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J Affect Disord. 2015 Jan 15;171:39-47. doi: 10.1016/j.jad.2014.09.016. Epub 2014 Sep 23.

Cannabis use and mania symptoms: a systematic review and meta-analysis.

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Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, CV4 7AL, UK.
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, CV4 7AL, UK; Early Intervention Service, Swanswell Point, Coventry CV1 4FH, UK. Electronic address:
Caludon Centre, Coventry and Warwickshire Partnership Trust, CV2 2TE, UK.
Warneford Hospital, University of Oxford, OX3 7JX, UK.



Whilst cannabis use appears to be a causal risk factor for the development of schizophrenia-related psychosis, associations with mania remain relatively unknown. This review aimed to examine the impact of cannabis use on the incidence of manic symptoms and on their occurrence in those with pre-existing bipolar disorder.


A systematic review of the scientific literature using the PRISMA guidelines. PsychINFO, Cochrane, Scopus, Embase and MEDLINE databases were searched for prospective studies.


Six articles met inclusion criteria. These sampled 2391 individuals who had experienced mania symptoms. The mean length of follow up was 3.9 years. Studies support an association between cannabis use and the exacerbation of manic symptoms in those with previously diagnosed bipolar disorder. Furthermore, a meta-analysis of two studies suggests that cannabis use is associated with an approximately 3-fold (Odds Ratio: 2.97; 95% CI: 1.80-4.90) increased risk for the new onset of manic symptoms.


We were only able to identify a small number of studies of variable quality, thus our conclusions remain preliminary.


Our findings whilst tentative, suggest that cannabis use may worsen the occurrence of manic symptoms in those diagnosed with bipolar disorder, and may also act as a causal risk factor in the incidence of manic symptoms. This underscores the importance of discouraging cannabis use among youth and those with bipolar disorder to help prevent chronic psychiatric morbidity. More high quality prospective studies are required to fully elucidate how cannabis use may contribute to the development of mania over time.


Bipolar; Cannabis; Mania; Meta-analysis; Systematic review

[Indexed for MEDLINE]

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