A patient with bipolar disorder developed cannabinoid hyperemesis syndrome, and the three weeks of vomiting likely lowered their mood stabilizer blood levels enough to trigger a manic episode.
Read this if you use cannabis while taking psychiatric medications, particularly mood stabilizers.
3 weeks of CHS vomiting lowered mood stabilizer levels, triggering mania
What the researchers found
This case report describes a patient with bipolar disorder who developed cannabinoid hyperemesis syndrome (CHS), the vomiting condition seen in heavy cannabis users. The resulting three weeks of persistent vomiting likely prevented adequate absorption of their mood stabilizer medication, lowering serum levels and precipitating a manic episode.
The case illustrates an underappreciated risk of CHS: for patients on oral psychiatric medications, prolonged vomiting can disrupt medication absorption and trigger the very psychiatric conditions those medications are designed to prevent.
The patient's CHS resolved with cessation of cannabis use, consistent with the established treatment for this condition.
Why it matters
This case highlights an important and overlooked interaction between heavy cannabis use and psychiatric treatment. CHS is not just a gastrointestinal problem. For the many patients who use cannabis while taking psychiatric medications, CHS-induced vomiting can create a dangerous secondary psychiatric crisis.
The numbers in context
Three weeks of vomiting preceded the manic episode. CHS symptoms were characterized by cyclic nausea and vomiting with relief from hot bathing. Mood stabilizer serum levels were lowered by poor oral absorption during the vomiting period.
How the study worked
Single case report of a patient presenting with both cannabinoid hyperemesis syndrome and bipolar mania. The temporal relationship between CHS-induced vomiting, medication levels, and mania onset was analyzed.
What this study cannot tell us
Single case report cannot establish causality. Other factors may have contributed to the manic episode. The specific mood stabilizer levels before and during CHS were not reported in detail.
How to read the evidence
Single case report providing clinical illustration of an important drug-condition interaction. No statistical evidence.
When this study was published
Published in 2016. Cannabis potency and CHS prevalence have both increased since.
The bigger picture
As cannabis use becomes more common among people with psychiatric diagnoses, the intersection of CHS and psychiatric medication management deserves more attention. This case demonstrates that cannabis side effects can have cascading consequences that go well beyond the direct effects of the drug.
Questions still open
- How common is this cascade of CHS leading to psychiatric medication failure? Should patients on mood stabilizers be specifically warned about CHS risk? Would monitoring drug levels during CHS episodes prevent psychiatric crises?
Common questions
Can cannabinoid hyperemesis syndrome affect psychiatric medications?
What should bipolar patients who use cannabis know?
Read the original research
Cannabinoid hyperemesis syndrome and the onset of a manic episode.
BMJ case reports, 2016
Citation
Gregoire, Phillip; Tau, Michael; Robertson, David. (2016). Cannabinoid hyperemesis syndrome and the onset of a manic episode.. BMJ case reports, 2016. https://doi.org/10.1136/bcr-2016-215129
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