Post-Traumatic Stress Disorder (PTSD) is defined by the PTSD Foundation of America as a psychiatric disorder that can occur following the experience or witnessing of life-threatening event such as military combat, natural disasters, terrorist incidents, serious accidents, or physical or sexual assault in adult or childhood. 

Military veterans who suffer from PTSD vary by service area. PTSD diagnoses among veterans, as well as those currently in-service, may stem from war zone deployment, training accidents, and military sexual trauma (MST). 

Why cannabinoid therapy for PTSD? 

Medications recommended for the treatment of PTSD are currently either selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), which do not specifically target the memory process. This could be why the pharmacological treatment of PTSD has shown to be difficult, with the potential for considerable side effects. However, interventions that directly affect our endocannabinoid system (ECS) have shown promise as they can affect both emotional and cognitive aspects. Recent studies have pointed towards the ways in which cannabinoid therapy may help alleviate associated symptoms of PTSD such as anxiety, nightmares, increased alertness, panic attacks, depression, and overwhelming emotions. 

There have been two observations of importance that have led researchers to further explore cannabinoid therapy as a PTSD treatment option. First, patients with PTSD were found to be more likely to consume cannabis as a form of self-medication in an attempt to reduce their symptoms of anxiety and disrupted sleep. Secondly, patients with PTSD were shown through research to have increased levels of cannabinoid receptors while decreased peripheral levels of the endogenous cannabinoid, Anandamide (AEA). This means that those suffering with PTSD may be experiencing an AEA deficiency. 

Due to the modulating effect of cannabidiol (CBD) on the ECS, and considering the many body processes that the ECS regulates, CBD has seen increased research for potential value in several conditions. Research has stated that the “ECS can provide more efficient and better tolerated alternatives to the standard treatments for PTSD”. The potential of cannabinoid therapy has been repeatedly demonstrated in animal models of traumatic event exposure as well as anecdotally in humans. CBD, in particular, is promising as it has been researched for its effectiveness among generalized anxiety disorders, depression, and traumatic memories while proving to be well tolerated by humans, both in overall safety and possible side effects.

Decreasing anxiety and aversive memories

Animal studies have shown that CBD is effective in reducing cardiovascular and anxiety responses caused by stress. For example, administered CBD lowered responses related to trauma when administered both before an event and when retrieving the aversive memory in these studies. These effects have been suggested to possibly promote the extinction of fear memories through CBD use. 

How this happens relates back to the role of the ECS in this process. To be free from an unpleasant memory requires the involvement of CB1 receptors. By blocking the action of CB1 receptors in previously conditioned mice, either through pharmacological blocking of the receptors in the nervous system or deleting genetically, results showed strongly impaired anxiety and memory extinction. 

Confirming benefits seen in animal studies in humans is essential to efficacy and provides validation. Current evidence of oral CBD use for PTSD in humans is minimal, however anecdotal data is being gathered. 

Some studies do suggest that the reduced memory of fear due to CBD or a CBD to delta-9-tetrahydrocannabinol (THC) ratio may be a result of blocked reconsolidating of the memory versus increased extinction of it, but either way we have seen that cannabinoids are capable of interfering with memory processing in such a way that it potentially diminishes the aversive memory. 

Studies with human participants

The first evidence of CBD in the extinction of fear-based learning in humans was studied in 2013 where forty-eight participants were subjected to electric shocks. It was found that CBD was successful in helping to extinguish the memory as well as avoid recall of the electric shock. 

In 2016, one case report showed that a daily dose of CBD for a 10-year old patient with PTSD from sexual trauma was associated with a reduction in their anxiety symptoms and sleep disruption without significant side effects. Prior to receiving CBD therapy, the child did undergo standard pharmacological treatment for the conditions, which only produced short-lasting and partial relief but also included disruptive side effects. 

Another study, which included 21 adults with PTSD to understand the clinical benefit of CBD for symptom relief was completed between 2016 and 2018, published in 2019. CBD was administered alongside medical treatment, psychiatric medications, and psychotherapy for eight weeks. Of the participants in the study, those who were taking a CBD capsule were instructed to do so once or twice per day based on severity of symptoms. After 4 weeks into the study 91% of individuals saw a decrease in symptom severity. After the 8 weeks, 73% of patients reported a further decrease in PTSD symptoms. Those who continued to receive CBD for 36 weeks or more, reported an improvement in their nightmares as well as improvement in quality of sleep over time. 

Sleep

In addition to the processing of traumatic events that lead to aversive memories, animal studies have also shown favorable effects of CBD in sleep disorders, another common manifestation of PTSD symptoms. CBD has been researched for its therapeutic potential for sleep disorders through limiting symptoms that may keep us awake at night (pain, anxiety, inflammation) but also may contribute to an increase in sleep duration and depth, as well as decrease in the anxiety responses induced by sleep disturbance. 

Nabilone, a synthetic cannabinoid, was approved for treatment of chemotherapy-induced nausea in 1982 by Health Canada and has been since studied for potential benefits. Researchers have found similar effects between nabilone and THC and benefits among those experiencing PTSD. Results from two studies, one among prison inmates and the other among varied traumatic circumstances showed statistically significant improvements in nightmare occurrences and/or severity, therefore an improvement in quality of sleep. Studies, such as these, show support for further research as well as potentially utilizing acute administrations of THC, or medical cannabis, to alleviate sleep disturbances among individuals living with PTSD. 

How to find support

Finding support and recommendations for cannabinoid therapy and PTSD can be difficult. But that is where Realm of Caring may step in to help. Our care specialists are trained to help with product and practical administration suggestions. In general, cannabis is safe but responsible use and guidance, as well as oversight by a healthcare professional whenever possible, are always recommended. We are here to help start and facilitate those conversations along the way. 

If you want to reach out to our care team to discuss anything cannabinoid therapy related one on one, or how to get enrolled in research to further legitimacy for this form of therapy, we are here for you! You can call us at 719-347-5400, email us at info@realmofcaring.org, or schedule an appointment.