A licensed health care practitioner should be involved when using medical marijuana for PTSD.
PTSD is a complex condition that can have far-reaching effects for patients who suffer from the disorder and for the people in their lives.
Clinical studies with medical marijuana show promising results for treating PTSD with the cannabinoids THC and CBD ins some patients.
Some cannabis strains are more helpful for PTSD symptoms than others, which is why you should consult with a health care practitioner before attempting to medicate for this condition.
Medical Marijuana for PTSD
PTSD, or Posttraumatic Stress Disorder, is an incapacitating psychological condition that emerges after a traumatic experience.
PTSD is associated with morbidity, disability, and impairment of regular life functions. Symptoms can include:
- reliving the traumatic event or the emotional aspects of it
- avoiding thoughts, people, places, and other stimuli associated with the event
- emotional numbing
- elevated arousal
The amygdala is the portion of the brain that responds to emotional memories and fear.
PTSD changes how the amygdala is structured and how it functions. For example, PTSD reduces the amygdala’s ability to regulate serotonin (a neurotransmitter that helps regulate mood, sleep, and much more).
Supporting the health of the endocannabinoid system may be a way to help this condition, since it is associated with memory extinction of stressful or fearful events. Researchers in a recent study scanned the brains of PTSD patients and found abnormalities with their endocannabinoid system, verifying that it has a role to play in the treatment of this condition (Neumeister et al. 2013).
Cannabis has been observed in double-blind, placebo-controlled clinical studies to combat symptoms related to PTSD. So far, research shows that cannabis may help stave off long-term anxiety, depression and insomnia related to PTSD (Campos et al. 2012; Rabinak et al. 2013).
When used with selective serotonin reuptake inhibitor medications (SSRIs), cannabis has been observed to reduce or treat nightmares that were otherwise treatment resistant.
PTSD & Cannabinoids
Researchers have known for decades that phytocannabinoids (cannabinoids found naturally in marijuana) affect memory processing.
But until recently, there were no conclusive studies about cannabinoids and PTSD. The primary cannabinoids are cannabidiol (CBD) and tetrahydrocannabinol (THC). Both have been shown to alleviate PTSD symptoms in certain patients.
In a promising study from 2013, researchers administered synthetic THC to patients with PTSD. They found that THC (when compared to the placebo) inhibited patients’ usual fear response to memories of the traumatic event (Rabinak et al. 2013).
A 2009 clinical trial tested the effects of a synthetic cannabinoid on patients who were both diagnosed with PTSD and had treatment-resistant nightmares.
They found that the synthetic cannabinoid alleviated or ceased nightmares in 72% of patients. Some patients reported an improved quality of sleep, reduced night sweats, and fewer daytime flashbacks (Fraser 2009).
This study had no placebo control, so more research is needed to fully explore this pharmacological effect.
How does CBD Help PTSD?
The cannabinoid CBD is valued for its medical properties and is non-psychotropic.
That is to say, it doesn’t get you high or change your mental state the way THC can.
There is a growing body of human research that examines the pharmacology of CBD’s anti-anxiety effects. One animal study has investigated its effects on PTSD in particular.
In 2012, researchers studied the anti-anxiety properties of CBDs by exposing a group of rats to a cat and thereby triggering a predator threat response.
An hour later they administered doses of CBD or a vehicle (only inert substances). They measured protein expression in the hippocampus, amygdaloid complex and other regions of the brain.
The researchers found that repeated doses of CBD prevented long-lasting anxiety that could result from a single traumatic experience (Campos et al. 2012).
Indica or Sativa for PTSD?
Indica and sativa are two types of cannabis that you can buy, along with hybrids.
But Sativa is often a misnomer. Drug varieties of Cannabis are usually Indicas, and Sativas technically refer to industrial hemp varieties that contain less than 1% THC.
When you buy a Sativa today, it is often a sub-type of Indica called narrow-leafleted drug (NLD) that has been mislabeled. It bears a closer resemblance to fiber varieties of cannabis in its appearance, which is why this naming convention has persisted.
For the most part, NLD-dominant strains, often labelled Sativas, are associated with higher levels of CBD. Broad-leafleted drug (BLD) varieties of Cannabis, often labelled simply “Indicas” in today’s marketplace, are associated with higher THC, but there are plenty of strains that break the rule.
For example, there are NLDs (called Sativas) available that are bred to have high volumes of THC.
PTSD treatment with cannabis cannot be reduced to a specific species or strain. Patients can use products labelled sativas, indicas and hybrids to treat different aspects and symptoms of PTSD.
Three of the most popular, stains for treating PTSD in Canada are also award-winning: Bedrocan, Pink Kush, and Dancehall. The THC and CBD levels vary between each of these strains to fit each patient’s needs.
Bedrocan is labelled as a sativa-dominant hybrid with 22% THC and 0.1% CBD. This strain was developed in the Netherlands to fulfill a Dutch Health Ministry requirement to make a high-THC strain available for patients.
It is derived from the popular Jack Herer cannabis strain and is reported to improve mood, stress, depression, anxiety and lack of appetite. It is prescribed for depression, stress, pain and insomnia, which are all potential symptoms of PTSD. Bedrocan is commonly vaporized and has an average duration of 2.3 hours.
Pink Kush is labelled as an indica-dominant hybrid with 21.3% THC and 0.05% CBD. This strain is well-known for its sedative effects and is reported to improve insomnia, anxiety, lack of appetite, stress and depression.
It is prescribed for pain, insomnia, depression, stress and headaches. Pink Kush is typically smoked and has an average duration of 2.4 hours.
Dancehall is labelled as a sativa-dominant hybrid with nearly equal parts THC (10%) and CBD (9-11%).
This strain is reported to make patients want to smile and dance by improving mood, pain, depression and lack of appetite. It is prescribed for anxiety, insomnia, depression and pain.
Dancehall is often vaporized and has an average duration of 2.6 hours. Patients who use this strain report feeling energetic, happy, and free of anxiety or pain.
These are suggestions to begin your search, but patients should work directly a health care practitioner to find the right strain and dosage. Dosage should be approached with great care as there is research that suggests high doses of THC can actually make anxiety worse.
THC & CBD Dosage for PTSD
There are currently no medical guidelines for treating PTSD with Cannabis. This is because the drug’s effects on the condition are not fully understood.
When used in conjunction with another conventional therapy, one Israeli study saw significant improvement in global symptoms with two doses of 5 mg per day of THC (Roitman et al. 2014). But this should not be taken as a standardized dosage.
A health care practitioner authorized to prescribe cannabis in your province will be able to assess your medical history and provide you with a good starting dose. From there, you can work together to find the most effective dosage regimen for you.
The amygdala plays a key role in PTSD since the condition emerges from a traumatic experience. Medical marijuana has been observed to help some patients forget the fearful or stressful event that triggered their condition.
Preliminary research has found that while CBD helps alleviate anxiety, THC inhibits the natural fear response that patients feel when they do remember the event.
We recommend against starting with the question of sativas vs. indicas vs. hybrids when looking for a strain for your condition. Focus instead on cannabinoid content and terpenes.
A health care practitioner can help you get started when it comes to medical marijuana for PTSD.
- Campos, Alline Cristina, Frederico Rogério Ferreira, and Francisco Silveira Guimarães. “Cannabidiol blocks long-lasting behavioral consequences of predator threat stress: possible involvement of 5HT1A receptors.” Journal of psychiatric research 46, no. 11 (2012): 1501-1510.
- Cunha, Jomar M., E. A. Carlini, Aparecido E. Pereira, Oswaldo L. Ramos, Camilo Pimentel, Rubens Gagliardi, W. L. Sanvito, N. Lander, and R. Mechoulam. “Chronic administration of cannabidiol to healthy volunteers and epileptic patients.” Pharmacology 21, no. 3 (1980): 175-185.
- Fraser, George A. “The Use of a Synthetic Cannabinoid in the Management of Treatment‐Resistant Nightmares in Posttraumatic Stress Disorder (PTSD).” CNS Neuroscience & Therapeutics 15 (2009): 84-88.
- Neumeister, Alexander, Marc D. Normandin, Robert H. Pietrzak, Daniele Piomelli, Ming-Qiang Zheng, Ana Gujarro-Anton, Marc N. Potenza et al. “Elevated brain cannabinoid CB 1 receptor availability in post-traumatic stress disorder: a positron emission tomography study.” Molecular psychiatry 18, no. 9 (2013): 1034.
- Rabinak, Christine A., Mike Angstadt, Chandra S. Sripada, James L. Abelson, Israel Liberzon, Mohammed R. Milad, and K. Luan Phan. “Cannabinoid facilitation of fear extinction memory recall in humans.” Neuropharmacology 64 (2013): 396-402.
- Roitman, Pablo, Raphael Mechoulam, Rena Cooper-Kazaz, and Arieh Shalev. “Preliminary, open-label, pilot study of add-on oral Δ 9-tetrahydrocannabinol in chronic post-traumatic stress disorder.” Clinical drug investigation 34, no. 8 (2014): 587-591.
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