PTSD

Conventional therapy for PTSD consists primarily of psychotherapy, with a focus on cognitive therapy, exposure therapy, and desensitization eye movement and processing (EDMR). Depending on the severity of symptoms, some PTSD patients are also prescribed anti-depressants and anti-anxiety medication.

Global Prevalence Of PTSD

The ‘US National Comorbidity Survey Replication’ estimates the prevalence of lifetime PTSD in America at 6.8%. Within these figures, prevalence of lifetime PTSD in American men is 3.6% and in women 9.7%.

According to a 2019 study published in the European Journal of Pyschotraumatology, the number of adults suffering from PTSD worldwide is estimated at 354 million, with 117 million suffering from so-called comorbid PTSD and major depression. These figures are the result of analyses conducted on people who were victims of war between 1989 and 2015 and who were still alive in 2015. From this meta-analysis, 33% of these PTSD patients were also diagnosed with major depression.

Not every individual who experiences a traumatic event will eventually develop PTSD. One study found that 17% of Iraq veterans eventually developed PTSD, generalized anxiety disorder or depression. Another study estimated that about 25% of children exposed to trauma develop PTSD. Another study in turn concluded that monozygotic (identical) twins are more likely to develop PTSD after experiencing war trauma if one of the twins also suffers from the disorder; indicating a genetic predisposition.

PTSD And Dependence On Certain Substances

Research has found a high rate of substance abuse in PTSD sufferers. In one study in particular, women showed a high rate of PTSD and substance abuse comorbidity, between 30% and 59%. For women within this category, PTSD is usually caused by repeated psychological and sexual assaults during childhood.  With men, the comorbidity rate is two to three times lower and the cause in most cases has to do with trauma related to fighting or violence.

Another small-scale study of 91 participants attending a substance abuse program found that up to 52.8% of participants had some form of PTSD. While 37.4% were considered PTSD patients, the remaining 15.4% were determined to have possible PTSD.

Whether cannabis can really be seen as a possible treatment for PTSD remains a question mark since people suffering from this disorder seek comfort in these substances and it is therefore difficult to ascertain whether it is also effective medication.

Although there has been a great deal of research into the use of certain substances by people suffering from PTSD, research into the effect of cannabis as a treatment is fairly scarce.  Until fairly recently, the general consensus within the medical community was that PTSD was a contributing factor in cannabis use disorders, and little research has been done on the brain mechanisms by which such disorders develop.

The Role Of The Endocannabinoid System In PTSD

In recent years, the complex structure of the endocannabinoid system has been increasingly understood, bringing the role it plays in regulating the symptoms of PTSD and other similar disorders into focus. An article published in 2012 noted that stress-tolerant individuals exposed to acute stress elicited during a parabolic flight experiment showed significantly elevated plasma endocannabinoid concentrations.

Non-stress tolerant individuals experienced no increase, even though these individuals were healthy and not suffering from any form of chronic stress disorder. PTSD (and other chronic stress) patients, on the other hand, consistently showed increased levels of endocannabinoid concentrations compared to non-patients, even in normal, non-stressful situations. This indicates that the endocannabinoid system does play a role in the response to stress, but how exactly the mechanism works is still unclear.

Interestingly, in another 2015 article published in Nature Reviews Neuroscience, researchers looked at the role of the endocannabinoid system in processing anxiety-related memories from different angles. The study suggests that “repeated exposure to a fear-related stimulus in the presence of the threat causes markedly increased activity of the endocannabinoid system.” The researchers claim that these incessant signals from the endocannabinoid system may lead to the elimination of the fear response.

This research shows a possible biological indication for diagnosing PTSD, which, in most cases, is currently still determined through a questionnaire. While the study itself does not refer specifically to PTSD, it does refer to the psychological phenomenon that supports PTSD: the repeated fear response in the absence of a threat.  

Genetic Phenotype Of CB Receptors Increase Predisposition For PTSD

Another 2012 study by Alexander Neumeister supports the findings from the Nature Review Neuroscience study mentioned above. The article describes the role of the CB1 receptor in the experience and memory of stressful events. Normal responses of the endocannabinoid system through the receptor help to remove anxiety and reduced responses of the system are then associated with failure to erase these traumatic memories. This has also been linked to chronic anxiety and depression (in animal trials).

The article also noted that people started using existing medications for PTSD rather “as a leap of faith” after their benefits were discovered and that these medications were originally developed for other conditions. However, often such medications have limited efficacy and are also accompanied by a lot of serious side effects.

In general, we see a common thread within the academic literature when it comes to the link between endocannabinoid responses, processing anxiety and the development of PTSD. Although PTSD can only be caused by the occurrence of a traumatic event (without trauma the disorder is not named as PTSD), there can also be a genetic predisposition to the disorder.

THC And Nabilone As Possible Treatments

Neumeister concluded in his research that THC may provide temporary relief from PTSD symptoms, but long-term use may lead to worsening of the CB1 receptor response. This, in turn, can lead to increased severity of anxiety, irritability and sleep disturbance in PTSD patients.

A 2009 study also examined the efficacy of synthetic cannabinoids as a complementary treatment for PTSD. A complementary therapy is one that is prescribed in addition to the primary medication. In this case, the primary medications were antidepressants and hypnosis sessions and the synthetic cannabinoid used was Nabilone. The study found that 72% of patients experienced no or fewer nightmares, improved sleep time and sleep quality, and fewer flashbacks were observed during the day.

While the results of this study are promising, due to the small scale of the study (in only 47 individuals), further research into the efficacy of Nabilone is needed. As there is an ever-increasing and rapidly growing interest in the use of cannabinoids as a treatment for PTSD, we will undoubtedly see new results from further research in the future.

Other Ways For Cannabis To Alleviate Symptoms Of PTSD

As far as our current understanding of PTSD goes, there is no pharmacological way to cure PTSD because of the nature of the condition. It is acquired from a trauma, and there is no known pharmacological treatment to “undo” a trauma. This is why treatment typically includes managing symptoms of anxiety, insomnia, depression and flashbacks. While cannabis may not technically cure, or even contribute to a cure for PTSD, it has properties that may help with symptoms.

Cannabis Can Have Anxiolytic Effects

While the anxiolytic effects of THC have been questioned several times in recent years, there is a general consensus among scientific academics that mainly CBD possesses anxiolytic effects. For certain individuals, THC is also able to reduce anxiety symptoms.

One of the main symptoms of PTSD is anxiety and it is often one of the symptoms that can be treated with medication. A 2011 study on mice concluded that excessive triggering of CB2 receptors reduced anxiety-related behavior and also caused an increase in gamma-aminobutyric acid (GABA) in the hippocampus and hypothalamus.

During another study (in vivo, on humans), they observed reduced levels of the endogenous cannabinoid andandamide in individuals suffering from PTSD. Consumption of CBD is thought to increase serum levels of anandamide by inhibiting FAAH, the enzyme responsible for the breakdown of anandamide. This is one of the mechanisms caused by CBD which is thought to have anxiolytic and anti-depressant effects.

Cannabis Is Neuroprotective

The understanding of PTSD within neuroscience is still in its infancy, but scientists are continuously searching for reliable biomarkers for the disorder. Of course, and as mentioned before, endocannabinoid responses show promising potential. In this 2018 study, Graziano Pinna discusses the role of neurotransmitters in cases of PTSD and the possibility of using neurology as a form of PTSD treatment.

In essence, Pinna suggests that certain chemical processes in the brain that contribute to neuroprotection could play an important role in regulating cognitive processes and emotional behavior. Although we are only at the beginning of the study of how neuroprotection affects human behavior and emotions, this is something intuitive to the field of research.

The phytocannabinoids THC and CBD have shown their neuroprotective effects, including the ability to stimulate neurogenesis, countless times during academic research. While it is not clear how neuroprotection can alleviate the symptoms of PTSD, a connection between the two has been made.

Cannabis Could Help Against Insomnia And Reducing Nightmares 

As mentioned earlier in this article, many PTSD patients experience nightmares that are resistant to treatment. In the study we referenced earlier, patients who suffered from nightmares showed a positive response to Nabilone; a synthetic cannabinoid.

How exactly THC and CBD can reduce nightmares is not yet known, but it is generally known that THC reduces sleep latency. Because of this function, it could help PTSD patients by providing them with sleep and a more or less dreamless night. By reducing sleep latency, the REM sleep is either skipped or shortened to such an extent that nightmares do not stand a chance.

There still needs to be done a lot of research to better understand PTSD as a disorder and also to determine the extent to which cannabis can be used as a treatment. There is some controversy surrounding cannabis as a treatment for PTSD since it is not a treatment per se but rather a complementary therapy aimed at relieving symptoms.

Despite the current controversy regarding the efficacy of medical cannabis as a treatment for PTSD, the Medical Cannabis Advisory Board recommends that PTSD be kept on the list of conditions qualified for prescriptions for use by potential cannabis users. And we would like to add that the Blue Dreams strain is a good place to start with if you want to try this method for yourself.

PTSD | Frequently Asked Questions