Cannabis & PTSD
How Medical Marijuana Helps PTSD Symptoms
Innovative research findings surface daily in the medical realm, and fascinating developments of the therapeutic effects of medical marijuana show promise to those suffering from life-altering mental health problems. One condition that demonstrates such promise is Post Traumatic Stress Disorder (PTSD).
This document will cover PTSD and its various forms, the function of the Endocannabinoid System in the body, and supportive clinical trial findings on acute medical cannabis use as a form of mental health treatment for PTSD sufferers.
What is Post Traumatic Stress Disorder (PTSD)?
Post Traumatic Stress Disorder is a neuropsychiatric condition arising from exposure to one or more highly traumatic experiences. According to the U.S. Department of Veterans Affairs, approximately 12 million people in the United States have PTSD. These ordeals are disturbing in nature, involving (actual or threatened) serious injury, violence, or sudden, tragic loss.
PTSD symptoms experienced may be classified into subtype diagnoses, including Dissociative, Complex (c-PTSD), or Comorbid PTSD. Although commonly known to be associated among veterans, posttraumatic stress disorder can affect anyone. Sometimes symptoms develop within three months of event onset but may occur several years later.
Every year, it is estimated that 3.5% of the U.S. adult population is affected by PTSD. Seventy percent of adults encounter at least one traumatic experience in their lifetime, and roughly 20% of those individuals will develop the disorder. According to the U.S. Department of Veterans Affairs, although men have reported more traumatic events, women were twice as likely to exacerbate symptoms. Therefore, PTSD is shown to be more common in women than men.
According to a 2022 peer-reviewed study, intentional trauma was found to have a more significant association with PTSD than traumatic events that were unintentional/non-assaultive. Also, an increased duration of exposure to trauma was associated with a higher risk of PTSD.
Causes and Risk Factors
There is a misconception that PTSD is a condition experienced only among veterans. Despite increased awareness among military veterans in recent years, this condition is known to affect anyone who has experienced a traumatic event.
Some risk factors for PTSD may include:
- Ongoing childhood abuse
- Being in a job with increased risk of exposure to traumatic events (i.e., – military veterans, military personnel, first responders)
- Having little or no social support system after a traumatic experience
- Victim of sexual abuse or assault
- History of abuse in various forms (i.e.-physical, verbal, emotional)
- Witnessing or experiencing a traumatic event that threatens survival
- Sudden and tragic loss
- History of substance abuse or recreational drug use
- Acute stress disorder
According to the Sidran Institute, the estimated risk percentage of developing PTSD for those who have experienced the following traumatic events is as follows:
- Rape (49 percent)
- Severe beating or physical assault (31.9 percent)
- Other sexual assault (23.7 percent)
- Serious accident or injury, for example, car or train accident (16.8 percent)
- Shooting or stabbing (15.4 percent)
- Sudden, unexpected death of family member or friend (14.3 percent)
- Child’s life-threatening illness (10.4 percent)
- Witness to killing or severe injury (7.3 percent)
- Natural disaster (3.8 percent)
While inconclusive, recent data suggest that distinct pathophysiological changes exist in the brain of PTSD sufferers compared to a healthy control group. Documented clinical trials also indicate that prolonged trauma may disrupt or alter the neurobiological systems that regulate stress response. As a result, critical systems, including endocrine and neurotransmitter pathways that process fear behaviors at conscious and unconscious levels, are affected.
For example, a meta-analysis using magnetic resonance imaging scans showed those with PTSD had decreased volume of the hippocampus, left amygdala, and anterior cingulate cortex, areas of the brain that process memory and stress response, compared with matched controls.
Other reports reveal unstable cortisol during psychological trauma, suggesting the overactivation of the cortisol-releasing hormone/norepinephrine cascade (CRH-NE), resulting in prolonged stress responses. This further affects the dysregulation of GABA, serotonin, and neuropeptide Y, neurotransmitters that are vital contributors to balancing body function and fear responses. As a result of these altered stress hormone and norepinephrine pathways, learning and memory extinction processes are impacted, another clinically significant finding in those with PTSD.
Other areas of the brain that are impacted include the poorly regulated hippocampus, which may affect the PTSD sufferer’s ability to discern safe versus unsafe stimuli. Combined with amygdalar response dysfunction, symptoms such as behavioral changes, hypervigilance, fear association, and hyper-exaggerated stress responses are exhibited.
Despite being reported as transient in nature, sufferers often experience alarming and unpleasant symptoms that can poorly impact daily living and relationships with others. According to a 2022 medical journal article, clinical manifestations are essentially grouped into three primary domains:
(i) reminders of the traumatic event (including flashbacks, intrusive thoughts, nightmares, and traumatic memories)
(ii) activation (including hyperarousal, insomnia, agitation, irritability, impulsivity, and anger)
(iii) deactivation (including emotional numbing, avoidance, withdrawal, confusion, derealization, dissociation, and depression).
Diagnosis and Classification
According to the National Institute of Mental Health National Library of Medicine, diagnostic criteria for PTSD include the individual experiencing the following symptoms for at least one month:
At least one re-experiencing sign (i.e., flashbacks, frightening thoughts/traumatic memories, nightmares)
At least one avoidance symptom (i.e.-avoiding places that are reminders of the traumatic event, emotional numbing)
- At least two arousal and reactivity symptoms (i.e., hypervigilance, irritability, insomnia, easily startled)
- At least two cognition and mood symptoms (i.e., Lack of interest in previously enjoyable activities, feelings of guilt or shame about self or world, trouble recalling details of the traumatic event)
Co-occurring PTSD Disorders
According to the United States Department of Veterans Affairs, approximately 80% of people with PTSD have one or more co-occurring disorders. Those with depression, substance use disorder, and trauma-related anxiety disorders are two to four times more prevalent in PTSD patients. In addition, there is a higher risk of personality (dissociative) and mood disorders.
Co-occurring disorders may portray significant health risks, including self-harm and suicidal thoughts. Also, there is a prominent link between PTSD and a higher risk of medical conditions, including cardiovascular, pulmonary, autoimmune, endocrine disease, irritable bowel syndrome, chronic pain, and sleep disturbances.
PTSD Treatment and Therapies
The dysregulated and marked pathophysiological changes in the brain of people with PTSD have prompted researchers to enter a new complex dimension of neuroscience to better understand the disrupted neural pathways caused by traumatic brain injury. Due to the complexity and variations of neural connectivity of each person, determining a cure for all solution may not be possible. However, the prognosis is good for treating PTSD symptoms through psychotherapy, pharmacotherapy, cognitive behavioral therapy, Eye Movement Desensitization and Reprocessing (EMDR), and exposure therapy. These mental health treatment options have demonstrated a therapeutic impact in mitigating symptoms and providing relief.
Cannabis for PTSD
Although cannabinoid research is still developing, complementary and alternative treatment options, such as cannabidiol (CBD) and tetrahydrocannabinol (THC), have also been used to treat PTSD.
THC and CBD have chemical similarities, such as sharing the same molecular weight of 21 carbon atoms, 30 hydrogen atoms, and 2 oxygen atoms and containing similar chemical compositions. However, the varied rearrangement of atoms causes them to interact differently.
Derived from a cannabis plant, THC and CBD are compatible with the body’s naturally producing endocannabinoid system (ECS), known to ensure the homeostasis of critical systems in the body, which means THC and CBD can influence homeostatic function in the body. This recently discovered system will be explained in greater detail.
Preliminary data from clinical trials suggest that people with PTSD may have brain dysregulation, which contributes to symptoms such as sleep disturbances, hypervigilance, poor extinction learning, and anxiety, to name a few. The following section will cover the ECS and how CBD and THC can affect these central body processes.
Despite the limited research on chronic cannabis use, preliminary observational study trials reveal that medical cannabis treatments provide short-term relief, positively impacting those with PTSD symptoms. Examples of these documented studies of marijuana use as a form of treating PTSD will be explained in more detail in a later section.
PTSD and the Endocannabinoid System (ECS)
According to the National Institutes of Health, the ECS is a neuromodulatory biological system of receptors and lipid-based neurotransmitters in the brain and nervous system. It is considered the largest widespread network of receptors responsible for central nervous system (CNS) development, synaptic plasticity, and response to endogenous and environmental stimuli.
The ultimate goal of the endocannabinoid system is to ensure homeostasis of the central physiological systems in the human body. It is quite literally the bridge between body and mind. This highly complex network comprises three primary components: cannabinoid receptors, endogenous cannabinoids (endocannabinoids), and enzymes.
CB1 and CB2 Receptors – The “Lock”
Cannabinoid receptors are regulatory mechanisms responsible for maintaining homeostasis of body systems that affect sleep, appetite, mood, memory, pain, and inflammation. Two primary receptors that are the main gatekeepers of body responses are CB1 and CB2 receptors. Similar to a lock and key configuration, each receptor type has a designated shape that is “unlocked” when activated by an endocannabinoid designed to fit inside the receptor. Once activation occurs, a body change is initiated. Where the elicited response occurs depends upon the location of the receptor.
CB1 receptors are considered the most abundant in the central nervous system (CNS) and present in the cortex, basal ganglia, hippocampus, hypothalamus, and cerebellum. They are responsible for learning and memory, executive function decision-making, emotional reactions, sensory and motor responsiveness, and other homeostatic processes.
CB2 receptors may be found sparingly within the CNS, but most are in microglia (immune cells) and vascular elements in the peripheral nervous and immune system. These receptors are primarily known for reducing generalized systemic inflammatory responses in the body.
As a general idea, CB1 receptors facilitate mostly psychoactive effects while CB2 receptors primarily involve immunosuppressive and anti-inflammatory action.
Endocannabinoids – The “Key”
The endocannabinoid that fits into CB1 receptors is Anandamide (AEA), discovered in 1992 by Lumir Ondrej Hanus and William Anthony Devane. It is a messenger neurotransmitter responsible for what is known as “runner’s high” and plays a role in appetite, memory, memory, pain, and fertility.
The second type of Endocannabinoid is 2-Arachidonoylglycerol, or 2-AG, located predominantly in the brain, liver, and lungs and assists in regulating pain, appetite, and immune system response.
Enzymes are biological catalysts that facilitate chemical reactions within the body and assist in recycling used endocannabinoids. They play a role in the synthesis and degradation of used-up endocannabinoids. (i.e. – FAAH, MAGL).
Cannabis for PTSD: How Does Medical Marijuana Affect the ECS and Help Treat Post-Traumatic Stress Disorder PTSD?
Although research is developing, below are findings that support the beneficial use of medical marijuana for people with PTSD:
CBD, or Cannabidiol, another compound of cannabis, weakly binds with CB1 or CB2 cannabinoid receptors. Because of this, body system responses can occur with little to no unwanted side effects. A 2019 medical cannabis case study on Cannabidiol (CBD) use in the treatment of Posttraumatic Stress Disorder demonstrated that decreased anxiety and sleep disturbance symptoms were reported in 91% of PTSD patients.
Like anti-anxiety medications prescribed to inhibit specific ECS enzymes, preliminary data suggest that CBD can also target the same enzymes, producing a comparable anxiolytic effect.
Tetrahydrocannabinol (THC) binds with CB1 cannabinoid receptors, producing similar body system responses as Anandamide. A 2020 randomized, double-blind study performed by the research team at Wayne State University determined how acute low doses of THC affected amygdalar responses to threat. Clinical participants were classified into three groups: (1) non-trauma-exposed healthy controls, (2) trauma-exposed adults without PTSD symptoms, and (3) trauma-exposed adults with PTSD. Low doses 0f THC were found to lower threat-related amygdala reactivity, reducing anxiety and fear responses in trauma-exposed individuals.
However, due to psychotropic effects, caution should be taken when THC is given alone in high concentration, as it can potentially exacerbate symptoms in PTSD patients. Yet, a therapeutic effect can be established when THC is combined with CBD at a higher concentration. This is due to allosteric inhibition, as Cannabidiol (CBD) decreases the psychoactive effect of THC. As such, combination medical marijuana therapy can be one of many available treatment options to reduce the physical symptoms commonly associated with anxiety disorders like PTSD.
In conclusion, due to their influence on the main body processes regulated by the Endocannabinoid System, current scientific evidence suggests that THC and CBD are known to decrease PTSD symptoms.
Cannabis Users Experience Relief Without Adverse Effects
Widely used treatments for PTSD may include traditional methods such as exposure therapy and eye movement desensitization and reprocessing. Yet, cannabis research, although limited and somewhat stigmatized, has made a profound therapeutic impact as acceptable alternative treatment of PTSD. Additionally, sufficient preliminary data supports cannabis use as a mental health treatment option for co-occurring disorders such as trauma-related anxiety and depression. Medical cannabis users have experienced positive therapeutic effects and short-term relief of their PTSD physical symptoms, including decreased sleep disturbances, lowered threat response activity, and improved extinction learning and memory processes. Also, short-term marijuana use has not been associated with marijuana addiction.
DocMJ is Here to Help!
Medical marijuana for PTSD can be sold in various forms. For example, these cannabis products may be administered via inhalation and ingestion methods. It is important to note that the route of administration will affect potency. Therefore, as with any health plan, professional medical advice is always essential to achieve optimal well-being and quality of life. Our highly skilled and compassionate DocMJ team of physicians is here to help formulate an individualized PTSD treatment plan that is right for you.
At DocMJ, we stand firm in providing you with the latest science surrounding PTSD and the various treatment options available. Developing data findings show that cannabis helps and is a worthy treatment option for PTSD. We strive to keep you updated on the latest findings on medical cannabis to arm you with the freedom to make informed decisions about your mental health to achieve optimal well-being and quality of life. Please call our office today to set up an in-person physician evaluation.