Similarly, the majority of evidence suggests harmful effects of cannabis use in bipolar disorder (BD), another common mood disorder associated with CUD [97]. Using a nationally representative sample of over 40,000 individuals, cannabis use has been associated with a greater risk of BD onset [27]. This association has been found by others, with higher frequency cannabis use further potentiating the risk for developing BD and worsening BD symptomology, including sucide risk [111, 144]. One study highlights a positive association between BD and cannabis use, but with interactive effects of cannabis use and BD measures on gender and medication type [86], while other studies describe cannabis use as predictive of longer affective episode duration, more frequent rapid cycling between mood states, as well as lower remission rates and lower clinical and functional recovery [137, 155]. In contrast, another study suggests an improvement in BD symptoms 4 hours following cannabis use [126]; however, this only reflects an acute profile of cannabis use in BD. There are additional studies that suggest no statistically significant relationship between cannabis and BD outcomes [73, 121]. Moreover,
