Overview of PTSD
Post-traumatic stress disorder (PTSD) often comes to mind when thinking about combat veterans but it also affects the general population as well. PTSD in a clinical sense is characterized by hyperarousal and recurrent stressful memories after an emotionally traumatic event. The risk of developing PTSD after a traumatic event is approximately 15% for the general population and approximately 30% for military personnel deployed to areas of combat. It is currently not well understood why certain individuals will develop PTSD and others will not when they are exposed to comparable trauma.
PTSD is not only a public health concern because of the debilitating nature of the symptoms but also to individuals in close proximity to those affected by it. Individuals with PTSD have high rates of comorbidity with other psychiatric disorders such as major depression and bipolar disorder.
People with PTSD also experience chronic inflammation, metabolic disorder, increased incidence of coronary artery disease, and increased rates of early mortality (Girgenti, Hare, Ghosal & Duman, 2017).
How Cannabis Effects PTSD
In 2009, New Mexico became the first state to authorize the use of medical cannabis for people with PTSD. A study published in 2014 in the Journal of Psychoactive Drugs studied the first 80 PTSD patients who used medical cannabis in New Mexico. The researchers used the Clinician-Administered PTSD Scale (CAPS) which asks questions about the presence of traumatic experiences and the immediate emotional response to them as well as a rating of the frequency and intensity of 17 symptoms associated with re-experiencing, avoidance, and hyperarousal.
After conducting over 80 evaluation between 2009 and 2011, CAPS scores were analyzed to assess differences in PTSD symptoms with vs without cannabis use. Patients in this sample reported over 75% reduction in all three areas of PTSD symptoms while using cannabis (Greer, Grob & Halberstadt, 2014). The researchers also noted that these results could be due to a highly select group of pre-screened patients who had already found that cannabis reduced their PTSD symptoms and patients may have reported their no-cannabis PTSD symptoms when they were also experiencing a cannabis-withdrawal. Nightmares, anger, and insomnia have been reported as common symptoms of cannabis withdrawal.
How Cannabis Relieves Symptoms Associated with PTSD
According to the National Institute of Mental Health, classic PTSD symptoms are grouped into four categories which are: re-experiencing, avoidance, arousal/reactivity, cognition/ mood-related symptoms ("NIMH » Post-Traumatic Stress Disorder", 2018).
Cannabis may offer relief from the following symptoms associated with these groups:
In this small sample, a synthetic cannabinoid medication called Nabilone, which is a CB1 and CB2 receptor agonist similar to THC, provided significant relief for military personnel with PTSD who experienced Nightmares, indicating that it shows promise as a clinically-relevant treatment for patients with nightmares and a history of non-response to traditional therapies (Jetly, Heber, Fraser & Boisvert, 2015).
A study published in the Journal of Neuroscience in 2009 demonstrated that CB1 receptor activation in the basolateral amygdala (BSA) by synthetic cannabinoid WIN55,212-2 led to reduced anxiety-related behavior. Researchers noted that this effect was dose-dependent due to the biphasic nature of cannabinoids (Ganon-Elazar & Akirav, 2009). This is relevant to avoidance due to the fact that the BSA has been implicated in social anxiety in rat studies (WANG, ZHAO, LIU & FU, 2014).
The same 2009 study demonstrated that CB1 receptor activation led to reduced anxiety-related behavioral responses as well as decreased corticotropin-releasing hormone levels in the amygdala, which may account for reduced stress responses (Ganon-Elazar & Akirav, 2009).
Cognitive/Mood - CB1 and CB2 receptor activation by synthetic cannabinoid WIN55,212-2 in a rat model of stress induce depression was found to prevent the effects of chronic mild stress. This suggests that enhancing cannabinoid signaling could represent a novel approach to the treatment of cognitive deficits that accompany stress-related depression (Segev, Rubin, Abush, Richter-Levin & Akirav, 2013).
*It is also important to note that not all these studies have not been replicated in humans.
Know Your Dose
In my time as a patient assistant, I have had few experiences more rewarding than helping veterans with PTSD find relief using medical cannabis. These men and women often turned to cannabis as a last resort so it was critical to get them started effectively and safely. Here are a few tips:
- Patients suffering from PTSD are often on many different medications which could potentially interact with cannabis. It is important to consult a physician before beginning a cannabis regimen to mitigate any potential contraindications.
- Dosing is absolutely critical. Cannabis is biphasic meaning at lower doses it can alleviate anxiety but higher doses can anxiety. Use products that are accurately dosed and easily measured.
- Products that contain the terpene linalool work great for anxiety as well as sleep due to its anxiolytic and anesthetic properties. I recommend the strain Granddaddy Purple for this reason as low doses relieve stress and higher doses induce sleepiness.
- Edible or sublingual administration provides longer effects which can help keep patients with PTSD in a stable mental state. The sharp onset and offset of inhalation can aggravate mood swings.
The most current updates on the use of cannabis for PTSD can be found here.
Derek Espinoza, Baked Bros Director of Education
Ganon-Elazar, E., & Akirav, I. (2009). Cannabinoid Receptor Activation in the Basolateral Amygdala Blocks the Effects of Stress on the Conditioning and Extinction of Inhibitory Avoidance. Journal Of Neuroscience, 29(36), 11078-11088. doi: 10.1523/jneurosci.1223-09.2009
Girgenti, M., Hare, B., Ghosal, S., & Duman, R. (2017).Molecular and Cellular Effects of Traumatic Stress: Implications for PTSD. Current Psychiatry Reports, 19(11). doi: 10.1007/s11920-017-0841-3
Greer, G., Grob, C., & Halberstadt, A. (2014). PTSD Symptom Reports of Patients Evaluated for the New Mexico Medical Cannabis Program. Journal Of Psychoactive Drugs, 46(1), 73-77. doi: 10.1080/02791072.2013.873843
Jetly, R., Heber, A., Fraser, G., & Boisvert, D. (2015). The efficacy of nabilone, a synthetic cannabinoid, in the treatment of PTSD-associated nightmares: A preliminary randomized, double-blind, placebo-controlled cross-over design study. Psychoneuroendocrinology, 51, 585-588. doi: 10.1016/j.psyneuen.2014.11.002
NIMH » Post-Traumatic Stress Disorder. (2018). Retrieved from https://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-ptsd/index.shtml
Segev, A., Rubin, A., Abush, H., Richter-Levin, G., & Akirav, I. (2013). Cannabinoid Receptor Activation Prevents the Effects of Chronic Mild Stress on Emotional Learning and LTP in a Rat Model of Depression. Neuropsychopharmacology, 39(4), 919-933. doi: 10.1038/npp.2013.292
WANG, Y., ZHAO, S., LIU, X., & FU, Q. (2014). Effects of the medial or basolateral amygdala upon social anxiety and social recognition in mice. TURKISH JOURNAL OF MEDICAL SCIENCES, 44, 353-359. doi: 10.3906/sag-1301-2