Post-Traumatic Stress Disorder (PTSD): Cannabinoids and CBD Research Overview

Post Traumatic Stress Disorder (PTSD) treated with CBD Oil
Post-traumatic stress disorder, most common in war veterans, involves uncontrollable anxiety and flashbacks following a traumatic experience. Studies have shown cannabinoids are effective at lessening the emotional impact of traumatic events and can help patients experience less anxiety and fear and improve their sleep.

Overview of Post-Traumatic Stress Disorder

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, plane 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 Cannabinoids and CBD on Post-Traumatic Stress Disorder

Cannabis has been found to help PTSD patients manage their symptoms13. Two major cannabinoids found in Cannabis, tetrahydrocannabinol (THC) and cannabidiol (CBD), influence the body’s endocannabinoid system, which plays an essential role in maintaining emotional homeostasis and in regulating memory consolidation, retrieval and extension. Cannabinoids found in cannabis 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 processes2. The cannabinoids block the continuous retrieval of the traumatic event, thus enhancing its extension and reducing its associated anxiety1,9,12.

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 not8.

Military veterans use cannabis for coping purposes, especially those whose condition causes difficulties in emotional regulation or stress tolerance11. An improvement in sleep patterns in those who suffering from insomnia or nightmares is another primary motivating factor for cannabis use in PTSD patients2,5,9. The more severe the PTSD symptoms, the more that military veterans desire to use cannabis to cope4,5,6. Preclinical evidence supports CBD as having considerable potential as a treatment for PTSD when it’s administered acutely as symptoms arise rather than chronically3.

There’s 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 memories9. In addition, administering cannabinoids shortly after the exposure to an intensely stressful event can help prevent the development of PTSD-like symptoms7 .

States That Have Approved Medical Cannabis for Post-Traumatic Stress Disorder

Currently, 24 states have approved medical cannabis specifically for the treatment of PTSD. These states include: Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Maine, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, Washington, and West Virginia.

A number of other states will consider allowing medical cannabis 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 cannabis has been recommended by a physician), and Massachusetts (other conditions as determined in writing by a qualifying patient’s physician).

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

Recent Studies on Cannabinoids and CBD’s Effect on Post-Traumatic Stress Disorder

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.
PTSD symptom reports of patients evaluated for the New Mexico Cannabinoids Program.
(http://www.ncbi.nlm.nih.gov/pubmed/24830188)

Evidence from human studies indicates that CBD found in cannabis has considerable potential as a treatment for anxiety disorders.
Cannabidiol as a Potential Treatment for Anxiety Disorders.
(http://www.ncbi.nlm.nih.gov/pubmed/26341731)

A review of published evidence finds that cannabinoids help PTSD patients manage the condition’s three major symptoms (re-experiencing, avoidance and numbing, hyperarousal) and helps improve sleep in those PTSD patients suffering from insomnia and nightmares.     
Use and effects of cannabinoids in military veterans with post traumatic stress disorder.
(http://www.ncbi.nlm.nih.gov/pubmed/26195653)

 

Resources:

  1. 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/.
  2. Betthauser, K., Pilz, J., and Vollmer, L.E. (2015, August). Use and effects of cannabinoids in military veterans with posttraumatic stress disorder. American Journal of Health-System Pharmacy, 72(15), 1279-84.
  3. Blessing E.M., Steenkamp, M.M., Manzanares, J., and Marmar, C.R. (2015, September 4). Cannabidiol as a Potential Treatment for Anxiety Disorders. Neuotherapeutics, Epub ahead of print. Retrieved fromhttp://www.ncbi.nlm.nih.gov/pubmed/26341731.
  4. Boden, M.T., Babson, K.A., Vujanovic, A.A., Short, N.A., and Bonn-Miller, M.O. (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.
  5. Bonn-Miller, M.O., Babson, K.A., and Vandrey, R. (2014, March 1). Using cannabis to help you sleep: heightened frequency of cannabinoids use among those with PTSD. Drug and Alcohol Dependence, 136, 162-5.
  6. Bonn-Miller, M.O., Vujanovic, A.A., and Drescher, K.D. (2011, September). Cannabis use among military veterans after residential treatment for posttraumatic stress disorder. Psychology of Addictive Behavior, 25(3), 485-91.
  7. Campos, A.C., Ferreira, F.R., and Guimaraes, F.S. (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.
  8. Greer, G.R., Grob, C.S., and Halberstadt, A.L. (2014, January-March). PTSD symptom reports of patients evaluated for the New Mexico Cannabinoids Program. Journal of Psychoactive Drugs, 46(1), 73-7.
  9. Passie, T., Emrich, H.M., Karst, M., Brandt, S.D., and Halpern, J.H. (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.
  10. Post-traumatic stress disorder (PTSD). (2014, April 15). Mayo Clinic. Retrieved fromhttp://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/basics/definition/con-20022540.
  11. Potter, C.M., Vujanovic, A.A., Marshall-Verenz, E.C., Bernstein, A., and Bonn-Miller, M.O. (2011, April). Posttraumatic stress and Cannabis use coping motives: the mediating role of distress tolerance. Journal of Anxiety Disorders, 25(3), 437-43.
  12. 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.
  13. 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.
  14. What is Post-traumatic Stress Disorder (PTSD)? (n.d.). National Institute of Mental Health. Retrieved fromhttp://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml.