Cannabis for PTSD?

If you or a loved one are suffering from Posttraumatic stress disorder (PTSD) and you have done some research it would be normal to ask “Can weed help PTSD?” If you google something around PTSD treatments or look at boards online you will hear time and time again how cannabis has helped relieve somebodies psychological and/or emotional suffering. (Marijuana may also help with pain.)

We’ll review a brief into into PTSD, it’s causes and symptoms. Then we will introduce the science of cannabis and cannabinoids to answer whether marijuana can help.

What Is PTSD?

If you or a loved one are suffering from Posttraumatic stress disorder (PTSD) and you have done some research it would be normal to ask “Can weed help PTSD?” If you google something around PTSD treatments or look at boards online you will hear time and time again how cannabis has helped relieve somebody’s psychological and/or emotional suffering. (Marijuana may also help with pain.)

PTSD is a psychiatric disorder occurring in some people who experience and/or witness a single or multiple traumatic events. It has really been become accepted as medical condition since 1980 when it was included  by the American Psychiatric association in the DSM III (Diagnostic and Statistical Manual of Mental Disorders – 3rd addition). as a defined disorder.   The American psychiatric community had become immersed in PTSD since the Vietnam war had brought so many soldiers and their suffering upon return to the US to the forefront of American culture.

Causes of PTSD

The range of such potential trauma is broad and includes viewing or experiencing:

  • rape, sexual violence and threats
  • combat and wars
  • serious accidents/disasters
  • physical and psychological violence and threats
  • shocking/dangerous events and traumas
  • exposure to horrible details of trauma

Who’s at risk of PTSD?

It is important to know that – in 1980 it was not generally believed that PTSD was a common condition but newer data shows that it is much more of a common problem with the lifetime risk of diagnosis being 11%. Everybody is potentially at risk irrelevant of ethnicity, age or culture.

However individuals in the US have different risks based on:

  • gender – with the risk of females being 3 times more than males
  • race – Black, Latino and Native Americans
  • experience in combat
  • childhood trauma
  • having little or no social support after the event
  • a history of mental illness or substance abuse

Symptoms and Diagnosis of PTSD

Those suffering from PTSD continue to have intense psychological effects long after the trauma itself. While not all people who suffer the same trauma develop PTSD but those that do have similar symptoms that fall into four categories and the diagnosis of PTSD in an adult requires that they experience ALL of the following for a minimum of 1 month:

  • At least one re-experiencing symptom e.g. intrusive memories, flashbacks and/or nightmares
  • At least one avoidance symptom of reminders such as places, events, or objects related to the trauma
  • At least two arousal and reactivity symptoms including increased irritability, anger, trouble sleeping and concentrating
  • At least two cognition and mood symptoms e.g. detachment from friends, family and society, loss if interest

Treatment of PTSD

PTSD can be treated with different types of psychotherapy or medication.

Trauma-focused Psychotherapies  are the most highly recommended type of treatment for PTSD as determined by the National Center for PTSD which  focuses on the memory of the traumatic event and its meaning. There are several types including EMDR and CRT (cognitive processing therapy).

Anti-depressant medications have shown to be effective in PTSD for the treatment of anxiety and depression. SSRI’s such as Zoloft (sertraline) and Paxil (paroxetine) are common as well as SNRIs such as Effexor (venlafaxine). Other classes of medications such as MAOI’s like Nardil (phenelzine) and older tricyclic anti-depressants such as Tofranil (imipramine) also have shown efficacy.

More treatments such as meditation, acupuncture and transcranial magnetic stimulation continue to be investigated.

Marijuana as a treatment for PTSD?

Due to the Federal illegality of cannabis – the studies which should have been done to give us better scientific evidence and data for the potential benefits of cannabis use in PTSD has been woefully inadequate. And like the many other purported benefits of marijuana, much of the evidence supporting the benefits of cannabis in humans are anecdotal with the few studies done being observational. Furthermore we know that many of those suffering from PTSD use cannabis to self-mediate reporting improvement in  sleep, anxiety and the hyperarousal state.

In December 2020 the results of a prospective study which for one year assessed PTSD patients every 3 months for their levels of symptoms and functioning in one population that used cannabis and the control group which did not. They found a statistically significant correlation in that those who were using cannabis had over 2.5 times the likelihood of no longer meeting the criteria required to be diagnosed as having PTSD.

As in the case of many other purported benefits of cannabis, much of the supportive evidence in humans has come from anecdotal or case reports as well as observational studies that provide little evidence of a causal connection. For instance, individuals presenting with PTSD characteristics frequently use cannabis in an effort to self-medicate, reporting that the drug diminished anxiety and arousal and enhanced sleep.

Other evidence supporting marijuana – and more specifically THC and CBD can be found.

In one small study of ten people with PTSD a dose of 5mg taken twice daily in addition to their normal treatments showed an improvement in sleep quality and decreased nightmares and other symptoms of PTSD such as hyperarousal. Synthetic THC analogs have shown similar improvements.

Much research is still required to properly assess the efficacy and safety of marijuana and cannabinoids in treating PTSD and related disorders (e.g. anxiety disorders)  other conditions. Many questions remain including dosing, rates of tolerance and addiction, effects on mood, longevity of any potential benefits and racial and gender differences amongst other things.

While significant research in animals points to potential benefits of cannabis and cannabinoids in animal PTSD models, human studies have been small. While we await larger studies we can also look at preclinical studies evaluating the efficacy of cannabis use in the treatment of PTSD which are also supportive of the potential for the use of cannabinoids in the treatment of PTSD.

Summary

The Cannabis plant and its components have promise in the treatment of PTSD.  Ongoing research is required and we suggest that you speak with your physician to discuss the use of cannabis and specific cannabinoids.

Area of future interest include investigating whether cannabis’s anti-inflammatory effects may also be involved in decreasing the ramped up inflammatory process in the brains of PTSD patients. This may be due to activation of cannabinoid receptors (CB2).

 

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