Written by Renata Filiaci, MSHW

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury.

PTSD has been known by many names in the past, such as “shell shock” during the years of World War I and “combat fatigue” after World War II, but PTSD does not just happen to combat veterans. PTSD can occur in all people, of any ethnicity, nationality or culture, and at any age. PTSD affects approximately 3.5 percent of U.S. adults every year, and an estimated one in 11 people will be diagnosed with PTSD in their lifetime. Women are twice as likely as men to have PTSD.

People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.

Cannabis has been shown to be an alternative way to help manage and reduce PTSD symptoms. Scientific studies have focused on using cannabidiol (CBD) and tetrahydrocannabinol (THC) cannabinoids from the cannabis plant to produce results. In a placebo-controlled, double-blind study, the peer-reviewed journal specified levels of improvement among participants using smoked cannabis blends with a 9 percent THC concentration. The research showed improvements in samples containing 11 percent CBD, as well as mixed samples containing 8 percent of both THC and CBD. This study followed an earlier study that was conducted which compared participants diagnosed with PTSD who used prescribed cannabis with other PTSD sufferers who do not use cannabis to treat symptoms. Over the course of a year, the study found that cannabis users reported a greater decrease in the severity of their PTSD symptoms. They also were more than 2.5 times as likely to no longer meet the diagnostic criteria for PTSD as those who did not use cannabis.

Researchers are finding that low endocannabinoid tone contributes to the amygdala hyperactivation as well as the anxiety and hyperarousal symptoms characteristic of PTSD. Given that endocannabinoid processes are affected by stressors and can affect anxiety and fear, it was hypothesized that endocannabinoid functioning is tied to the development of PTSD, possibly through a corticotropin-releasing hormone–mediated reduction of anandamide in several brain regions. Paralleling this view, it was maintained that pharmacological manipulations of endogenous cannabinoids could be used in the treatment of PTSD. Importantly, PTSD was associated with increased expression of cannabinoid receptor type 1 (CB1) and reduced peripheral levels of the endocannabinoid anandamide, as well as a compensatory increase of CB1 availability, which was linked to excessive threat processing and with features of anxious arousal. In this regard, in a small study, 5 mg of THC was administered twice a day as an add-on treatment which enhanced sleep quality and reduced the frequency of night-mares, PTSD hyperarousal, and global symptom severity. Alongside, cannabis also mitigated the propensity for inflammation and may be useful in psychological conditions that involve elevated inflammatory processes within the brain.

In another study focusing primarily on the cannabinoid, CBD, scientists administered between 9-25mg of CBD in either capsule or spray form once to twice a day, if necessary, for 8 weeks. Patients taking daily oral CBD over an 8-week period demonstrated an overall decrease in PTSD symptom severity as measured by continual decreases in mean Post-Traumatic Stress Disorder Checklist for the DSM-5 (PCL-5) scores. CBD was well tolerated and no patients discontinued it due to side effects, although a minority of patients did report fatigue and gastrointestinal discomfort. Patients did generally report greater improvement in symptoms with higher doses of CBD. A surprising number of patients with significant symptomatology related to PTSD nightmares reported subjective improvement in these symptoms.

Although studies are sparce and still emerging, we can see a trend in the use of cannabis, whether it be THC or CBD, for PTSD patients as it has helped mitigate and manage involved symptoms.