PTSD and Cannabidiol

Post-Traumatic Stress Disorder (PTSD) Ė Medical Marijuana Research Overview

21 September, 2015
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Post-traumatic stress disorder, most common in war veterans, involves uncontrollable anxiety and flashbacks following a traumatic experience. Studies have shown marijuana is effective at lessening the emotional impact of traumatic events and can help patients experience less anxiety and fear and improve their sleep.

Overview of PTSD

Post-traumatic stress disorder (PTSD) is a mental condition that develops after experiencing or witnessing a traumatic event. Those suffering from PTSD experience flashbacks, severe anxiety, nightmares, and uncontrollable thoughts about the event, according to Mayo Clinic. They often feel stressed and in danger when no real threat exists. According to the National Institute of Mental Health, other symptoms of PTSD include staying away from places or events that are reminders of the traumatic experience, feeling numbness or guilt, losing interest in former enjoyable activities, being easily startled, feeling tense, having problems sleeping and experiencing angry outbursts.

PTSD is prevalent in military veterans, but can develop following any type of traumatic event, such as a mugging, kidnapping, car accident plant crash, physical attack or natural disaster.

Currently, PTSD is commonly treated with psychotherapy efforts that include exposure therapy, which exposes patients to trauma they experienced but in a safe way, cognitive restructuring, which helps patients make sense of the bad memories, and stress inoculation training, which teaches patients how to reduce their anxiety. Antidepressant medications are often prescribed to help curtail feelings of sadness, anger, worry and numbness. These medications can sometimes have side effects like headache, nausea, sleeplessness or drowsiness, agitation and sexual problems.

Findings: Effects of Cannabis on PTSD

Cannabis has been found to help PTSD patients manage their symptoms (Walsh, et al., 2016). Two major cannabinoids found in marijuana, tetrahydrocannabinol (THC) and cannabidiol (CBD), influence the bodyís endocannabinoid system, which plays an essential role in maintaining emotional homeostasis and in regulating memory consolidation, retrieval and extension. Cannabinoids found in marijuana activate the cannabinoid receptors (CB1 and CB2) of the endocannabinoid system, which in turn modulates the release of neurotransmitter and produces a wide range of effects on the central nervous system, including an increase in pleasure and the alternation of memory processes (Betthauser, Piilz, Vollmer, 2015). The cannabinoids block the continuous retrieval of the traumatic event, thus enhancing its extension and reducing its associated anxiety (Akirav, 2013) (Trezza & Campolongo, 2013) (Passie, et al., 2012).

These effects help PTSD patients manage the three core symptoms of the condition, which include re-experiencing, avoidance and numbing, and hyperarousal. PTSD patients saw a 75% reduction in PTSD symptoms, as measured by the Clinical Administered Post-traumatic Scale, when they were using cannabis compared to when they were not (Greer, Grob & Halberstadt, 2014).

Military veterans use cannabis for coping purposes, especially those whose condition causes difficulties in emotional regulation or stress tolerance (Potter, et al., 2011). An improvement in sleep patterns in those who suffering from insomnia or nightmares is another primary motivating factor for cannabis use in PTSD patients (Betthauser, Piilz, Vollmer, 2015) (Bonn-Miller, Babson & Vandrey, 2014) (Passie, et al., 2012). The more severe the PTSD symptoms, the more that military veterans desire to use cannabis to cope (Boden, et al., 2013) (Bonn-Miller, Vujanovic & Drescher, 2011) (Bonn-Miller, Babson & Vandrey, 2014). Preclinical evidence supports CBD as having considerable potential as a treatment for PTSD when itís administered acutely as symptoms arise rather than chronically (Blessing, Steenkamp, Manzanares & Marmar, 2015).

Thereís evidence to suggest, however, that the benefits of cannabis for PTSD patients go beyond temporary. Findings support that cannabis has the potential to dampen the strength and emotional impact of traumatic memories (Passie, et al., 2012). In addition, administering cannabinoids shortly after the exposure to an intensely stressful event can help prevent the development of PTSD-like symptoms (Campos, Ferreira & Guimaraes, 2012).

States That Have Approved Medical Marijuana for PTSD

Currently, 20 states have approved medical marijuana specifically for the treatment of PTSD. These states include: Arizona, Arkansas, Connecticut, Delaware, Florida, Hawaii, Illinois, Maine, Michigan, Minnesota, Montana, Nevada, New Mexico, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island and Washington.

A number of other states will consider allowing medical marijuana to be used for the treatment of other conditions, including PTSD, with the recommendation by a physician. These states include: California (any debilitating illness where the medical use of marijuana has been recommended by a physician), and Massachusetts (other conditions as determined in writing by a qualifying patientís physician).

In Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment.

Recent Studies on Cannabisí effect on PTSD

References

Akirav, I. (2013). Targeting the endocannabinoid system to treat haunting traumatic memories. Frontiers in Behavioral Neuroscience, 7, 124. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776936/.

Betthauser, K., Pilz, J., and Vollmer, LE. (2015, August). Use and effects of cannabinoids in military veterans with posttraumatic stress disorder. American Journal of Health-System Pharmacy, 72(15), 1279-84.

Blessing EM., Steenkamp, MM., Manzanares, J., and Marmar, CR. (2015, September 4). Cannabidiol as a Potential Treatment for Anxiety Disorders. Neuotherapeutics, Epub ahead of print. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26341731.

Boden, MT., Babson, KA., Vujanovic, AA., Short, NA., and Bonn-Miller, MO. (2013, May-June). Post-traumatic stress disorder and cannabis use characteristics among military veterans with cannabis dependence. The American Journal on Addictions, 22(3), 277-84.

Bonn-Miller, MO., Babson, KA., and Vandrey, R. (2014, March 1). Using cannabis to help you sleep: heightened frequency of medical cannabis use among those with PTSD. Drug and Alcohol Dependence, 136, 162-5.

Bonn-Miller, MO, Vujanovic, AA., and Drescher, KD. (2011, September). Cannabis use among military veterans after residential treatment for posttraumatic stress disorder. Psychology of Addictive Behavior, 25(3), 485-91.

Campos, AC., Ferreira, FR., and Guimaraes, FS. (2012, November). Cannabidiol blocks long-lasting behavioral consequences of predator threat stress: possible involvement of 5Ht1A receptors. Journal of Psychiatric Research, 46(11), 1501-10.

Greer, GR., Grob, CS., and Halberstadt, AL. (2014, January-March). PTSD symptom reports of patients evaluated for the New Mexico Medical Cannabis Program. Journal of Psychoactive Drugs, 46(1), 73-7.

Passie, T., Emrich, HM., Karst, M., Brandt, SD. and Halpern, JH. (2012, July-August). Mitigation of post-traumatic stress symptoms by Cannabis resin: a review of the clinical and neurobiological evidence, Drug Testing and Analysis, 4(7-8), 649-59.

Post-traumatic stress disorder (PTSD). (2014, April 15). Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/basics/definition/con-20022540.

Potter, CM., Vujanovic, AA., Marshall-Verenz, EC., Bernstein, A., and Bonn-Miller, MO. (2011, April). Posttraumatic stress and marijuana use coping motives: the mediating role of distress tolerance. Journal of Anxiety Disorders, 25(3), 437-43.

Trezza, V., and Campolongo, P. (2013, August 9). The endocannabinoid system as a possible target to treat both the cognitive and emotional features of post-traumatic stress disorder (PTSD). Frontiers in Behavioral Neuroscience, 7, 100.

Walsh, Z., Gonzalez, R., Crosby, K., S Thiessmen, M., Carroll, C., and Bonn-Miller, M.O. (2016, October 12). Medical cannabis and mental health: A guided systematic review. Clinical Psychology Review, 51, 15-29.

What is Post-traumatic Stress Disorder (PTSD)? (n.d.). National Institute of Mental Health. Retrieved from http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml.

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