Jan 10, 2023

Post Traumatic Stress Disorder and Medical Marijuana

Can medical marijuana treat PTSD? Post Traumatic Stress Disorder, or PTSD, is a mental health condition that’s becoming more pervasive in the United States with seven to eight out of every 100 people suffering from PTSD at some point in their lives. New studies have begun to indicate that medical marijuana can serve as a suitable treatment method to ameliorate PTSD symptoms - particularly in treatment-resistant cases. Medical marijuana - particularly the cannabinoids associated with the plant - have been shown to have a versatile therapeutic effects through stimulating the endocannabinoid system, which makes medical marijuana a hopeful source of relief for many who suffer from PTSD.

Post Traumatic Stress Disorder arises when an individual experiences a life-threatening situation (such as combat, assault, or natural disaster) and continues to be affected by lingering memories. These symptoms continue until normative brain activity is altered. Symptoms include loss of sleep, emotional changes, perception changes, and difficulty maintaining a quality standard of life.[1]

If you suspect you might be afflicted with PTSD, we strongly encourage you to seek help from a medical professional. We would also encourage you to seek out some form of talk therapy, be it group or one-on-one. To rebuild and maintain your mental health, you ought to consider a multilateral approach. For many, talk therapy is crucial to their recovery process, however, talk therapy can only provide so much relief.[13]

In this post, we will dive into whether medical marijuana is a good supplement to your recovery.

REVIEW: MEDICAL MARIJUANA AND OUR SYSTEM

In previous posts[3], we have mentioned how medical marijuana affects our body’s “Endocannabinoid System.” The main cannabinoids in marijuana/cannabis are CBD and THC (hence the term ‘cannabis.) CBD is non-psychoactive, while THC is psychoactive, which causes you to feel high. Other influencing agents include terpenes and flavonoids, which we will cover in a later post.[2]

The Endocannabinoid System in humans mediates essential functions such as mood, happiness, fear, anxiety, and memory consolidation/retrieval. Within our system, when we take medical marijuana, cannabinoid receptor 1 (CB1) and cannabinoid receptor 2 (CB2) are activated; but how does that affect individuals with PTSD? More on this to follow.

First let us address how the brain changes when afflicted by post-trauma.

HOW PTSD AFFECTS THE BRAIN

After a traumatic experience, many survivors (up to 50%) experience Acute Stress Disorder. If left untreated, Acute Stress Disorder devolves into Post Traumatic Stress Disorder, and changes in the pathophysiology of the brain take place.

Changes include increased activity of the amygdala (fear center of the brain), decreased volume in the prefrontal cortex (executive center of the brain), and decreased volume of the hippocampus (memory center of the brain). These changes lead to an increase in fear response, intrusive thoughts, flashbacks, nightmares, impulsivity, and arousal.

Additionally, during the trauma, there is a cortisol surge, which causes adrenal exhaustion, and results in dysfunction of the hypothalamic-pituitary axis. Which leads to a decreased baseline cortisol level. Then the negative feedback system overcompensates, hyper-arousal and hyper-vigilance kick into effect during benign activities.[8]

HOW MARIJUANA HELPS WITH SYMPTOMS OF POST-TRAUMA

This is a hotly debated topic within the scientific community. Many studies have been discredited due to bias or peer-reviewed blind spots. We do know that cannabinoids, the active ingredient in cannabis, are able to alter the PTSD addled brain and it’s processing of memories[4]. But the efficacy and accuracy fall into the research blind spot category. Many veterans swear that ingesting CBD or THC type products has alleviated their nightmares and/or flashbacks, yet the study often quoted on this topic has been discredited and the lead researcher stripped of their position.[12]

What is fascinating is the alignment in terms of which systems are affected by PTSD and medical marijuana. As a disclaimer, we do want to caution our patients - stay vigilant of your own treatment, medical marijuana may not be the right approach for you. However there is an abundance of anecdotal evidence that it may, so we’ll defer to the experts in this field.

Dr. Michael Bloomfield (UCL Psychiatry and Traumatic stress Clinic, St. Pancras Hospital) has been researching new treatments to deal with mental illness in the adult brain and cognitive function. He has received honors such as the Excellence Fellowship.

“Based on the evidence, we cannot make any clinical recommendation about using cannabinoids to treat PTSD. Current prescribing of cannabinoids for PTSD is not backed by high-quality evidence, but the findings certainly highlight the need for more research, particularly long-term clinical trials[5].”

Contrary to Dr. Bloomfield’s clinical recommendations are the findings of Canadian neuroscientist Matt Hill. Your Brain on PTSD: The Impact of Cannabis[8] is a Ted Talk on our topic and we encourage you to watch.

“What does THC do to the amygdala when someone gets very stressed out? …What they found is they got a very robust blunting of the amygdala in response to stress cues. So you show people these things that normally light up the amygdala and help generate a state and anxiety, and in the presence of THC this just didn’t really seem to happen. So, what we’ve learned from animal research to add on top of this is that cannabinoids like THC actually seem to have the ability to reduce the firing of neurons in the amygdala. And the way that they seem to do this is they seem to inhibit the release of excitatory neurochemicals in the amygdala.

So there are two types of neurochemicals we have. Excitable ones, that when they get released they make neurons fire, and brain areas light up. Or, inhibitory, they silence neurons and quiet brain areas down. So, in the amygdala, release of excitatory neurochemicals in this part of the brain in response to stress and this helps generate that state of anxiety.

…But what about the other side of the coin, in the prefrontal cortex?

In [one] study where [researchers would play] an auditory tone then [the researchers would give the volunteers] a mild electrical shock. So you do these enough and then when you play the tone, people actually start sweating. You get like a skin conductance response because they’re expecting a shock delivered to them. Then what [the researchers did] is start playing the tone a whole bunch without the shock.

…What [humans] are able to do as organisms that have these complex cognitive processes is we can unlearn that in a way. We can extinguish that memory. And doing this seems to really involve the prefrontal cortex. So during these tasks the prefrontal cortex seems to come online and it’s telling the amygdala, ‘No, no, don’t worry about it anymore, now this isn’t predictive of danger.’

So in this study, they did that task. They either gave [the PTSD diagnosed] THC or didn’t. Giving people THC really facilitated the ability to now learn that that was no longer a danger signal. So it promoted what we would now refer to as ‘fear extinction’ or ‘safety learning.’ At the same time when looking at the neuro-imaging patterns, like the previous study they did see reduced activity in the amygdala, but interestingly they actually found increased activity in the prefrontal cortex. So what this is saying is you’re getting very different effects of cannabis in two different brain regions.”

Based on varying evidence, the debate as to whether medical marijuana is effective in treating PTSD has yet to be settled. As you can see, there is compelling evidence for continued study.

There is an overwhelming outpour of anecdotal evidence on the matter. So much so that a large-scale movement of veterans have united to proclaim their support. They are known as the Veteran’s Cannabis Project.

VETERAN’S CANNABIS PROJECT

Of the many supporters for raising awareness of medical marijuana and its ability to help veterans with PTSD is the Veteran’s Cannabis Project[6]. The VCP “is dedicated to improving U.S. military veterans quality of life through the opportunity of cannabis.” And they believe, “medical cannabis saves live and that veterans deserve full and legal access.”

The VCP has a three-pronged approach for the issue of veterans (many with PTSD) and their legal access to medical cannabis. First is ADVOCATING on behalf of the veterans. Second is EDUCATING policymakers and the public about the value of cannabis to vets and reduce the overall stigma associated with it. Thirdly, SUPPORTING veterans across the nation with the resources they need to understand the value of medical cannabis, know their rights, and arming them with the crucial knowledge to help change policy but most importantly in educating themselves on the potential benefits they may receive for lingering mental or physical conditions for serving their country. Finally——HEALING. For far too long the VA has defaulted to a laundry list of prescriptions for Veterans. These prescription “cocktails” have left them in “zombie-like states.”[6]

On their website, you can read numerous stories of how medical marijuana helped vets kick their reliance on pharmacological “cocktails” and regain their sense of well being. Going from a “zombie-like” state to a capable, functioning individual.

OUR CONCLUSION

In 25 states, PTSD is listed as a valid condition for a medical marijuana license. Given the overwhelming anecdotal evidence counterposed with inconclusive medical advice, we believe in cautioning our patients. Medical marijuana may help those of you suffering from the horrors of PTSD. We do, however, recommend that you be very attentive to your regimen and doses, as it may be the key to minimizing the negative and improving your overall well-being.

Dr. Kramer is of the strong opinion that further research into the medical applications of cannabis will yield new methods of treatment and support for common, chronic illnesses. Patients shouldn’t have to suffer from symptoms that can be ameliorated or solved with the use of medical marijuana. We’ve reached a new period in healthcare where medical cannabis and medical marijuana is continuously being used in new, innovative ways - the more studies that can effectively measure and gauge potential uses of medical marijuana, the more options we’ll have as a society for healing and finding filling in the many gaps in our healthcare. Thank you for reading our blog, and for more information regarding medical marijuana or medical cannabis you can access the resources in the links below.

If you are interested in obtaining a medical marijuana card with Dr. Kramer, you can use this link to begin the process of obtaining one.

Citations

[1] http://www.ptsd.va.gov/index.asp

[2] http://echoconnection.org/post-traumatic-stress-disorder-ptsd-medical-cannabis-and-cbd-research-overview/
[3] Previous post(s)
[4] http://sciencedaily.com/releases/2019/09/190903194249.htm

[5] http://twitter.com/docbloomfield?lang=en

[6] http://www.sciencedaily.com/releases/2013/05/130514085016.htm

[7] http://www.vetscp.org/about-us

[8] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007739/#!po=16.1538

[9] http://youtu.be/tigFDVhbX-U

[10] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258013/#!po=11.4035

[11] https://doi.org/10.1080/15504263.2019.1652380

[12] http://www.nytimes.com/2016/06/28/health/nyu-cannabis-ptsd-psychiatry.html