High-dose CBD vaping triggered a manic episode in a man with no psychiatric history

A 31-year-old male with no psychiatric history developed irritability, decreased need for sleep, hyperactivity, and aggression after three months of escalating daily CBD use via vaping, reaching high doses before admission. Toxicology screening was negative for other substances. Clinical improvement occurred with mood stabilizers and antipsychotics following CBD discontinuation.

Single case report documenting the clinical presentation, substance use history, toxicology screening, treatment, and clinical course of a CBD-associated manic episode.

CBD is widely perceived as safe and non-psychoactive, but this case suggests that high-dose CBD may trigger mania in susceptible individuals. The absence of prior psychiatric history and negative toxicology for other substances strengthens the association, though commercial CBD product variability (contamination, mislabeling) complicates interpretation.

As CBD products proliferate with minimal regulation, the assumption of complete safety is being challenged by case reports like this. While CBD at therapeutic doses appears generally well-tolerated, high-dose use without medical supervision may carry psychiatric risks, particularly given the variability in commercial product composition.

Single case report cannot establish causation. Commercial CBD products may contain contaminants, other cannabinoids, or be mislabeled. Dose escalation pattern suggests possible dependence behavior. Cannot rule out undiagnosed bipolar disorder that was unmasked rather than caused by CBD. No genetic or family psychiatric history details provided.