Cannabis Use in Teens with Depression or Bipolar Disorder Linked to Higher Suicidality and Clinical Severity | Research

The takeaway

Among adolescents with major depression or bipolar disorder, cannabis use and cannabis use disorder were associated with significantly higher odds of suicidal ideation and attempts, along with greater clinical severity.

child psychiatrists, adolescent medicine specialists, parents of teens with mood disorders

What the researchers found

Cannabis use was most prevalent in adolescents with MDD, followed by BD, then controls. Cannabis use disorder was most prevalent in adolescents with BD. In both MDD and BD groups, cannabis use and CUD were associated with significantly higher odds of lifetime suicidal ideation and attempts, as well as other indicators of clinical severity.

Why it matters

Adolescents with mood disorders are already at elevated risk for self-harm. Understanding that cannabis use further increases suicidality risk in this population is critical for clinicians treating young people with depression or bipolar disorder.

The numbers in context

MDD: 354 with cannabis use, 70 with CUD, 688 without. BD: 79 with cannabis use, 32 with CUD, 184 without. Controls: 1,413 with cannabis use, 333 with CUD, 6,970 without. Significantly higher suicidal ideation/attempts in cannabis-using mood disorder groups.

How the study worked

Cross-sectional data from the 2001-2004 National Comorbidity Survey-Adolescent Supplement. In-person epidemiologic survey of adolescents ages 13-18. MDD (n=1,112), BD (n=295), controls (n=8,716). Covariate-adjusted ordinal logistic regression.

What this study cannot tell us

Cross-sectional design cannot determine causation. Data from 2001-2004 may not reflect current cannabis landscape. Self-reported cannabis use. Cannot determine temporal sequence between cannabis use and suicidality.

How to read the evidence

Large nationally representative sample with adjusted analyses, but cross-sectional design and older data (2001-2004) limit conclusions.

When this study was published

2025 publication analyzing 2001-2004 survey data.

The bigger picture

Since this study used data from 2001-2004, before the increases in cannabis potency and availability over the past two decades, the authors note current adverse associations may be even stronger. This finding has direct implications for clinical screening and intervention.

Questions still open

Would the associations be stronger with current high-potency cannabis products?
Does treating cannabis use disorder reduce suicidality risk in teens with mood disorders?

Common questions

Is cannabis use risky for teens with depression?

This study found that teens with major depression who used cannabis had significantly higher odds of suicidal ideation and attempts compared to depressed teens who did not use cannabis. The association held after adjusting for other risk factors.

Does cannabis worsen bipolar disorder in teenagers?

Cannabis use disorder was most prevalent among teens with bipolar disorder, and both cannabis use and CUD were associated with greater clinical severity and higher suicidality in this group.

Read the original research

Correlates of cannabis use and cannabis use disorder among adolescents with major depressive disorder and bipolar disorder in the National Comorbidity Survey-Adolescent Supplement (NCS-A).

Journal of affective disorders, 371, 268-278

View on PubMed ↗Publisher’s paper ↗

Citation

Sultan, Alysha A; Goldstein, Benjamin I; Blanco, Carlos; Kennedy, Kody G; Conway, Kevin P; He, Jian-Ping; Merikangas, Kathleen. (2025). Correlates of cannabis use and cannabis use disorder among adolescents with major depressive disorder and bipolar disorder in the National Comorbidity Survey-Adolescent Supplement (NCS-A).. Journal of affective disorders, 371, 268-278. https://doi.org/10.1016/j.jad.2024.09.114