A case of new-onset mania in older adulthood related to cannabidiol and low-dose prescription stimulant use

Abstract

This is a case study of a 57-year-old female admitted to the inpatient psychiatry ward for new-onset mania following a recent increase in cannabidiol (CBD) use and prescribed low-dose dextroamphetamine-amphetamine for newly diagnosed attention-deficit/hyperactivity disorder (ADHD). The psychiatric implications from using cannabis products and prescription stimulants are active areas of investigation, especially given the increase in recreational cannabis use and stimulant prescriptions in recent years. Substance-induced bipolar disorder represents one such psychiatric condition that can result from using these substances, typically resolving with the cessation of their use. Substance-induced psychosis resulting from either stimulant or cannabis use, conferred by the psychoactive component tetrahydrocannabinol (THC), is well-represented in the literature. However, substance-induced bipolar disorder in the setting of increased CBD use and concurrent low-dose stimulant use in patients 40 years and older without a personal or family history of bipolar disorder has not been significantly studied. This case study explores a case of substance-induced bipolar disorder in an older adult associated with use of prescription stimulants and cannabidiol products. We show that this patient was effectively treated with cessation of dextroamphetamine-amphetamine and CBD products in conjunction with use of olanzapine for four months following presentation without recurrence of mania at 15 months follow-up.