As human beings we live increasingly stressful and overwhelmed lives. Across the board anxiety is on the rise, but overall as a species we are hardwired to be resilient, forget our daily woes, and start afresh the next day.
But what happens when someone lives through events so shocking that they remain indelibly etched in their memory forever? Such as ex-servicemen and women returning from the horrors of war, the civilians who live with the daily shower of missiles and cluster bombs, or a rape victim whose life will never return to normal after a violent, sexual assault.
The result for many is Post Traumatic Stress Syndrome (PTSD), in which sufferers literally relive again and again the horrors of the past. Relentless nightmares make sleep almost impossible and seemingly innocuous reminders of the original trauma provoke intense fear and panic.
Approximately 8% of Americans have PTSD at any one time, and as ever more countries fall into warfare throughout the globe, worldwide numbers will inevitably increase. Treatment options tend to favour antidepressants such as Selective Serotonin Reuptake Inhibitors (SSRIs) or psychological therapy. But studies show that in the case of US Army veterans, self medicating with cannabis is in high prevalence with in 2014, 40,000 Vets being diagnosed with a ‘cannabis use disorder.’
Ex-soldiers who regularly use cannabis say it helps promotes sleep and reduce nightmares, and in some states in the US, PTSD is in fact a qualifying condition for medical cannabis. But is it possible that cannabis could do more than just ameliorate PTSD symptoms and bring an end to the interminable suffering?
Cannabis helps to forget – and for PTSD that’s a good thing
The fact that PTSD is considered a memory disorder gives a clue as to why cannabis can have such a therapeutic effect. That’s because the compounds in cannabis called cannabinoids interact with the body’s own endocannabinoid system, which has a modulating effect on numerous physiological actions, like appetite, mood, sleep but importantly for PTSD, remembering and forgetting.
According to Safe Access Now Chief Scientist Jahan Marcu, “In relation to PTSD, how cannabis is particularly useful is with the ‘forgetting’ part. If I remembered every face I saw today on the subway, my head would explode. Your body needs a system to get rid of information that is no longer useful, or harmful to you.”
This system, known as the ability to extinguish fear, no longer functions correctly in cases of PTSD, leading to the continual reliving of fear based events.
But scientists have found that a balanced endocannabinoid system plays an important role in regulating this extinction process, in particular the CB1 receptors in the brain and central nervous system.
In the paper, ‘The Role of the Endocannabinoid System in Anxiety and Stress-Related Disorders,’ author Irit Akirav from the University of Haifa says, “The Endocannabinoid System participates in multiple brain circuits implicated in neuropsychiatric conditions, such as those modulating stress reactions, learning, extinction of fear, emotional regulation, and reward processes. Neuroimaging studies have revealed that these structures are indeed active in individuals who smoked cannabis.”
Akirav suggests that in anxiety related conditions such as PTSD, there is poor endocannabinoid signalling and that by moderately increasing this signalling, stress and anxiety decreases.
One way to do this is by introducing what scientists call a ‘CB1 receptor agonist’ – i.e. a chemical that through binding to the receptor produces a biological response. This can be done by increasing the levels of the body’s own CB1 agonist Anandamide, or by introducing something externally, which in cannabis terms would be the cannabinoid THC, as it also activates the CB1 receptor.
But here the word ‘moderate’ is key. Too much CB1 signalling can have the opposite effect and actually create more anxiety, so in cannabis dosing terms for PTSD, less can indeed be more.
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CBD – important role in reducing PTSD anxiety
For many people taking cannabis for anxiety related conditions, the fact that THC produces a psychoactive effect can be difficult to handle. In the past, only THC heavy strains were available, but in recent years, as more strains containing Cannabidiol (CBD) have come on the market, anecdotal reports from the Veterans’ Alliance for Medical Marijuana suggest that many veterans prefer “a balanced THC to CBD intake for management of PTSD symptoms.”
CBD, the second most abundant cannabinoid found in cannabis doesn’t affect the brain and central nervous in the same way as THC, so without the ‘high’, many people intolerant to THC find it helpful for reducing anxiety. And in strains containing both cannabinoids together, CBD has been shown to actually counteract THC’s psychoactive effect.
Clues to why the two cannabinoids can have such opposing effects can be found in a 2009 study using neuroimaging. Published in the Archives of General Psychiatry, it found that Cannabidiol (CBD) reduced activity in the amygdala – the part of brain that’s activated during anxious episodes – when subjects viewed fearful stimuli. While in contrast THC was found to modulate activation in frontal and parietal areas, associated with an increase in the anxiety response.
Another unique action of CBD is its ability to raise levels of the body’s own feel good chemical, anandamide, which can become depleted in individuals with PTSD. Anandamide is broken down in the body by an enzyme called fatty acid amide hydrolase (FAAH). However, CBD is a FAAH inhibitor, so by taking CBD, there is less FAAH present in the body, resulting in higher levels of anandamide and greater endocannabinoid signalling. All of which scientists believe could have therapeutic benefit for someone with PTSD.
Anti-inflammatory action of Cannabis may help PTSD
The anti-inflammatory nature of cannabis and its chemical compounds THC and CBD has been well documented, but it’s thought this could also explain why smoking cannabis proves helpful for many PTSD sufferers. A longitudinal study in US Marines reported an association between higher pre-deployment levels of the inflammation marker, C-reactive protein (CRP) and post-deployment development of PTSD, and in another study women whose PTSD symptoms were in remission exhibited lower levels of CRP compared to those with current PTSD.
In a current clinical trial studying the effects of cannabis on individuals with PTSD, these inflammation markers will be assessed to “to investigate whether the anti-inflammatory properties of THC/CBD mediates the treatment effect of marijuana on PTSD symptom expression.”
PTSD and Cannabis Clinical Trial
Having taken 5 years to get federal approval, the trial is being overseen by Dr Sue Sisley and Marcel Bonn Miller, with clinical studies taking place in Pheonix and Baltimore. It will target army veterans who have found their condition resistant to conventional treatment and will “evaluate whether i) smoking whole plant marijuana attenuates PTSD symptoms, ii) to compare the efficacy of varying ratios of THC and CBD to placebo using standard clinical measures, and to iii) collect safety data.”
This will be welcome news for the thousands of veterans living in US states where medical cannabis is either unavailable or where PTSD isn’t considered a qualifying condition. Indeed over recent years there have been a number of cases where army veterans diagnosed with PTSD have been arrested for possessing or cultivating cannabis for their own medical use, including one ex-soldier in Oklahoma who is facing the possibility of a life sentence in prison.
This coupled with an average of 20 deaths per day of US army veterans suffering with PTSD, makes the study’s success of vital importance. In a recent interview published on NewsMax Health Sisley said, “if there is even a chance that cannabis could help reduce the suffering of our veterans community then we have a duty to these vets to find ways to change public policy, to bring the science forward, and let the data speak for itself.”
However, if successful medical cannabis advocates hope the study’s findings will have repercussions that go well beyond the plight of US army veterans, reaching PTSD sufferers, whatever the root of their trauma, worldwide.