Post-Traumatic Stress Disorder (PTSD) & Medical Cannabis

Post-Traumatic Stress Disorder (PTSD) and Medical Cannabis

Definition

PTSD is a condition where an extremely traumatic, stressful, distressing or frightening experience is relived. Nightmares, flashbacks, feelings of isolation, guilt, irritability, anxiety and depression are common symptoms. PTSD is often – but not always – grouped with anxiety disorders.

Potential Efficacy / Quality of Evidence (Low, Average, High)

Average

Cannabinoids, Terpenes/Terpenoids, Strains and Ratios that May Help

THC, CBD, CBG and CBN may be of particular use.

Limonene, linalool, bisabolol, myrcene, beta-caryophyllene and humulene may be helpful.

Pros

Terpenes such as linalool, beta-caryophyllene and limonene may help beat stress and anxiety.

CBD may improve regional cerebral blood flow (rCBF) in the brain, helping reduce anxiety and increasing the amount of important hormones and nutrients move through the brain.

May help keep the mind off of reliving traumatic experiences.

Terpenes like pinene can help prevent hyperventilation.

May help promote sleep and a night’s rest, with fewer sleep disturbances and nightmares.

Unfortunately, sometimes even drugs that have no proven efficacy for PTSD (e.g. benzodiazepines, antipsychotics) are still prescribed. Cannabinoids may help replace these substances, and may actually work rather than causing harm!

Cons

Take care with using THC – too high a dose may increase anxiety and heart rate.

Can cause an initial increase in heart rate.

Can cause or increase the feeling of depersonalization.

Care must be taken with regards to dosage – too much THC may prompt an anxiety attack.

More About the Condition

PTSD is often put under the umbrella of “anxiety disorders”, although nowadays it is often given its own separate section in some mental health manuals. There are many similarities with anxiety disorders, in that there are abnormal levels of norepinephrine and cortisol (usually low levels of both) in the blood in comparison to those without PTSD.

Whilst antidepressants may prove effective for PTSD, there do seem to be some marked differences in terms of how biochemical changes in the brain and body occur when compared to depression. So, whilst PTSD can share similar symptoms with anxiety and depression (and could well be a co-morbid condition), there are definitely many differences between the conditions.

Those with PTSD have a smaller hippocampus, and there seems to be an abnormality in the hypothalamic-pituitary-adrenal (HPA) axis. Exposure to traumatic events can increase the likelihood of suffering from PTSD, and the HPA axis that coordinates the response to stress activates the LC-noradrenergic system, which results in an over-consolidation of specific memories. Those with PTSD also have chronically low levels of serotonin.

Approximately 5% of Americans – around 13 million people – have PTSD at any one given time. An estimated 8% of adults – or 1 in 13 people – in the US will develop PTSD during their lifetime.

Quotes from Experts

“There have been indications that cannabis or some of its components, primarily THC and CBD, diminish particular symptoms of PTSD. In this regard, in a small study (n = 10), 5 mg of THC twice a day as an add-on treatment enhanced sleep quality and reduced the frequency of night-mares, PTSD hyperarousal (based on the Clinician-Administered PTSD Scale) and global symptom severity. The synthetic analogue of THC, nabilone, similarly enhanced sleep, reduced nightmares and diminished other PTSD symptoms among patients.” Source: Abizaid, Alfonso et al. ‘Cannabis: A potential efficacious intervention for PTSD or simply snake oil?‘ Journal of psychiatry & neuroscience : JPN vol. 44,2 (2019): 75-78. doi:10.1503/jpn.190021