CBD and PTSD

PTSD Introduction:
Everyone reacts to traumatic events differently. People are different in their ability to manage fear and stress and to cope with the threat posed by a traumatic event. For that reason, not everyone who experiences a traumatic event will experience PTSD.

PTSD was first bought to the attention of the medical community by war veterans who faced shock and battle fatigue syndrome. PTSD can occur to anyone who has faced a traumatic event that threatens death or violence, even children. People who have been abused as children or have been repeatedly exposed to life threatening situation are at a greater risk of developing PTSD. Victims of trauma related to physical and sexual assault face the greater risk of developing PTSD. Women are more likely to develop PTSD, this may be due to the fact that women are more likely to be the victims of domestic violence, rape and abuse



Symptoms: The symptoms most often begin within three months of the event. In some cases, however they begin years after the event

Reliving: People with PTSD repeatedly relive the ordeal they had experienced through thoughts and memories of the trauma. These may include flashbacks, hallucinations and nightmares.

Negative thoughts and changes in mood: People with PTSD form negative thought patterns that involve negative thoughts about oneself, other people, difficulty experiencing positive emotions, feeling emotionally numb, hopelessness about the future.

Avoiding: People with PTSD may avoid the places, people, thoughts or situations that remind them of the trauma. This can lead to feelings of detachment and isolation as well a loss of interest in the activities that the person once enjoyed


Increased Arousal: These include excessive emotions like outbursts of anger, difficulty falling or staying asleep, difficulty concentrating, getting jumpy or easily startled, always being on guard for danger, self-destructive behaviour such as drinking too much or driving too fast, overwhelming guilt or shame.

Physical symptoms include increased blood pressure and heart rate, rapid breathing, muscle tension nausea and diarrhoea.

Young children with PTSD may suffer from delayed development in areas such as toilet training, motor skills and language.

Some studies suggest that early intervention with people who have suffered a trauma may reduce some of the symptoms of PTSD or prevent it all together.

Causes:
You can develop post-traumatic stress disorder when you go through, see or learn about an event involving actual or threatened death, serious injury or sexual violation.

Doctors aren't sure why some people get PTSD. As with most mental health problems, PTSD is probably caused by a complex mix of:

  • Stressful experiences, including the amount and severity of trauma you've gone through in your life
  • Inherited mental health risks, such as a family history of anxiety and depression
  • Inherited features of your personality — often called your temperament
  • The way your brain regulates the chemicals and hormones your body releases in response to stress

Diagnosis:
PTSD is not diagnosed until at least one month has passed since the time of a traumatic event has occurred. Although there are no lab tests to specifically diagnose PTSD, doctors use various tests to rule out physical illness as the cause of the symptoms. If physical illness is not found the patient is referred to a mental health professional who is specially trained to treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for the presence of PTSD or other psychiatric conditions. The doctor bases his or her diagnosis of PTSD on reported symptoms, including any problems with functioning caused by the symptoms.

Treatment: The goal of PTSD treatment is to reduce the emotional and physical symptoms, to improve the daily functioning of the patient with day to day activities and to help the person better cope with the traumatic event that triggered the disorder. Treatment of PTSD may include psychotherapy (a type of counselling), medication or both.

Medication:
Doctors use certain anti-depressant medications to treat PTSD and to control the feelings of anxiety and its associated symptoms including Selective Serotonin Reuptake Inhibitors (SSRIs) such as Paxil, Celexa, Luvox, Prozac, and Zoloft; and tricyclic antidepressants such as Elavil and Doxepin . Mood stabilizers such as Depakote and Lamictal and atypical antipsychotics such as Seroquel and Abilify are sometimes used. Certain blood pressure medicines are also sometimes used to control particular symptoms. For example, prazosin may be used for nightmares, or propranolol may be used to help minimize the formation of traumatic memories.

Psychotherapy: It involves helping the person learn skills to manage the symptoms and develop ways of coping with them. Therapy also aims to teach the person and his or her family about the disorder, and help the person work through the fears associated with the traumatic event. A variety of psychotherapy approaches are used to treat people with PTSD, including:

Cognitive behavioural therapy, which involves learning to recognize and change thought patterns that lead to troublesome emotions, feelings, and behaviour.
Prolonged exposure therapy, a type of behavioural therapy that involves having the person re-live the traumatic experience, or exposing the person to objects or situations that cause anxiety. This is done in a well-controlled and safe environment. Prolonged exposure therapy helps the person confront the fear and gradually become more comfortable with situations that are frightening and cause anxiety. This has been very successful at treating PTSD.
Psychodynamic therapy focuses on helping the person examine personal values and the emotional conflicts caused by the traumatic event.
Family therapy may be useful because the behaviour of the person with PTSD can have an effect on other family members.
Group therapy may be helpful by allowing the person to share thoughts, fears, and feelings with other people who have experienced traumatic events.

CBD:
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. Current pharmacological therapies for PTSD have been shown to be inefficient and produce considerable side effects. Since the discovery of the involvement of the endocannabinoid (eCB) system in emotional memory processing, pharmacological manipulation of eCB signalling has become a therapeutic possibility for the treatment of PTSD.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.

Methods: This retrospective case series examines the effect of oral CBD administration on symptoms of PTSD in a series of 11 adult patients at an outpatient psychiatry clinic. CBD was given on an open-label, flexible dosing regimen to patients diagnosed with PTSD by a mental health professional. Patients also received routine psychiatric care, including concurrent treatment with psychiatric medications and psychotherapy. The length of the study was 8 weeks. PTSD symptom severity was assessed every 4 weeks by patient-completed PTSD Checklist for the DSM-5 (PCL-5) questionnaires.

Results: From the total sample of 11 patients, 91% (n = 10) experienced a decrease in PTSD symptom severity, as evidenced by a lower PCL-5 score at 8 weeks than at their initial baseline. The mean total PCL-5 score decreased 28%, from a mean baseline score of 51.82 down to 37.14, after eight consecutive weeks of treatment with CBD. CBD was generally well tolerated, and no patients discontinued treatment due to side effects.

Conclusion: 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.

Subjects/test(s) used

Effective dose/route of administration

Effect

19 year-old male with PTSD (case report)

CBD + THC (cannabis resin from Turkey – 1/1 proportion)/smoked

Patient experienced reduced stress, less involvement with flashbacks and a significant decrease of anxiety.

Healthy humans/Pavlovian fear-conditioning paradigm

CBD 32 mg inhaled

Enhanced consolidation of explicit fear extinction

80 patients with PTSD

CBD + THC (cannabis – unknown proportion)/smoked

Cannabis (CBD + THC) is associated with PTSD symptom reduction.

10 year-old girl with PTSD (case report)

CBD oil at least 25 mg daily for 5 months/oral capsules

Maintained decrease in anxiety and a steady improvement in the quality and quantity of the patient’s sleep.



Source of medical journals:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482919/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6066583/