Post Traumatic Stress Disorder (PTSD) is far more common than people realize. Approximately 8% of American adults have PTSD during any given year, and about 4% of children under age 18 develop PTSD (Anxiety and Depression Association of America, 2018) (Stanford Children’s Health, 2018). That’s about 25 million Americans, but it is most likely underestimated because many people live with PTSD symptoms without ever seeking help or being diagnosed. When people work in high risk professions, the prevalence of PTSD is much higher, and symptoms are often much worse. We are going to briefly review current treatments, and then discuss the evidence for cannabidiol (CBD) and how scientists think it works to treat and even prevent PTSD.
Current treatments: Are PTSD patients getting the care they really need?
Current treatments for PTSD include cognitive behavioral therapy (CBT, also called talk therapy) and/or anti-anxiety medications, antidepressants, and high blood pressure medications (Mayo Clinic, 2018). It is worth noting that most of the drugs used for PTSD are used off-label, only two antidepressants are approved by the FDA for PTSD, and even when medications are prescribed, only about 20% of patients achieve remission. That’s not very effective. If I had PTSD, I wouldn’t be very happy with those odds when swallowing a pill riddled with side effects that might actually make matters worse.
For most pharmacological therapies, there is inadequate evidence regarding efficacy for PTSD. Cognitive behavioral therapy is a widely accepted method of treatment for PTSD, but there is clearly an urgent need to identify more effective pharmacological approaches for the management of symptoms. – Reisman, M., Pharmacy and Therapeutics Journal, 2016.
Will cognitive therapy work for you? Maybe–but its a coin toss. According to Kar (2011), nonresponse to CBT by PTSD patients is as high as 50%. Further, according to Holmes and Maron (2015) the stress symptoms of PTSD actually reduce the effectiveness of cognitive behavioral therapy, and ultimately, a more effective approach might be the targeted erasure of traumatic memories. Is talking about the traumatic experience really the best way to heal from the trauma? I don’t believe so. I believe it is better to help people find a way to forget about it, and move on with their lives.
There is good news here. There is a lot of evidence that taking CBD oil provides an effective way to manage it.
The endocannabinoid system plays a significant role in PTSD for two major reasons: memory consolidation and emotional regulation (especially in response to stress). The two endocannabinoids (the ones we produce on our own) are anandamide and 2-arachidonoyl glycerol (2-AG). Cannabinoids bind to CB1 and CB2 receptors. CB1 receptors are found in the brain and central nervous system; whereas CB2 receptors are found primarily in the peripheral nervous system and immune cells.
Memory consolidation is the process that takes place in our brain after something happens (such as a traumatic event), and a stable memory “trace” is made. The effectiveness of this process during a stressful event relies heavily on the presence of cannabinoids that can bind to CB1 receptors. This image explains how we remember a traumatic event within different parts of our brain. You can click here to enlarge it.
CB1 receptors are densely located in almost every single part of the brain that plays a role in short and long term memory (Alger, 2013). The process of extinguishing (forgetting) an aversive memory (like the memory of a trauma) requires the participation of CB1 receptors and therefore it is not at all surprising that CBD can facilitate the extinction of aversive memories. CBD helps you forget traumatic or noxious memories.
Additionally, studies have also shown that [long term] CBD treatment may facilitate neurogenesis in the hippocampus of the brain, a structure well known for its important role in processing memories, and that is found to be smaller in patients with PTSD – Bitencourt & Takahashi, Frontiers in Neuroscience, 2018
In animal studies, cannabinoids administered shortly after exposure to a traumatic event were found to prevent the development of PTSD (Akirav et al, 2016), and therefore a state of endocannabinoid deficiency could potentially predispose a person to the development of PTSD (Campolongo, et al., 2018). These are immensely promising findings. It is possible that in the future, cannabidiol can be given to people immediately after a trauma to prevent the development of PTSD and help them to appropriately process the memory of the experience. Additional studies in humans are necessary, because obviously we aren’t rats, and animal studies only go so far. Still, so far it seems that on the topic of CBD, the results from animal studies lead to new hypothesis for humans which are later tested and proven in human studies. Of course that is not always the case for many other substances.
Fear extinction: Putting out the fight or flight response fire
The endocannabinoid system helps us deal with traumatic life experiences as a part of a normal coping mechanism—to forget it and leave the past behind . . . Failure to extinguish learned fearful responses may underlie posttraumatic stress syndrome. -Alger, Cerebrum: The Dana Forum on Brain Science, 2013
CBD stimulates the endocannabinoid system and decreases the fear response (Bitencourt & Takahashi, 2018). Click here for a longer explanation of fear extinction if you want to look into it further. For our purposes, just know that impaired fear extinction is implicated in PTSD, and it is likely that anandamide deficiency is what impairs it.
Why do PTSD patients have more CB1 receptors than people without PTSD?
Research has consistently demonstrated that the human endocannabinoid system plays a significant role in PTSD. People with PTSD have greater availability of cannabinoid type 1 (CB1) receptors. – U.S. Department of Veterans Affairs, 2017
Research indicates that PTSD afflicted brains compensate for low anandamide levels by upregulating the CB1 receptors (Bailey et al., 2013). Essentially, the PTSD brain is seeking anandamide by increasing the number of receptors to which anandamide can bind. So where is the anandamide? Why are they deficient? Chronic stress depletes the endocannabinoid system. Not surprisingly, people who are exposed to chronic life stressors prior to the traumatic event have substantially increased risk for PTSD (Sareen, 2016). Life stressors can be anything from financial problems to marital issues… the standard adult stressors. And who is more chronically stressed than our military, police, firefighters, paramedics, and nurses–all of which have a substantially increased risk for PTSD than the average population.
Under conditions of chronic stress, the endocannabinoid system appears to “collapse.” . . . [Cannabinoids] are a critical component of stress resilience and impairments in this system may result in an increased vulnerability to the adverse effects of stress and, potentially, may be a biological substrate related to the development of stress-related psychiatric illnesses. – Hill and Lee, Biological Psychiatry, 2016
Why medical marijuana / self medicating with marijuana is not the answer
Medical cannabis and the form that is smoked or found in edibles contains another cannabinoid called tetrahydrocannabinol (THC). THC is psychoactive, and provides the “high” from cannabis. THC has various medicinal properties as well, but perhaps not the kind that will help PTSD patients long term. I think the problem lies in the fact that THC can actually reduce the number of CB1 receptors that are available. This is why PTSD patients may find relief from their symptoms when the smoke marijuana. However, I mentioned before, they need those CB1 receptors so that cannabinoids can aid in the processing and extinction of unpleasant trauma memories. Indeed it is well known that many PTSD patients resort to cannabis use for relief of symptoms. But the relief is temporary and the symptoms seem to return soon after it wears off. This leads me to believe that the THC may actually interfering with beneficial actions of CBD. You can develop tolerance to THC, but CBD dosing does not cause tolerance. Smoking marijuana–in my opinion–is simply a crude way to reap its medicinal benefits, not to mention that it remains illegal in most states. Why take that risk at this time?
Indeed administering THC on a chronic basis reduces the number of available cannabinoid receptors by 20%–60%, which effectively leaves the body’s natural endocannabinoids with fewer sites to activate, which may reduce their overall impact. Yarell, The Primary Care Companion for CNS Disorders, 2015
To me, it is glaringly clear that supplementing with cannabidiol (CBD) is the most logical, evidence based treatment choice for PTSD sufferers. Fortunately, CBD oil is quite easy to obtain. One brand that I personally trust is MedTerra as their CBD oil is CO2 extracted and has zero THC. Oh, and just a heads up: Amazon does not sell any CBD oil whatsoever. The hemp oil being sold by many companies on Amazon is not CBD oil. For more information on CBD oil and what to consider before you make your first CBD oil purchase, click here.
I will be posting in the future about the enzymes that degrade our endocannabinoids, and what we can do to inhibit them. I will also be posting about amino acid supplementation which may also help with PTSD symptoms.
If you have any questions or comments, or if you feel it is necessary to correct something that you read in my blog, feel free to do so below. I appreciate any and all of your contributions. If you think this post could help a friend, share it. You might change their life.
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Alger, B. (2013). Getting high on the endocannabinoid system. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997295/
Anxiety and Depression Association of America. (2018). Post traumatic stress disorder. Retrieved from https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd
Bailey, C., Carson, R., Corsi-Travali, S., Gujarro-Anton, A., Henry, S., Lin, S., . . . Zheng, M. (2013). Elevated brain cannabinoid CB1 receptor availability in post-traumatic stress disorder: a positron emission tomography study. Retrieved from https://www.nature.com/articles/mp201361
Bitencourt, R. & Takahashi, R. (2018). Cannabidiol as a therapeutic alternative for post-traumatic stress disorder: From bench research to confirmation in human trials. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6066583/
Campolongo, P., Hill, M., Patel, S., & Yehuda R. (2018). Integrating endocannabinoid signaling and cannabinoids into the biology and treatment of posttraumatic stress disorder. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28745306
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Reisman, M. (2016). PTSD treatment for veterans: What’s working, what’s new, and what’s next. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047000/
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Stanford Children’s Health. (2018). Post-traumatic stress disorder in children. Retrieved from https://www.stanfordchildrens.org/en/topic/default?id=post-traumatic-stress-disorder-in-children-90-P02579
U.S. Department of Veterans Affairs. (2017). Marijuana use and PTSD among veterans. Retrieved from https://www.ptsd.va.gov/professional/co-occurring/marijuana_use_ptsd_veterans.asp
Yarnell, S. (2015). The use of medicinal marijuana for posttraumatic stress disorder: A review of the current literature. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578915/