Table of Contents
Introduction:
Post-traumatic stress disorder (PTSD) is a psychological condition that develops as a reaction to intense or prolonged stress, like facing combat situations or enduring interpersonal violence (which can be physical, emotional, or sexual). Many individuals with PTSD resort to using cannabis for self-medication, and various studies suggest potential positive outcomes.
As the term implies, post-traumatic stress disorder (PTSD) arises directly from exposure to a traumatic incident. Indications encompass reliving the traumatic occurrence through flashbacks, evading triggers linked to it, and experiencing anxiety, depression, anger, and heightened vigilance.
Standard treatment approaches for PTSD primarily involve psychotherapy, with an emphasis on cognitive therapy, exposure therapy, and eye movement desensitization and reprocessing (EDMR). Depending on symptom severity, certain individuals with PTSD may also be recommended antidepressants and anti-anxiety medications.
Prevalence of PTSD Around the World
Based on findings from the US National Comorbidity Survey Replication, the lifetime prevalence of PTSD in the United States is approximately 6.8%. This breaks down to around 3.6% for American men and 9.7% for women.
In accordance with a study published in the European Journal of Psychotraumatology in 2019, it is approximated that approximately 354 million adults worldwide have experienced PTSD, among which 117 million have comorbid PTSD and major depression. These statistics stem from an analysis of individuals affected by conflicts between 1989 and 2015, who are still alive in 2015. According to this meta-analysis, approximately 33% of individuals with PTSD also receive a diagnosis of major depression.
Not all individuals who undergo a traumatic event will necessarily develop PTSD. A study found that 17% of Iraq veterans would experience either PTSD, generalized anxiety disorder or depression. Meanwhile, another study approximates that roughly 25% of children exposed to trauma may subsequently develop PTSD. Furthermore, another study concluded that monozygotic (identical) twins face an increased likelihood of developing PTSD following combat trauma if their twin also experiences the disorder, suggesting a genetic predisposition.
PTSD and Substance Dependence
Studies have indicated a notable occurrence of substance abuse among individuals affected by PTSD. In a specific study, it was observed that women, in particular, exhibited elevated rates of comorbidity between PTSD and substance abuse, ranging from 30% to 59%. Among women in this group, the primary origins of PTSD are frequently linked to recurring childhood incidents of physical and/or sexual assault. Conversely, for men, the rates of comorbidity are notably lower two to three times less, and typically arise from trauma related to combat or violence.
In another study conducted on a limited scale, which involved 91 participants enrolled in a community-centered substance abuse program, results indicated that as many as 52.8% of the participants exhibited signs of PTSD. Among them, 37.4% were identified as individuals with confirmed PTSD, while the remaining 15.4% were categorized as potentially having PTSD.
The question of whether cannabis can genuinely be considered a treatment for PTSD remains uncertain, as individuals affected by the condition might turn to such substances for comfort regardless of their actual effectiveness as medications.
While there has been substantial research conducted on substance use among individuals dealing with PTSD, studies focusing on the efficacy of cannabis as a treatment are comparatively limited. Until fairly recently, the prevailing viewpoint within the medical community often indicated that PTSD played a role in the emergence of cannabis use disorders. As a result, minimal exploration was carried out into the brain mechanisms that underline the development of such disorders.
The Role of the Endocannabinoid System in PTSD
In recent times, there has been a growing comprehension of the intricacies of the endocannabinoid system, shedding light on its potential involvement in overseeing the symptoms of PTSD and related conditions. An article from 2012 highlighted that individuals with a higher capacity to handle stress, who underwent an acute stressor in the form of a parabolic flight experiment, exhibited a noteworthy rise in endocannabinoid levels in their bloodstream. Conversely, individuals with lower stress tolerance did not experience a similar increase.
Nevertheless, these individuals were in a state of well-being and not grappling with any ongoing chronic stress ailment. Conversely, individuals afflicted with PTSD (as well as other chronic stress conditions) displayed consistently heightened levels of endocannabinoids in their system when contrasted with those not experiencing such conditions. This suggests that the endocannabinoid system indeed participates in the stress response, although the precise mechanisms remain veiled in uncertainty.
Curiously, in a separate article from 2015 published in Nature Reviews Neuroscience, investigators delved into the function of the endocannabinoid system in various facets of the processing of fear-related memories. The assessment proposes that “repeated exposure to a fear-inducing stimulus in the absence of danger progressively triggers endocannabinoid signaling.” The researchers posit that this continual endocannabinoid signaling could potentially lead to the fading away of the fear response.
This research offers a potential biological indicator for identifying PTSD, a process that typically relies on questionnaires. Although the study doesn’t explicitly mention PTSD, it does pertain to the psychological aspect that forms the foundation of PTSD: the recurring fear reaction even when no threat is present.
Genetic Phenotype of CB Receptors Could Increase Predisposition to PTSD
Additional research conducted in 2012 by Alexander Neumeister corroborates the outcomes of the previously cited study from Nature Reviews Neuroscience. This piece of literature elucidates the part played by the CB1 receptor in the encounter and recollection of stressful occurrences. The conventional process of endocannabinoid signaling via this receptor aids in the fading of fear, whereas compromised signaling is connected to an inability to eliminate traumatic memories. The phenomenon was also associated with persistent anxiety and depression (in animal subjects).
The article also highlighted that current medications for PTSD have been utilized in an “opportunistic” manner upon realizing their advantages. These medications were typically initially developed for different conditions. Frequently, such pharmaceuticals exhibit restricted efficacy and on occasion, might result in significant adverse effects.
In general, a recurring theme in scholarly literature suggests a connection between endocannabinoid signaling, the processing of fear, and the emergence of PTSD. Although the occurrence of a traumatic event is a prerequisite for PTSD (as the condition cannot manifest without trauma), there might exist a genetic inclination towards the condition.
Ways that Cannabis Can Ease Symptoms of PTSD
In the current understanding of PTSD, there is no pharmaceutical method to provide a complete cure due to the inherent nature of the condition. Since PTSD stems from trauma, there is currently no established pharmacological treatment to reverse the impact of trauma. This is why therapeutic approaches often focus on addressing anxiety, insomnia, depression, and flashbacks-associated symptoms. While cannabis might not directly lead to a cure or directly contribute to curing PTSD, its properties could potentially aid in alleviating symptoms.
1. Cannabis may have anxiolytic effects
Although there has been ongoing debate regarding the anxiolytic effects of THC over the years, the majority of scientific experts agree that CBD, in particular, demonstrates anxiolytic effects. Additionally, for specific individuals, THC can also help ease symptoms of anxiety.
Anxiety is a significant symptom associated with PTSD, and it’s commonly addressed through medication. A study conducted on mice in 2011 found that the overexpression of CB2 receptors led to a decrease in anxiety-related behaviors and an increase in gamma-aminobutyric acid (GABA) in the hippocampus and hypothalamus.
In a different study (in vivo, on humans) researchers found that people with PTSD had lower levels of a natural cannabinoid called anandamide. Taking CBD is believed to boost anandamide levels in the body by blocking an enzyme called FAAH, which breaks down anandamide. This is one way CBD might help reduce anxiety and depression.
2. Cannabis is neuroprotective
The scientific knowledge about PTSD is still in its early stages, but researchers are trying to find reliable signs of the condition. The way our body’s endocannabinoid system works seems to have promising potential, as mentioned earlier. In a study from 2018, Graziano Pinna talks about how chemicals in the brain, called neurotransmitters, might be related to PTSD. He also discusses the idea of using brain science to treat PTSD.
Basically, Pinna suggests that some chemical processes in the brain that protect our brain cells could also be involved in how we think and feel. Even though we’re just starting to understand how the brain affects our behavior and emotions, this idea makes sense in the field of study.
The natural compounds THC and CBD found in cannabis have been shown in research to help protect the brain cells and even create new ones. Although we’re not sure exactly how brain protection can help with PTSD symptoms, there seems to be a connection.
3. Cannabis may help treat insomnia and relieve nightmares
As mentioned earlier in this article, many people with PTSD have nightmares that don’t respond well to treatment.
We’re not exactly sure how compounds like THC and CBD in cannabis help reduce nightmares, but scientists think that THC might make it easier to fall asleep. This could help people with PTSD get better sleep and have fewer dreams that cause distress. When falling asleep becomes quicker, the stage of sleep where we usually dream, called REM sleep, might get shorter, which could lead to fewer nightmares.
There’s still a lot to learn about PTSD and how cannabis might be used as a treatment. Some people are concerned about using cannabis for PTSD because it’s not a main treatment but more like an extra way to help with symptoms. It could also have risks like addiction, especially because people with PTSD are more likely to develop problems with substances.
Even though there’s a debate about how well medical cannabis works for PTSD, the Medical Cannabis Advisory Board thinks that PTSD should still be a reason why people can get medical cannabis prescriptions.
