The PTSD treatment paradigm, currently reliant on a spectrum of medications, has been increasingly challenged for the dependence it facilitates and its artificial approach to healing a complex, integrated system. Emerging from this has been a cry for increased research on holistic alternatives, namely cannabis and/or CBD use. Legal complications have tied up the field for a while but new research should be emerging soon as a Phase 2 study on the safety and efficacy of smoked marijuana for PTSD symptoms in US veterans is completed.
In the meantime, The Journal of Alternative and Complementary Medicine recently published the first study investigating the clinical effects of CBD for people with PTSD. It does need to be supported by randomized, controlled studies, as it was performed on a small sample of 11 patients who were also exposed to psychiatric medications and psychotherapy at the same time, but it is an optimistic opening for this field of research.
Over the course of 8 weeks, the study participants took CBD orally (either in pills or a liquid spray) once or twice a day. They completed the PTSD checklist (PCL-5) at the beginning of the study and again after 4 weeks and 8 weeks. The PCL-5 assesses symptom severity on a scale of 0 to 4, which allowed the researchers to study both the overall impact as well as the effect on specific symptoms.
The average baseline score for the participants was 51.82, which then dropped to 40.73 after 4 weeks and 37.14 after 8 weeks, showing an overall decrease in the severity of symptoms. Of the 11 participants, 10 experienced a decrease in their score by the fourth week, with an average of a 21% drop. While 3 of the 11 participants experienced increases in their symptom severity (an average increase of 8 points) from weeks 4 to 8, 10 of the 11 still experienced an overall decrease from the baseline, with an average of a 28% drop.
One of the symptoms most impacted by the study was sleep. Of the participants who responded to the question assessing “repeated, disturbing dreams of the stressful experience” with a score of 3 or higher, 50% reported an improvement in their nightmares. In all participants, 38% remarked improvement in the quality of their sleep. Other symptoms for which participants expressed benefits were anxiety, focus, and mood.
While more clinical studies are necessary to investigate the intricate effects of different types, dosages, frequencies, and conditions of cannabis usage on PTSD symptoms, this research sits on a strong foundation of theory. In fact, we are beginning to understand that there are innate systems in the body designed to respond to compounds found in cannabis as well as to regulate symptoms associated with PTSD.
The connection between PTSD symptoms and the effects of cannabis seems to be based on the compound anandamide – the “bliss molecule”. Anandamide is an endocannabinoid, meaning that it is produced internally (“endo”) and stimulates a system of cannabinoid receptors in the body. These receptors, along with the cannabinoids that stimulate them, comprise the endocannabinoid system, which maintains homeostasis through regulating appetite, immunity, memory, mood, motor control, pain, reward, fertility, and temperature regulation. Interestingly enough, there are compounds in cannabis with similar structures that can also trigger cannabinoid receptors in the body. THC, responsible for the “high” associated with cannabis, activates the same receptors as anandamide.
As we currently understand it, there are two cannabinoid receptors in the body – CB1 and CB2. CB1 receptors are mostly found in the brain and central nervous system and mediate emotional learning, stress adaption, and fear extinction. These receptors are understimulated in those with PTSD, for their signaling “deactivates traumatic memories and endows us with the gift of forgetting”.
The use of phytocannabinoids like THC and CBD to stimulate CB1 receptors shows promise in balancing the endocannabinoid system and restoring its ability to regulate fear, anxiety, and joy. By allowing the system to have breaks from the constant stress it finds itself in when experiencing PTSD symptoms, cannabis use can reeducate the body to respond to stress as it does to acute stress. While endocannabinoids are broken down under chronic stress, under acute stress they are actually released to allow for return to baseline stress levels. What this means in terms of concrete response to symptoms, only the clinical trials will tell us, but there is reason to believe that cannabis users will become better equipped to respond to the stressors and symptoms that come with PTSD.
Although alternative treatments like CBD and medical marijuana still need conclusive evidence, our current approach to PTSD treatment has also yet to show any meaningful, consistent impact. In fact, PTSD United has shown that “in the past year alone the number of diagnosed cases in the military jumped 50%”. Many movements have emerged to raise awareness and funding for the cause, but, as organizational theorist Kenichi Ohmae recognized, “rowing harder doesn’t help if the boat is headed in the wrong direction.” The structure toward which this increasing energy is being devoted must be willing to evolve. We must seek new methods, challenge our current understanding, and form a more nuanced approach to treatment that includes a variety of techniques and is responsive to individuals and their unique needs. We will never know what could be achieved unless we open our minds and try it.
“If you want something you have never had, you must be willing to do something you have never done.” – Thomas Jefferson
About Makin Wellness
Founded in 2017 , Makin Wellness is Pittsburgh’s premier therapy & coaching centers located in Downtown Pittsburgh and Downtown New Kensington. The company’s mission is to help people heal and become happy again. Makin Wellness specializes in depression, anxiety, addiction, trauma, medical marijuana assisted treatment and relationship counseling.
Alex Brooks, Psychology Intern