Can cannabis help PTSD?
Medical cannabis is an approved treatment for PTSD (Post-Traumatic Stress Disorder) in an increasing number of countries and US states, and there is a growing body of research into how it can help those living with the condition.
While research into cannabis as a treatment for PTSD is still sparse, large numbers of PTSD patients themselves report that it helps with both the primary symptoms of the condition and secondary side effects including anxiety and sleep disturbances. Furthermore, because cannabis triggers body receptors that regulate memory, some researchers are looking at ways medical cannabis could help the brain “overwrite” traumatic memories.
How cannabis works on PTSD
The endocannabinoid system (ECS) exists in all vertebrates and helps regulate crucial functions such as sleep, pain, and appetite. The human body produces its own cannabinoids, which modulate and activate its various functions, but as its name suggests, the ECS can also be modulated and activated by cannabinoids found in the cannabis plant.
Endocannabinoids are molecules produced by the human body that are very similar to some of the active chemicals in cannabis, and act as messengers, sending signals to cannabinoid receptors. Because the ECS plays a role in regulating both stress response and memory building — two major factors in PTSD — there is reason to believe that marijuana could be particularly helpful for people suffering from the condition. In addition, researchers have found that impaired endocannabinoid functioning after a stress-inducing event may be a factor in patients developing anxiety disorders and PTSD.
Marijuana is also known for being especially effective in helping users get a good night’s sleep — no small thing for people suffering from the trauma and distress of PTSD.
Medical studies on cannabis and PTSD
Legal prohibitions against cannabis have inhibited research, but there is nonetheless a growing body of work that suggests how medical marijuana can help people with PTSD, as well as a host of other conditions and diseases.
- A 2015 meta review stated that “the evaluated evidence indicates 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.”
- A 2017 article stated that the regions of the brain that are involved in stress-induced behavioral consequences “are modulated by endocannabinoids and, therefore, are also potential therapeutic targets for cannabinoid drugs.”
- A 2016 article stated that “the end result of the current clinical and preclinical data is that cannabinoid agents may offer therapeutic benefits for PTSD.”
- A 2014 study performed in New Mexico (the first state to list PTSD as an approved condition for medical cannabis) found that “cannabis is associated with reductions in PTSD symptoms in some patients.” The study found a greater than 75% reduction in CAPS (Clinician Administered Posttraumatic Scale) symptom scores when patients were using cannabis.
- A 2014 study found that cannabis use led to statistically significant improvements in global symptom severity, sleep quality, frequency of nightmares, and PTSD hyperarousal symptoms.
It is prudent to note that cannabis is also known to potentially cause anxiety and paranoia in some users, though research has shown that this is linked to the amount and strength of the marijuana that is consumed. This is by no means universal — the same type and amount of marijuana given may have a relaxing effect in one patient, and spur anxiety and/or paranoia in another.
There have also been observational studies on PTSD patients that showed negative effects from cannabis treatment. 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.
CBD and PTSD
Cannabidiol (CBD) is one of the 146 identified cannabinoids, and because it does not have the psychotropic effects of THC, it is often widely-available in places where medical marijuana has not been legalized. This also means that CBD is often more readily available for research.
- A 2019 article stated that “oral CBD, when given in addition to routine outpatient psychiatric care, may have a beneficial effect for patients with PTSD.”
- A 2018 article stated that “human and animal studies suggest that CBD may offer therapeutic benefits for disorders related to inappropriate responses to traumatic memories. The effects of CBD on the different stages of aversive memory processing make this compound a candidate pharmacological adjunct to psychological therapies for PTSD. CBD also shows an action profile with fewer side effects than the pharmacological therapy currently used to treat this type of disorder. In addition, even at high doses, CBD does not show the anxiety-inducing profile of compounds that directly activate eCB transmission.
A 2015 article stated that preclinical evidence conclusively showed CBD’s efficacy in reducing anxiety behaviors relevant to PTSD and a variety of other disorders including GAD (Generalized Anxiety Disorder), PD (panic disorder), OCD (obsessive compulsive disorder), and SAD (social anxiety disorder), and had a “a notable lack of anxiogenic effects.”
Cannabis is far safer than many other legal forms of medication, but it is not without its side effects. Most notably, the psychotropic qualities of THC can cause problematic cognitive effects that can interfere with work and make operating heavy machinery or driving more difficult than otherwise.
And while the reaction is different for each user, THC has been known to trigger anxiety and paranoia in some users, potentially aggravating the symptoms of PTSD.
These side effects are not a concern when taking hemp-derived CBD products, which do not have psychotropic qualities.
Also, smoking cannabis exposes users to the same cardiopulmonary risks of tobacco smoking, and while vaping is considered a safer option, it is still a relatively new practice, so further time is needed to gauge the long-term effects.
Marijuana can also be habit forming.
It is important to note, there have been no verified cases of death caused by cannabis.
When considering the use of cannabis for anxiety, or any other medical condition, it is important to consult with your doctor before initiating therapy.
The Cannigma content is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Always consult with an experienced medical professional with a background in cannabis before beginning treatment.
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