Can Cannabis Help PTSD?
More and more people suffering from PTSD are turning to medical cannabis as a treatment. It has been legalized for medical used to treat PTSD in a number of countries and US states, and the body of research into how it might help is growing.
However, the research is still in its early phases and there is no consensus in the medical community about the ability of cannabis to be an effective treatment for PTSD patients. Yet while the research is lagging behind, largely due to the history of prohibition, many PTSD patients themselves are reporting that it helps them—not only with primary symptoms but also in treating side effects of PTSD, namely sleep disturbances and anxiety.
Furthermore, because of the endocannabinoid system’s role in regulating memory, some researchers are looking at ways medical cannabis could help the brain “overwrite” traumatic memories.
The Endocannabinoid System
The body’s endocannabinoid system is comprised of endocannabinoids and cannabinoid receptors that act together to help maintain the body’s natural balance—homeostasis—and can affect important functions like: memory building, reducing inflammation, hunger, muscle control, sleep, mood, and pain response.
Endocannabinoids are molecules produced by the human body that are very similar to the active chemicals in cannabis, and act as messengers, sending signals to cannabinoid receptors. Cannabinoid receptors, primarily CB1 and CB2 which exist throughout the human body, bond with cannabinoids to regulate different bodily functions.
Phytocanabinoids, cannabinoids produced in the cannabis plant, also interact with the CB1 and CB2 receptors in the endocannabinoid system, producing many of the medicinal effects we see from the cannabis plant.
When it comes to PTSD, activating these receptors could be particularly helpful. The endocannabinoid system plays a big role in both stress response and memory building, which are both strong factors in PTSD.
When it comes to memory building, the CB1 receptor is responsible for a phenomenon called extinction learning. This process, found in mammals, allows new information to overwrite old memories. By covering over traumatic memories, the body can once again experience stimuli that might have caused a panic response when the memory was still fresh in someone’s mind.
For patients with PTSD and extreme anxiety, this function may be impaired by a deficiency of endocannabinoids, preventing them from covering over the traumatic memories with new memories. In fact, researchers have found that impaired endocannabinoid functioning after a stress inducing event may be a factor in patients developing anxiety disorders, like PTSD.
Yale associate professor of psychiatry R. Andrew Sewell theorizes that stimulating CB1 with cannabinoids might not only alleviate PTSD symptoms, but also actively cure the condition by allowing extinction learning to actually take place and overwriting traumatic memories. Still, his research on the topic is ongoing, so only time will tell if his theory can be shown clinically.
However, a common associated symptom of PTSD is poor sleep quality for a variety of reasons. Cannabis may be helpful in alleviating key symptoms of PTSD, such as sleep, which may also be indirectly treating the condition itself.
PTSD & Cannabis
Research on cannabis and PTSD is still in early phases and there is some disagreement from the experts on whether it is a helpful or harmful solution. This is largely due to the legal status of marijuana and limitations on its research in the past. Still, there are some promising pieces of research for those interested in learning more about PTSD and cannabis.
For one thing, the anecdotal evidence shows that many people suffering with PTSD use, or have used, cannabis to help manage their condition.
You can see the strong support for medical cannabis use among PTSD patients by reading through the comments submitted to the Arizona Department of Health Services on why PTSD should be added to the list of qualifying conditions for using cannabis. The document is filled with quotes from PTSD suffers praising the use of cannabis, such as:
“I found that the use of cannabis was more beneficial than the prescription medications I was previously on.”
“Medical cannabis has helped me immensely to deal with my PTSD.”
“Marijuana is the only thing that has given me my life back and empowered me to control my symptoms.”
“I have PTSD. I now use cannabis, and no longer have to take 10 pills a day. It has been life changing and now I can enjoy life again.”
Scientists have taken these reports seriously, and studied whether PTSD sufferers who use cannabis generally report improvements. Take for example, this 2015 metareview in the American Journal of Health-System Pharmacy, which found that “substantial numbers of military veterans with PTSD use cannabis or derivative products to control PTSD symptoms, with some patients reporting benefits in terms of reduced anxiety and insomnia and improved coping ability.” This study also found that cannabis seemed to decrease the severity of PTSD symptoms.
Of course, with anecdotal reporting it’s always difficult to tell what is a placebo effect and what is really helping with a condition, so it’s important to look at the research beyond this. And there is research that seems to back up these patient reports.
First of all, we know that cannabis intake can cause blunted stress reactions for those undergoing stressful stimuli. In one study, scientists administered stress tests, like doing math in public or plunging hands into ice water, to subjects who either used cannabis or did not. Those who used cannabis reported less stress during the test than those who did not. But even more interesting, test results showed that cannabis users had less cortisol in their system (a hormonal indicator of stress) than those who didn’t use cannabis.
This suggests that cannabis-using PTSD sufferers may be benefitting from reduced stress responses while using cannabis, which could account for their reports of reduced symptoms.
Other research has looked at cannabis use in PTSD patients specifically and found similar results. One study, for example, found that PTSD symptoms for cannabis using patients were reduced by more than 75% compared to those who didn’t use cannabis.
Another study found cannabis use led to statistically significant improvements in global symptom severity, sleep quality, frequency of nightmares, and PTSD hyperarousal symptoms.
But not all science points to improvements in PTSD symptoms. While cannabis can relieve anxiety, studies show that it can also cause it. The same cannabinoids that relieve anxiety in low doses, may increase it at higher doses.
And there have been observational studies on PTSD patients that showed negative effects from cannabis treatment, as well. One study also looked at veterans with PTSD who enrolled in a four-month treatment program found that initiating cannabis use after treatment was associated with worse PTSD symptoms such as more violent behavior, and alcohol use. These authors warn that cannabis may actually worsen PTSD symptoms or nullify the benefits of specialized, intensive treatment. Of course, it is important to note here that alcohol use is independently associated with violent behavior, and may be contributing to the violence observed in this study since alcohol use was also statistically correlated with cannabis use. It is also known that cannabis may be associated with psychosis in some people, so caution must be used in patients that have a history of hallucinations or delusions.
Still when larger meta-reviews of the data have been undertaken to analyse whether the research indicates that cannabis can help or harm with PTSD, experts are undecided. In both the National Academy of Sciences 2017 meta-review on cannabis from 2017 and a more recent review on PTSD and cannabis from 2018 the authors report that there simply isn’t enough data to know for sure whether cannabis can help. More intensive clinical research needs to take place before we can say for how cannabis affects PTSD.
Thankfully, some of this research is already underway. The Multidisciplinary Association for Psychedelic Studies (MAPS)—a non-profit that champions therapeutic cannabis research, just conducted the first triple-blind study on smoked cannabis for PTSD. The results of their study are currently being analyzed and prepared for publication. While we don’t know yet what the results are, we do know that this study looks at four different potencies of cannabis to determine whether certain blends of active ingredients in cannabis might be more effective (or counter productive) than others. By honing in on this factor, researchers hope to add clarity to the question of why some studies show worsening symptoms while others show improvement. It may be that some types of cannabis are more helpful than others in this process.
PTSD, or post-traumatic stress disorder, is a specific type of anxiety disorder that people develop after experiencing or witnessing traumatic events, like violence, abuse, or a terrorist attack. PTSD can also develop after upsetting but not necessarily violent experiences, like if a loved one dies unexpectedly.
Not everyone who experiences a traumatic event develops PTSD. When multiple people experience the same or similar event, some may end up with symptoms of PTSD while others will not display any long-term symptoms whatsoever. It is unclear why it develops in certain people and not others.
Children and teens can also get PTSD, sometimes as a result of incidents that might seem small and unimportant to adults, like watching a scary movie or getting publicly embarrassed at school.
It’s thought that 117 million adults worldwide live with PTSD and/or serious depression, including around 8 million Americans. In Europe, PTSD is more common in northern European countries, like the Netherlands, where 7.4% of adults have PTSD at least once in their lives. Women are more likely to be diagnosed with PTSD than men, at a rate of around 10% of women vs. 4-5% of men, although it’s possible that men may be under-diagnosed due to cultural pressure not to “break down.”
The symptoms of PTSD fall into four main categories:
- Reliving events, also called intrusive memories, are vivid memories of the traumatic event that are so powerful that you feel as though you’re experiencing it all over again. They include upsetting dreams or nightmares and involuntary flashbacks.
- Avoidance symptoms are when you go out of your way to avoid places, activities, people, or objects that remind you of the trauma. It also includes avoiding talking about what happened, or even thinking about it.
- Arousal and reactivity symptoms are when you feel stressed, easily startled, irritable, and have trouble sleeping. You would feel this way most of the time, not just when something happens to trigger a memory.
- Negative thoughts, mood, and cognition symptoms are recurrent negative thoughts about yourself and/or other people, like feeling that you can’t trust anyone or guilt about the trauma. You might also feel emotionally numb, detached from people close to you, hopeless, and lose interest in things you used to enjoy.
Most people who develop PTSD feel these symptoms within three months of the event, but for some people it can take much longer for them to appear. PTSD often appears together with other mental health disorders, like depression and other anxiety disorders.
Older children and teens with PTSD can become disruptive, disrespectful, and/or act in ways that hurt themselves and those they love, as well as showing symptoms listed above. They might also fantasize about revenge.
Very young children who are under six years old might:
- Have symptoms of regression, such as wetting the bed again, even after having learned not to already.
- Have a regression in their speech.
- Be unusually clingy to their parents or caregivers and unusually anxious when they leave.
- Act out the traumatic event through play.
- Have scary dreams.
- Be withdrawn when spoken to or interacted with.
- Have trouble making friends.
- Do poorly in school.
When you have PTSD, you’ll find that there are times when your symptoms are stronger and times when they fade. Being in a situation that reminds you of the traumatic event can bring on your symptoms. PTSD symptoms are strong enough to make it difficult for you to live your normal life, and can continue for months or even years.
When to see a doctor
If you’ve experienced a traumatic event or suddenly lost a loved one, it’s normal to be affected by it. Many people feel some or all of the symptoms of PTSD for a short time after the event, but then the impact begins to fade. You should go to your doctor if you’ve felt at least one of each of the main categories of symptoms for more than a month. If you have suicidal thoughts at any time, you should reach out for help immediately.
To diagnose PTSD, your doctor will talk to you about your symptoms and your recent experiences. They might also carry out some physical tests, like blood tests, to check that there’s no medical cause for your symptoms.
The immediate cause of PTSD is usually experiencing or witnessing a traumatic, violent, and/or upsetting event, but it can also happen as a result of hearing indirectly about a traumatic event, like learning about a violent attack on a loved one, or from watching traumatic events in movies or TV programs.
Professionals who are frequently exposed to terrible events, like police officers, military personnel, or healthcare professionals dealing with child abuse cases, can also develop PTSD because of their immersion in their daily work.
However, only a small percentage of people who experience traumatic events go on to develop PTSD. Scientists are not sure why some people develop PTSD and others do not, but there are some risk factors that make PTSD more likely:
- Existing mental health disorders, like depression or anxiety
- Not having a good support system of close family and friends
- Alcohol or substance abuse
- Close relatives with mental health disorders like depression or anxiety
- Having been exposed to traumatic events earlier in your life, like childhood abuse
- If you’ve been exposed to trauma for a long period of time, or the trauma is particularly intense, you’re also more likely to develop PTSD.
- PTSD is particularly common among military personnel and first responders, and people living in war zones.
If left untreated, PTSD can take over your life. It makes it difficult or even impossible to leave the house, hold down a job, or maintain a close relationship. It can stop you from sleeping and lead to serious anxiety and depression disorders.
If you keep on experiencing traumatic events and don’t get help, you could develop complex PTSD, which is much harder to treat and far more life-transforming. It’s thought that 27% of people with PTSD go on to commit suicide, and that people with PTSD are 13 times more likely to commit suicide than the rest of the population.
PTSD is treatable in a number of different ways. Not every treatment works for every person, so you might need to try a few options before you find one that works for you.
First of all, if someone with PTSD is in an ongoing situation of violence and trauma, you need to remove them from that situation.
One of the most effective options is to try to prevent PTSD from developing by talking about the events and getting support from friends and family, or a mental health professional, as soon as possible after the traumatic event, before you see any symptoms of PTSD.
Doctors do use medication to help treat PTSD, but it’s not always the most effective option. When they do prescribe medication, it’s usually antidepressants or anti-anxiety medication.
Psychotherapy, or talk therapy, is one of the mainstays of PTSD treatment. It can be done as group therapy or one-on-one, and includes a few different techniques:
- Cognitive behavioral therapy (CBT) helps you to identify negative patterns of thought in reaction to the trauma, and find ways to replace them with healthier thoughts.
- Exposure therapy can be used on its own, or as part of CBT. With exposure therapy, you’ll be gradually reexposed to the trauma that you experienced, but in a safe and guided way, so that you can learn how to contain it and to control your reactions to it.
- Eye movement desensitization and reprocessing (EMDR) is an intense approach that combines exposure therapy with guided eye movements. It helps you to process what you experienced and develop healthier ways to react to it.
Many people with PTSD find that alternative treatments help them to manage their PTSD symptoms. These treatments include:
- Mindfulness practices, like trauma-sensitive yoga and meditation, that encourage relaxation and focus
- Hypnosis and guided imagery
- Cranial-sacral therapy and/or massage therapy, to release stress and tension from the body