now and what your doctor thinks about that
What side-effects or long-term affects you might experience and what to do about them
How you feel on a daily basis

If it’s already been some time since you experienced trauma, you’ll also want to discuss whether you’ve made any progress, any actual symptoms, and if things are getting worse.

Trauma means you’re at increased risk of stress, stomach and digestion issues, sleeping issues (sleeping too much or too little), cardiovascular problems, and complications like PTSD. Sitting down with your doctor to discuss those risks, your recovery, and your options will allow you to decide what the next steps for your health should be and what you can do to support recovery.

What is the Normal Recovery Timeline for Untreated Trauma?

If you’ve experienced a traumatic event, recovery can take months. In fact, if a loved one dies, recovery times for that trauma are typically 6-12 months. For other events, you’re generally looking at a shorter recovery period.

The first two weeks are usually the worst in terms of symptoms such as anxiety, flashbacks, and fear
For some people, this initial peak can last as long as 2 months
Improvement starts gradually and can look like accepting things, feeling less discomfort, and being more capable or willing to push boundaries around trauma.

In most cases, the rule of thumb is that if someone isn’t showing gradual improvement after about 2 months, they aren’t going to recover on their own. That means you’ll need a mental health intervention such as counseling or therapy to help you step out of trauma and get back to your life.

For most people, that means giving it about a month to get back to feeling like yourself after a traumatic event like assault, robbery, a car accident, or a natural disaster. For others, that might look like 2 months. And for some people, it can take longer. Still, if you’re not showing gradual improvement after 2 months, you definitely want to talk to a professional.

Still, that can be further complicated by the fact that not everyone is aware they have to make steps to recover from trauma. That can mean you need counseling to even start processing trauma which can further complicate the process.

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Risks of PTSD

PTSD or Post-traumatic stress disorder is a complication of trauma in which your brain and your body do not heal from trauma. Instead, you become mentally stuck in the experience of trauma with a heightened adrenal response. That can mean you experience severe anxiety, avoidance, uncontrollable thoughts, nightmares, and flashbacks about the traumatic event(s) for even decades after the event. Normally, PTSD is diagnosable after about a month from a traumatic event.

Here, diagnosing PTSD depends on severity of the symptoms with severe anxiety, guilt or shame, guarded behavior, fear or anxiety, memory problems, negative thoughts, depression, flashbacks, and nightmares being key symptoms looked for. However, PTSD may also be diagnosed purely on the basis of duration of symptoms. Even mild symptoms are PTSD if you continue to experience them for a year after the traumatic event.

If you’re diagnosed with PTSD, you will need treatment. That typically means behavioral therapy like CBT and counseling to help you overcome the impacts of trauma on the brain. At the same time, that treatment can help you prevent complications of trauma to begin with.

Should You Get Treatment for Trauma?

In most cases, if you’ve experienced a traumatic event, it’s a good idea to talk to your doctor. From there, you can make decisions about getting treatment or not based on your history of mental health and potential complications. You can also make sure your doctor is aware of what’s going on, so if things don’t improve, they can help you take the next steps. If you have a history of trauma, it’s probably best to immediately look into treatment. In addition, if you have a mental health problem such as depression or anxiety, that can make recovering from trauma harder. Individuals who have experienced violent crimes are also more likely to experience complications, which means you should typically take advantage of counseling offered by emergency care services.

Otherwise, the best option for deciding on treatment is to wait. Talk to your doctor about what you can do to improve things in the meantime. Then, give your brain and your body time to heal. If you’re not seeing improvements after about a month, it’s a good idea to go back to your doctor, discuss next steps, and to start looking into treatment. Everyone recovers at their own pace, but staying on top of how you’re doing, looking for improvement, and taking action if it’s not there is critical no matter what your recovery process looks like. Starting out by talking to your doctor or your therapist is always a good step. In addition, if you have the option, getting preventive care for trauma is often a good way to ensure you have the tools to prevent complications and recover as quickly as possible.

Eventually, most of us experience trauma. Recovering from that takes time. Depending on you and your mental health, recovering from trauma can take months. For some of us, that won’t happen without therapeutic interventions and counseling. There’s no single path through trauma or trauma recovery. However, it’s important to be able to reach out and get help when you need it and that means talking to medical professionals, understanding what recovery should look like, and taking steps when nothing is changing. Hopefully, this helps you create a strategy so you have that support available to you and you can get help if you need it.

The Link Between Cannabis Use and Schizophrenia

Andrea Wagner on November 21, 2023

Cannabis is one of the most frequently used drugs in the United States, with an estimated 18.7% of the U.S. population using at least occasionally. That’s more than 52.5 million people. Cannabis and marijuana are more and more often accepted as a relatively safe drug for medical and recreational use. Yet, heavy use is also more and more often linked to behavioral health disorders like schizophrenia and paranoia. Schizophrenia is a complex mental health disorder linked to genetics, but research shows that cannabis use could trigger dormant schizophrenia. For that reason, it’s important that you be aware of the risks and how they might affect you or your loved one before using.

This doesn’t mean that cannabis can immediately trigger schizophrenia the first time you use. Instead, the relationship is likely complex, related to heavy use, and heavily dependent on genetics. For many people, cannabis only increases the risk of receiving a cannabis diagnosis. That does mean that understanding the risks will contribute to your ability to use safely.

How does Cannabis Contribute to Schizophrenia

Cannabis is widely regarded as increasing vulnerability to schizophrenia. Often, that means the individual had an underlying but dormant schizophrenic disorder. It’s not yet known if cannabis can cause schizophrenia in a person without genetic inclination for the disorder, but it is thought that the answer is no. This means that genetics play a very large role in cannabis contributing to schizophrenia.

Increased Risk of Psychosis – Most people are aware that if you smoke too much cannabis, you get paranoid. Even if you’ve never smoked, everyone has seen the friend being paranoid. Even that mild psychosis can contribute to schizophrenia. In fact, paranoia is one of the first symptoms of schizophrenia, with one study of over 15,600 participants showing that people who experience paranoia when smoking cannabis are at an increased risk of developing schizophrenia than those that don’t experience paranoia when smoking cannabis.
Poor Coping Mechanisms – People who smoke cannabis often do so to self-medicate and to alleviate existing symptoms and mental health problems. That can be using cannabis to relax. It can also mean using cannabis to treat early symptoms of schizophrenia instead of getting help for them.
Genetic Triggers – Some research shows that people with certain gene expressions will have an increased likelihood of a schizophrenia diagnosis after smoking cannabis. These currently include AKT1 C/C and COMT gene expressions, both of which increase the psychotomimetic effects of cannabis. Essentially, persons with those genes experience more psychosis than individuals without those gene expressions, which can mean a higher risk of schizophrenia – or that those genes are linked to underlying schizophrenia already being there.

Cannabis Increases Your Likelihood of a Schizophrenia Diagnosis

Today, it’s estimated that some 0.5-1% of the population has schizophrenia and that more than 3% of the population are vulnerable to schizophrenia. This means that 3% or more of the population carry all of the risk factors for schizophrenia, or what is otherwise known as “Dormant” schizophrenia.

However, studies that take individuals with high risks based on genetics show that individuals who smoke cannabis and have genetic risks are 40% more likely to receive a diagnosis than those that do not. Of course, that could also be related to a mix of factors such as:

Persons experiencing schizophrenia symptoms are more likely to self-medicate
Individuals with schizophrenia are more likely to take risks (e.g., drugs)
People who smoke cannabis are more likely to be from low-income homes and unable to receive proper mental health treatment

While it’s likely to be a combination of everything, multiple studies show that individuals who smoke cannabis are typically diagnosed with schizophrenia as early as 2.8 years sooner than family members with the same background and risks who do not smoke cannabis.

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What are Known Risk Factors?

There are plenty of risk factors that can contribute to your likelihood of a schizophrenia diagnosis related to cannabis usage. The following include some of the most common:

Gender – Men are both more likely to smoke cannabis and more likely to receive a schizophrenia diagnosis
Age of Usage – If you begin using cannabis before the age of 25, it may increase the risks of schizophrenia at a later age. That’s linked to the fact that the brain is more plastic and in development under the age of 25, meaning that changes to dopamine and serotonin regulation by cannabis are more likely to become permanent functions of how the brain works. This also means that reducing risks means waiting to smoke until after the age of 25. However, young adults aged 18-35 make up the most statistically significant population of cannabis users.
Amount of Usage – The more you smoke, the more you are at risk of developing complications, including psychosis. For example, studies show that even smoking a single joint per week can develop schizophrenia at a later date – although causation and correlation are still in question. On the other hand, the people most likely to receive a diagnosis are those who qualify as heavy users, or who smoke on average once or more per day.
Genetics – Genetics are still the most important trigger in a schizophrenia diagnosis. For example, individuals with the gene expression AKT 1 C/C are 7 times more likely to receive a schizophrenia diagnosis after heavy cannabis usage than those without the gene expression, even with comparable cannabis consumption. However, if you have the AKT 1 C/C gene expression, you’re more likely than a non-C/C expression person to receive a schizophrenia diagnosis, even if you don’t smoke cannabis. So, the gene is a risk and cannabis is only a trigger. This is also true with other genes, most notably COMT, which regulates how neurotransmitters like dopamine and serotonin are reabsorbed back into the brain.

It’s widely agreed that cannabis and schizophrenia interact a great deal. However, if you have a family history of schizophrenia, it’s significantly more likely to be the case.

So, what are the Risks?

If you have a family history of schizophrenia, it’s normally better to avoid psychosis-inducing drugs altogether. While they won’t “cause” schizophrenia, they can trigger it, bringing formerly dormant symptoms to the surface. Multiple studies indicate that cannabis can play a role in activating schizophrenia, meaning that you will be more likely to develop symptoms and to need a diagnosis. Therefore, it’s always a good idea to assess your medical history for the risk of schizophrenia before smoking. However, it’s also important to keep in mind that schizophrenia increases your risk of drug use and using cannabis to cope with symptoms. If you’re using, it’s a good idea to stop and evaluate why and to seek support and treatment for those symptoms.

In almost every case, there is a complex interplay between risks, factors, and triggers. You won’t develop schizophrenia because you smoked once. However, cannabis can and does contribute to an increase in psychosis, even if it seems mild. If you start experiencing paranoia, it’s a good first warning sign and a good reason to stop smoking and look for treatment.

Of course, most drugs are relatively safe in moderation. Still, many of us are “high risk”, meaning we take on extra risks of complications, triggering underlying problems, and even addiction when we use them. If that is you, it’s better to avoid smoking or using altogether.

Take the first step towards reclaiming control of your life by seeking help for cannabis addiction today. Contact our addiction treatment team today, we are here to support you on your journey to recovery.

How Can I Rebound After Psychosis and Jail?

Andrea Wagner on November 10, 2023

Psychosis is a largely unacknowledged but extremely prevalent factor behind people committing violent crimes and going to jail. In fact, an estimated 3.6% of male and 3.9% of female prisoners have a psychosis diagnosis in prisons worldwide. Psychotic episodes from personality disorders, schizophrenia, or other psychotic disorders can wreak havoc on your life – not just because they make it harder to maintain routines and relationships but also because they can get you into very real trouble with the law.

How do you bounce back from that after having hit rock bottom? If you’re getting out of jail or prison after a psychotic episode, you probably want to take steps to protect yourself and your future. Ensuring you have the tools to stay healthy and in control is important. Of course, your treatment will typically depend on your diagnosis and what you’re facing. However, these tips will help you rebound after psychosis.

Talk to Your Doctor

Your first step should always be to talk to your doctor. That’s true whether or not you have a diagnosis. Here, you should:

Verify your diagnosis or attempt to get one
Get a prescription for anti-psychotics
Get a referral into a mental health treatment program so that your health insurance covers it

Nearly everyone with a psychosis diagnosis will require medication either permanently or intermittently throughout their lives. Most schizophrenia patients require medication for their entire lives. Data shows that about 30% of schizophrenia patients can manage without medication – after 10 years of treatment and learning to cope with symptoms.

This means that talking to your doctor and working out your prescription, if your prescription is still right for you, and how to combine it with therapy is an important first step. You likely need antipsychotics to benefit from mental health treatment. That will mean getting a prescription if you don’t already have one, waiting for it to take effect, and then moving into treatment that can work with you based on those symptoms.

Seek Out Mental Health Treatment

Attending psychosocial rehabilitation programs is one of the most important steps you can take in ensuring your recovery and rebound. In fact, primary treatment for psychosis is a personally tailored mix of talking therapy and medication. This means that you’ll need treatment to ensure that you have the tools to manage psychosis symptoms. Mental health treatment typically includes 30-90 days programs of in-house or outpatient treatment, where you’ll attend a clinic with group therapy, individual therapy, and counseling. There, you’ll learn how to manage symptoms, how to change behaviors to reduce symptoms, and how to build skills and coping mechanisms that improve your quality of life around your symptoms.

Depending on you, that can mean learning to accept symptoms and your psychosis and working to manage it. You might also need help building stress management, routines, and self-care skills. Many people also need help building social networks, managing relationships, and learning to ask others for help. Your treatment will typically depend on where you are and what you need. However, you can expect it to involve behavioral therapy such as cognitive behavioral therapy or dialectal behavioral therapy. You’ll also get counseling and group therapy to help you deal with the problems that psychosis cause in your life, to deal with psychosis itself, and to recognize the symptoms of psychosis and react to them with enough time to get help.

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Look for Assisted Living

Assisted living and supported living solutions are an ideal way to rebound from psychosis and jail. Here, you’ll stay in a shared home for several months, sometimes longer. There, you’ll have a routine, set meal times, people to check up on you, and accountability. If you stop going to treatment or stop taking care of yourself, people notice. If you stop spending time with the group or sharing meals, people notice. That forced accountability can be an important part of recovery because it forces you to adopt the routines and schedule of self-care that can help you to stay in recovery.

Of course, assisted living centers aren’t right for everyone and some people get the same out of an inpatient treatment program. However, it can be a valuable way to bridge the gap between no autonomy in prison and total autonomy out of prison by giving yourself accountability and someone to help you with schedules and routines.

Long-term Support and Aftercare

If you’re living with psychosis, it’s a permanent part of your life (although you may have drug-induced psychosis like marijuana psychosis, in which case it may be temporary). However, that normally means you’ll have to look for long-term aftercare and support. That means having people who will notice if you start to slip, having people to check up on you, and ensuring that you maintain your routines. For many, a simple self-help group with weekly meetings will be more than enough for therapy maintenance. However, you’ll want to discuss your options with your therapist based on your progress.

In addition, it’s generally a good idea to have more rather than less support. If you have a probation officer checking up on you, that’s good. If you have a social worker doing so, even better. If you have recurring visits with your therapist to check in on your mental health, even after your treatment is over, even better. Ensuring you have long-term support, options to go back into treatment, and people to help you stay on top of your mental health is important for your long-term recovery.

Tracking Signs of Relapse

For many people, preventing relapse and recidivism is about tracking early warning signs of relapse. For most people with psychosis those symptoms include:

Irritability or nervousness
Reduced concentration and focus
Requiring time alone or more than usual
Sensitivity to stimulus (noise, light, touch)
Reduced quality of sleep
Nightmares
Unusual thought experiences

Depending on your specific diagnosis, that can vary a great deal. Therefore, you should sit down with your therapist to build a list and to learn how to recognize them in yourself.

Long-Term Care

Long-term care means investing your health for the long-term that means investing in self-care and ongoing support. This means:

Taking care of yourself with good sleep, eating, and exercise habits
Having a good routine
Learning communication and problem-solving skills
Having social support
Having meaningful things to do with your time
Getting ongoing treatment

Many people do prefer to get help with this, especially in the first few years after diagnosis. However, that should often be in the form of professional support and not simply relying on family to help you. This means assisted living, visiting social workers, social care, and even at-home nursing and care. What works for you will vary depending on your situation, but it is an important thing to consider.

Getting Help

If you’re moving back into your life after a psychosis breakdown and incarceration, it’s important to reach out and get help. That almost always starts with your doctor, where you can talk about what your options are, review your diagnosis and prescription, and get a referral into mental health treatment. From there, you can get mental health treatment to ensure you have the tools to manage your disorder long-term, so you can recover, and so you can learn to recognize and act when your mental health starts to go downhill. Good luck rebounding!

Redeemed Mental Health is a mental health & dual diagnosis treatment center offering PHP, IOP, and individual levels of care. Contact us today to begin your journey of recovery!