A Systematic Review of the Molecular and Cellular Alterations Induced by Cannabis That May Serve as Risk Factors for Bipolar Disorder

Int J Neuropsychopharmacol. 2024 Feb 1;27(2):pyae002. doi: 10.1093/ijnp/pyae002.


Background: Cannabis use is a risk factor of psychiatric illness, such as bipolar disorder type-I (BDI). Indeed, cannabis use strongly influences the onset and clinical course of BDI, although the biological mechanisms underlying this interaction remain unknown. Therefore, we have reviewed the biological mechanisms affected by cannabis use that may trigger BD.

Methods: A systematic review was carried out of articles in which gene expression was studied in cannabis users or human-derived cells exposed to tetrahydrocannabinol (THC) or cannabidiol (CBD). A second systematic review was then performed to identify articles in which gene expression was studied in BDI samples, highlighting those that described alterations to the same molecular and cellular mechanisms affected by cannabis/THC/CBD.

Results: The initial search identified 82 studies on cannabis and 962 on BDI. After removing duplicates and applying the inclusion/exclusion criteria, 9 studies into cannabis and 228 on BDI were retained. The molecular and cellular mechanisms altered by cannabis use or THC/CBD exposure were then identified, including neural development and function, cytoskeletal function, cell adhesion, mitochondrial biology, inflammatory related pathways, lipid metabolism, the endocannabinoid system, the hypocretin/orexin system, and apoptosis. Alterations to those activities were also described in 19 of 228 focused on BDI.

Conclusions: The biological mechanisms described in this study may be good candidates to the search for diagnostic biomarkers and therapeutic targets for BDI. Because cannabis use can trigger the onset of BD, further studies would be of interest to determine whether they are involved in the early development of the disorder, prompting early treatment.

Keywords: Cannabis; biomarker; bipolar disorder; risk factor.

Publication types

  • Systematic Review

MeSH terms

  • Bipolar Disorder* / drug therapy
  • Cannabidiol* / pharmacology
  • Cannabinoid Receptor Agonists
  • Cannabis*
  • Dronabinol / adverse effects
  • Hallucinogens* / therapeutic use
  • Humans
  • Risk Factors


  • Cannabinoid Receptor Agonists
  • Cannabidiol
  • Hallucinogens
  • Dronabinol