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Exploring the cannabis-PTSD connection

An estimated 70% of Americans will have a traumatic experience at some point in their lives. Of those, one in five will develop post-traumatic stress disorder (PTSD). At any given time, 13 million Americans live with PTSD, for which there are little existing treatment options beyond cognitive therapy and antidepressant medication. While this condition is typically associated with military veterans, anyone who experiences a traumatic event may develop PTSD.

Unfortunately, one-third of people diagnosed with PTSD do not significantly recover, even after years of current therapies. However, early research suggests that cannabis may be an option for those who live with the condition. Here’s how it works.

What is PTSD?

Post-traumatic stress disorder is a psychiatric disorder stemming from one or more traumatic events and characterized by a variety of symptoms, such as hyperarousal, anxiety, depressive symptoms, and insomnia1.

Emotional memory processing is a natural, evolutionary development in humans, which serves to prevent memories that elicit a strong emotional response from being forgotten. Under typical circumstances, this is key to survival; a traumatic memory is less likely to be forgotten, which teaches us to avoid or defend ourselves against that happenstance in the future.

However, for people living with PTSD, this survival mechanism becomes harmful instead of helpful2. Rather than helping a person avoid danger, the fight-or-flight response could be triggered in situations that are otherwise safe. 

PTSD is marked by three distinct categories of symptoms:

  • Persistent re-experience of the traumatic event: Often referred to as “flashbacks,” these sudden, vivid memories of traumatic events interrupt day to day life. Re-experience of trauma might also result in negative impacts to mood and self-image.

  • Consistently on high alert: PTSD patients might exhibit a highly alert state, called heightened arousal, even when there is no apparent danger. This is marked by anxiety responses, increased heart rate, irritability, and difficulty concentrating.

  • Avoiding triggering sounds, sights, smells, or events: Many PTSD patients exhibit avoidance of stimuli that could recall traumatic events. 

People living with PTSD may experience anxiety, depression, panic attacks, and vivid nightmares, in addition to the above symptoms.

While treatments for PTSD vary, a 2013 study published in Frontiers in Behavioral Neuroscience suggests  that “an ideal treatment would be a drug able to block the pathological over-consolidation and continuous retrieval of the traumatic event, while enhancing its extinction and reducing anxiety symptoms.” Research is ongoing into whether cannabis could be just the thing to achieve that goal.

How cannabis impacts PTSD

Some PTSD patients have turned to cannabis to cope with symptoms related to PTSD, including insomnia and anxiety. One clinical case report found a vast improvement in a patient with PTSD after he began consuming a balanced THC:CBD cannabis resin; incidences of intrusive flashbacks subsided, impulsive self-mutilation was significantly reduced, and the patient noted more self-control3. While his therapists were unaware of his cannabis consumption, they nonetheless noted the behavioral improvements.

However, it remains unclear to researchers whether cannabis is effective as a therapy for PTSD or simply alleviates certain symptoms associated with PTSD, such as anxiety responses. The potential of cannabis as a therapeutic agent for treatment of PTSD is a new and developing area of research.

So far, researchers have observed the influence cannabis has on endocannabinoid signaling in the brain. The endocannabinoid system has receptors throughout the body, with a large cluster in the brain. Two types of receptors, CB1 and CB2 receptors, can be found in the regions of the brain responsible for governing emotion and memory processing. Phytocannabinoids found in cannabis interact with the ECS in a similar manner as the endocannabinoids produced by the body. The interactions between phytocannabinoids and the ECS could explain why many PTSD patients find relief from consuming cannabis products. 

For example, researchers believe THC alters how the brain processes memories. THC appears to influence the sleep cycle and the brain’s ability to enter REM sleep, where memories are consolidated. Additionally, there is some evidence that phytocannabinoids could modulate neurotransmission associated with anxiety, a central symptom of PTSD4. Anxiety responses are particularly less common when THC and CBD levels are roughly equal in a cannabis product. 

However, it is important to note that high levels of THC sometimes elicit an anxiety response, which could be harmful to a person living with PTSD. THC causes an elevated heart rate in some consumers, which could be perceived as an oncoming panic attack that then triggers a genuine panic attack. It is important to proceed with caution and consult with a healthcare professional before using cannabis to treat PTSD symptoms.

What does the research say about cannabis and PTSD?

While the science regarding cannabis and PTSD is still emerging, what we know so far offers an insightful glimpse into how cannabinoid medicine can help those living with the disorder. Here’s a look at what researchers have uncovered so far:

  • A 2014 study found that a large sample of combat-exposed U.S. veterans who used cannabis at least once per week reported relief from a long list of symptoms, including: intrusive symptoms like flashbacks, nightmares, and disturbing thoughts; avoidance symptoms, such as an aversion to stimuli somehow associated with the trauma; and emotional symptoms, such as a tendency to feel numb or distant5.

  • A 2014 open-label pilot study of 10 outpatients with chronic PTSD found that 5mg of THC twice per day led to an improvement in sleep quality and a reduction in nightmares6. Side effects observed in this study included headaches, dizziness, and dry mouth.

  • A 2019 retrospective open-label study found that oral administration of CBD for 8 weeks resulted in a significant reduction in PTSD severity and intensity7. Additionally, researchers noted that CBD was well tolerated and none of the patients involved in the study discontinued treatment due to its side-effects.

The early research into cannabis and PTSD suggest a link between emotional memory processing and the ECS. However, the precise nature of this relationship remains to be fully understood. 

How is a cannabis therapy for PTSD determined?

Many states have already included PTSD on the list of eligible conditions to receive medical cannabis. If you’re considering a cannabis-based therapy for PTSD, consult with your healthcare professional for a specialized treatment plan. Keep in mind:

  • PTSD and associated symptoms are often highly personalized and can vary on a case by case basis.
  • Many factors, such as the amount of cannabis you consume, the environment you’re in, and your current circumstances can influence the consumption experience of cannabis, particularly as it relates to anxiety.
  • Start low and go slow. Consumption of cannabis should be gradual and measured to determine the right amount for you.

  • Keep a journal of how you feel before, during, and after consumption. Track how these feelings change over time and be sure to note external context for reference, such as where you were, what you were doing, or who you were with.

Cannabis and PTSD: new but promising

Cannabinoid-based therapies for PTSD are still a young, developing field of study. Researchers around the globe are focusing efforts into learning more about the PTSD-cannabis connection to help improve the lives of millions, including our veterans, who live with the disorder. As our knowledge of this connection deepens, we at Ethos are here to share this emerging information and help you explore how cannabis might be right for you.

Sources

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780141/pdf/medicina-55-00525.pdf
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3739026/pdf/fnbeh-07-00100.pdf
  3. https://dochub.com/adam-uzialko/7vA0q9lw2jQy8ykwPDNOxd/mitigation-of-post-traumatic-stress-symptoms-by-cannabis-resin-a-review-of-the-cl?pg=2
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808114/pdf/nihms518943.pdf
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780141/pdf/medicina-55-00525.pdf#page=12&zoom=100,101,784
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780141/pdf/medicina-55-00525.pdf#page=13&zoom=100,101,904
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780141/pdf/medicina-55-00525.pdf#page=13&zoom=100,101,250
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