Conclusions: Administration of oral CBD in addition to routine psychiatric care was associated with PTSD symptom reduction in adults with PTSD. CBD also appeared to offer relief in a subset of patients who reported frequent nightmares as a symptom of their PTSD. Additional clinical investigation, including double-blind, placebo-controlled trials, would be necessary to further substantiate the response to CBD that was observed in this study.
Wholeness Center is a large mental health clinic with a focus on integrative medicine and psychiatry. Practitioners from a range of disciplines (psychiatry, naturopathy, acupuncture, neurofeedback, yoga, etc.) work together in a collaborative and cross-disciplinary environment. Based on existing research and patient experience, CBD had been widely incorporated into clinical care a few years before this study.
Of particular interest to this study is the effect of CBD on the endogenous cannabinoid system. CBD has minimal affinity for CB1 and CB2 receptors, 11 but it does indirectly cause activation of CB1 receptors by increasing the availability of endogenous endocannabinoids. Anandamide is an endogenous cannabinoid that acts as a partial agonist at CB1 receptors. It is metabolically deactivated by the enzyme fatty acid amide hydrolase (FAAH). CBD has been shown in some studies to inhibit FAAH, thus increasing the availability of anandamide and causing activation of the endocannabinoid system. 12 Studies in rodent models have shown that pharmacologic activation of the endocannabinoid system through CB1-receptor agonist agents leads to decreased behavioral response to aversive memories in rodent models through the inhibition of memory reconsolidation and enhanced extinction. 13–15 This early research suggests that agents such as CBD that cause indirect activation of the endocannabinoid system may have utility in the treatment of PTSD.
Objectives: Cannabidiol (CBD) is a non-psychotomimetic cannabinoid compound that is found in plants of the genus Cannabis. Preclinical research has suggested that CBD may have a beneficial effect in rodent models of post-traumatic stress disorder (PTSD). This effect is believed to be due to the action of CBD on the endocannabinoid system. CBD has seen a recent surge in research regarding its potential value in a number of neuro-psychiatric conditions. This is the first study to date examining the clinical benefit of CBD for patients with PTSD.
Informed consent was obtained for each patient at their intake appointment. Appointments every 4 weeks included clinical evaluation and documentation of patients’ PTSD symptomatology through PCL-5 questionnaires. Concurrent psychiatric medications were held constant or changed according to routine clinical practice, whereas CBD was often intentionally used as a method of decreasing or avoiding the use of psychiatric medications. CBD was added to care, dropped from care, or refused as per individual patient and practitioner preference. The Western Institutional Review Board approved a retrospective analysis of the charts of patients with a diagnosis of PTSD who received CBD as part of their treatment program.
A second study, from researchers at Brazil’s Federal University of Parana, explored another potential way that cannabis could help those with PTSD – extinguishing the intensity associated with memories of their trauma. This mode of treating PTSD was first hypothesized by Yale associate professor of psychiatry R. Andrew Sewell who suggested that cannabis may be able to help PTSD patients “overwrite” traumatic memories with new memories in a process called ‘extinction learning’.
Amy Rising, an Air Force veteran, smokes medical marijuana. Rising has been working on legislation . [+] for veterans’ freedom to treat PTSD with medical cannabis. (Photo by Kevin Cook for The Washington Post via Getty Images)
Two recent studies point to the way that cannabinoids may help treat PTSD. One shows how cannabis can reduce activity in the amygdala – a part of the brain associated with fear responses to threats. Meanwhile, another suggests that the plant’s cannabinoids could play a role in extinguishing traumatic memories. Both effects could be therapeutic for those suffering from PTSD – according to recent studies.
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Sewell theorized that cannabis might be able to jump start this process – allowing those with PTSD to access extinction learning like their healthy counterparts, and curing the PTSD by helping them to move on from their trauma. Unfortunately, he was unable to complete his research before he unexpectedly passed away in 2013.
Still, Sewell believed that cannabis could help. Cannabis stimulates CB1 – a receptor in the endocannabinoid system that Sewell says has improved extinction learning in animal studies. Interestingly, those with PTSD show impaired functioning of the endocannabinoid system – which may be why they are unable to go through the normal extinction learning process.
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Army veteran Kevin Grimsinger 42 and other vet’s and supporters from Sensible Colorado submit a . [+] petition to add PTSD to the list of conditions approved for the use of medical marijuana to Mark Salley the communications director for the Colorado Department of Public Health and Environment Wednesday July 7th, 2010. Joe Amon, The Denver Post (Photo By Joe Amon/The Denver Post via Getty Images)
Those exposed to THC had lowered threat-related amygdala reactivity.