Medical Cannabis And PTSD
When people think of Post Traumatic Stress Disorder (PTSD), they often think of veterans. While our armed forces develop PTSD at a higher rate than others, PTSD is not something that only Vets experience.
PTSD is a mental health condition that affects millions of Australians. The only ‘requirement’ for an individual to get PTSD is exposure to a traumatic event. Research shows that about 12% of Australians develop PTSD in their lifetime, and approximately 25% of people exposed to traumatic events develop the condition. Women are more prone to developing PTSD and the condition can appear at any age.
Prior to diagnosis and treatment, individuals with this mental health disorder often struggle to get through daily life and experience anxiety, depression and, at times, extreme traumatic memories. Treatment for many PTSD patients is therapy often alongside a cocktail of prescribed medications.
Many individuals suffering from PTSD experience negative side effects from their treatment. While finding relief from some of the symptoms of their condition, patients may find themselves distant from others and turning to forms of self-medication such as drinking or abusing their medication to find further relief.
For decades, individuals with PTSD have recounted how cannabis has helped with some of the symptoms of PTSD. In the past decade, more research has been done on cannabis and PTSD and the results have shown great promise.
Cannabis is also prescribed to treat anxiety, depression and insomnia which are often comorbidities of PTSD. In this article, Dr Matty Moore discusses traditional treatments for PTSD and the benefits and side effects of cannabis for PTSD.
If you’d like to jump ahead, here’s what Dr Matty Moore covers:
- 00:16 | What is PTSD?
- 01:40 | What are some signs of PTSD?
- 02:27 | When should individuals seek a doctor’s help for PTSD?
- 02:50 | How is PTSD diagnosed?
- 03:49 | Can cannabis help treat PTSD?
- 04:33 | Can CBD or CBD oil help treat PTSD?
- 05:04 | Can THC help treat PTSD?
- 05:50 | Are there side effects specific to cannabis and PTSD?
- 06:38 | What type of cannabis is normally prescribed for PTSD?
- 08:22 | Will cannabis remove the need for all other medications for PTSD symptoms?
- 09:07 | Is there a typical dosage of cannabis for treating PTSD?
- 10:00 | What are the traditional treatments for PTSD?
- 12:13 | What are some of the side effects of traditional PTSD treatments?
- 13:05 | What does the research say about cannabis and PTSD?
What is PTSD?
According to the DSM-5 (a diagnostic manual for mental health conditions), PTSD is defined as; a debilitating stressor induced mental illness resulting from changes in the brain that developed from exposure to a life-threatening or traumatic event. Changes in the brain cause an inability to inhibit fear.
Individuals with PTSD experience fear and anxiety in both similar scenarios as the original event but also in completely different scenarios that trigger the brain to re-experience the original event. Re-experiencing trauma then puts the patient into a cycle of panic, fear and anxiety again which inevitably impact the individual’s life and overall well being.
What are some signs of PTSD?
PTSD often presents as anxiety but in a heightened form and centred around a specific memory or traumatic event.
The anxiety, hyper-arousal and memories often cause sleep disturbances, nightmares or insomnia, day time sleepiness and even panic attacks. Symptoms typically appear quite suddenly and illicit a fear or anger response in order for the patient to protect themselves. Often, the patient isn’t aware of what’s caused or triggered the emotions.
These emotional and mental attacks can create situations where the individual isn’t comfortable being around others or participating in everyday activities. PTSD and the comorbidities like anxiety, depression and insomnia often have a major impact on quality of life.
When should individuals seek a doctor’s help for PTSD?
PTSD symptoms include distressing memories, dreams, negative changes in mood and hyper anxiety or hyperarousal and avoidance of certain stimuli and association with a distressing event.
If you’re noticing any of these symptoms or other pains or medical concerns impacting your quality of life, it’s time to speak with your doctor.
How is PTSD diagnosed?
PTSD is diagnosed by using the DSM-5 framework and checklist.
The diagnostic criteria for PTSD includes:
- A stressor – exposure to a distressing or traumatic event
- Intrusion symptoms – the traumatic event is persistently re-experienced in some way
- Avoidance – avoiding the stimuli
- Negative alterations in cognitions and mood – negative thoughts or feelings that began or worsened after the trauma
- Alterations in arousal and reactivity – trauma-related arousal and reactivity that began or worsened after the trauma
These symptoms must have lasted for more than one month, creation distress or functional impairment and not be explained by or due to other medications, substance use, or other illness
Can cannabis help treat PTSD?
Yes, in many cases. From observational studies and anecdotal evidence we know that cannabis, both CBD and THC, may help patients improve PTSD symptoms.
Research has shown that we have an internal system called the Endocannabinoid system which helps the regulation of mood, anxiety and extinction of fear learning. The endocannabinoid system uses cannabinoids to help balance and control emotions.
A legitimate and potential cause of PTSD is that the condition stems from a problem with one of our bodies’ own internal cannabinoids (endocannabinoids) called Anandamide. Anandamide is also known as the bliss molecule because it can help with positive emotions. External cannabinoids, in this case from cannabis, can help stimulate the same receptors as Anandamide resulting in fear and anxiety decreasing, mood lifting and relief from hyper-arousal and hyper-stimulation and intrusive memories.
Can CBD or CBD oil treat PTSD?
CBD and CBD oil can help with some of the symptoms of PTSD. CBD, without THC, can help by reducing anxiety, disrupt fear memories and help REM sleep. CBD works by interacting indirectly with the CB2, dopamine and serotonin receptors.
CBD doesn’t actually increase serotonin or dopamine. It is a regulator that helps your body use chemicals that are there more efficiently or break chemicals down more slowly. Through interaction with certain brain pleasure centres, in particular the area that stimulates anandamide, scientists believe that CBD helps with serotonin and dopamine production and regulation.
Can THC help treat PTSD?
Yes, THC can help treat symptoms of PTSD. Anandamide is an internal cannabinoid (endocannabinoid) that helps send signals throughout the brain and body. It’s also known as the bliss molecule. Anandamide affects areas of the brain that influence concentration, coordination, memory, pleasure and more.
THC has a similar chemical structure as Anandamide and can help produce the same chemical outcomes as Anandamide. By acting on the cannabinoid receptors and regulating memory and memory retrieval, THC can lower anxiety, increase relaxation, improve sleep and most importantly decrease physical and emotional response to flashback memories.
Are there side effects specific to cannabis and PTSD?
There are no specific side effects for cannabis and PTSD, however cannabis may have potential side effects.
While THC can be great at helping improve sleep and reducing anxiety, taking too much THC can have negative impacts on sleep and increase anxiety. Other side effects include dry mouth, changes in cognition, dizziness, and fatigue.
CBD while usually very well tolerated can have minor side effects. At very high doses, some of the reported side effects of CBD are:
- Abnormal results on liver-function tests
Other known side effects are
- Dry mouth
- Low blood pressure
- Low appetite
- Weight loss
Most symptoms of CBD dissipate as you find your correct dosage over the course of the first month.
What type of cannabis is normally prescribed for PTSD?
Each patient is different and so there isn’t a specific cannabis medication that’s prescribed for PTSD patients. Dr Matty Moore, however, said
Because of the faulty Anandamide signalling in PTSD, regardless of delivery method chosen, there should be a moderate amount of THC in the patient’s medication.
He reiterated the fact that studies have shown that THC can help decrease PTSD symptoms and has a positive effect on sleep.
With regard to treatment methodology, Dr Matty Moore said that he’d normally start with a cannabis oil because of its long duration of action and providing a strong baseline relief that will last throughout the day. Oils are also very easy to titrate up and are generally well tolerated.
He also said that if a patient had acute episodes of anxiety or periods where the patient was reliving trauma, flower or a mucosal spray could be added in. These two methods have a faster onset than oil but a shorter duration of action.
Will cannabis remove the need for other medications for PTSD symptoms?
Maybe. There is no specific answer to this question because cannabis works differently for everyone, and in some cases doesn’t work at all. Dr Matty Moore said that a guiding principal for any medical management plan is that less is more if you’re getting relief.
A doctor that’s experienced with cannabis medicine may be able to help you move on to cannabinoid medicine and titrate off of other traditional medications. Some patients may respond well to this and others won’t. These are the discussions that your doctor should be able and willing to have with you.
Dr Matty Moore also said
It’s important that our patients don’t have false expectations. There’s always a chance with any medication, including cannabis, that it may not be beneficial or get us the outcomes we want.
Is there a typical dosage of cannabis for treating PTSD?
No. Every patient is different because everyone’s experiences and physiology is unique.
The mantra for all medical cannabis treatment is ‘start low and go slow’. The goal is to find the minimal amount of cannabis that’s effective with few to no side effects.
Patients who are cannabis naive, or have not consumed cannabis before, are likely to be started on a CBD only product at a very low volume of CBD. If your body is used to having cannabinoids then it’s likely you’ll need more medication to get the results you need. Patients who have consumed cannabis in the past or are regular consumers may start on a CBD and THC medication and generally start at a higher dosage.
While many doctors will start all naive patients with a CBD only product, Dr Matty Moore starts all PTSD patients with a balanced CBD-THC product. “The difference is that, with those who are cannabis naive, I start at an even lower dose.”
What are the traditional treatments for PTSD?
Traditional treatment of PTSD includes both therapy and pharmacological medications.
Therapies can include Trauma Focussed Cognitive Behavioural Training (TFCBT), Eye Movement Desensitisation and Reprocessing (EMDR), and Exposure Therapy (ET).
TFCBT is a variant of CBT (Cognitive Behaviour Therapy) that helps patients come to terms with trauma by changing the way they act or think about it. EMDR helps individuals process trauma by thinking of beliefs, images and sensations while the therapist guides their eye movements from side to side. EMDR seems to have good success. While there’s little science behind it, researchers think that it connects the left and right brain, allowing patients to put the trauma behind them.
ET is a form of extinction learning where the patient is repeatedly exposed to trauma-related stimuli to promote tolerance without causing fear.
Each of these can be effective but can depend on the patient’s engagement, participation and follow-through similar to any treatment.
First-line pharmacological treatments include antidepressants like Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs). These medications affect serotonin and noradrenaline, which are neurotransmitters involved with anxiety and depression.
Second-line and third-line therapies include Monoamine Oxidase Inhibitors (MAOIs), Tricyclic Antidepressants (TCAs), atypical antipsychotics, anticonvulsants and benzodiazepines (Valium or Tamazapam).
For veterans, many of these treatments may not necessarily be that effective. Research from 2006 showed that war veterans were prone to be more resistant to pharmacotherapy than other patients.
What are some of the side effects of traditional PTSD treatments?
There are very few side effects for the different therapies mentioned. Patients may have different experiences and for some, they may not work. It’s the pharmacological treatments that have side effects.
SSRIs and SNRIs can make depression worse and for some, they can worsen suicidal ideation. MAOIs can cause dry mouth, nausea, constipation, headache, and dizziness. When these drugs are combined with other medications, they can have interactions that can be life-threatening.
TCAs can cause drowsiness, blurred vision, constipation, dry mouth and drops in blood pressure. They can also impact urinary retention.
The unfortunate thing is that PTSD patients are often prescribed multiple medications which further increases their risks of side effects and drug to drug interactions.
The interesting thing is that while many of these drugs can have very bad and even life-threatening side effects, cannabis is very mild comparatively. So, for patients who have tried other treatments, cannabis can be a great other option.
What does the research say about cannabis and PTSD?
Formal medical cannabis research is still in its infancy even though cannabis has been used as medicine for thousands of years. Most of the research has happened in the last 20 years.
A study from January 2015 in the journal of Psychoneuroendocrinology showed that military personnel showed an improvement in 50% of the subjects treated with cannabinoids versus 11% of the placebo-treated subjects.
A study from December of 2018, in The Journal of Alternative and Complementary Medicine showed that 91% of the patients treated with CBD showed an improvement in symptoms, including a decrease in nightmares. While the sample size was only 11 people, the results are promising.
In 2014 in the Journal of Clinical Psychopharmacology, a study of 104 inmates of a mental health correctional facility were given synthetic THC for their conditions which included PTSD.
The results were that a majority of patients showed improvement in PTSD symptoms and many of their other medications were discontinued. The report stated that “Nabilone [THC] holds promise as an agent in the treatment of PTSD-related insomnia and nightmares and is an effective treatment for chronic pain.”
Finally, a study from 2009 in the journal of CNS Neuroscience and Therapeutics looked at 47 treatment refractory PTSD patients. The study showed that 72% of the patients experienced cessation of nightmares, had significant improvement in sleep time and quality and a reduction in daytime flashbacks.
While this is all great information, it’s not enough for doctors and regulators to trust in the benefits of cannabis. Researchers will need to continue working with cannabis and patients can help by looking into clinical trials for their conditions.