Can Medical Cannabis Help Ease Symptoms of PTSD?

Experts estimate that approximately 6% of the general population and as many as one-third of all veterans experience post-traumatic stress disorder (PTSD).

While PTSD does not discriminate based on gender, women are nearly twice as likely as men to experience PTSD after a traumatic event — nearly 8% of women develop PTSD compared to 4% of men. The roots of trauma can differ widely between men and women, with men more likely to witness death or physical injury due to combat, accidents, and even natural disasters while women are more likely to experience assault, sexual assault, and child abuse. Still, no matter the cause, lasting PTSD is a real mental health issue that must be treated to resolve.

Selective serotonin reuptake inhibitors (SSRIs) have long been used as a front-line pharmacological treatment for PTSD, but these pharmaceuticals are often ineffective. Around 60% of people respond to SSRIs and only 20-30% of them reach full remission. They can also cause a wide range of adverse side effects, including irritability, trouble sleeping, and thoughts of suicide. Psychotherapy is recommended as well, yet even the most efficacious treatments typically fail to remit or reduce symptoms below the clinical threshold for the disorder.

Because traditional treatment options for PTSD tend to be unsuccessful or even harmful, many of those who do not respond to SSRIs and psychotherapy are turning to other options for relief.

Is cannabis the answer?

Many people experience some of these symptoms in the days after a traumatic event, but a diagnosis of PTSD requires that these symptoms last for more than a month and result in significant distress or problems with daily functioning. It is possible to develop symptoms of PTSD within a few months of the trauma, but some people do not develop symptoms for months or years.

PTSD is correlated with other mental health problems, including depression, anxiety, substance use disorder, panic disorder, obsessive-compulsive disorder, and social phobia. Individuals with complex PTSD resulting from multiple traumatic events (such as community violence, combat, or domestic violence) tend to experience more intense symptoms, behavioral issues, and extreme emotional responses.

Cannabis for PTSD

There is currently a strong interest among researchers and clinicians regarding whether cannabis can serve as a safe, effective treatment for PTSD symptoms. Cannabis has been legalized for medical use in 36 states, and most of them include PTSD in their list of qualifying conditions. Multiple cross-sectional and prospective studies have documented that cannabis use is widespread among individuals with PTSD, and anecdotal evidence shows that many who use cannabis do notice a significant reduction in one or more symptoms.

Unfortunately, misinformation about cannabis and decades of prohibition have made it difficult to even obtain cannabis, let alone study its therapeutic effects in humans. Research has been limited, but it does suggest that cannabis can be a valuable treatment option for PTSD.

Recent Research on Cannabis and PTSD

In a 2020 prospective study, Bonn-Miller et.al. examined PTSD symptoms and functioning in 150 participants every three months for one year. Participants were divided into two groups – those who use cannabis and those who do not (the control). Over the course of the study, the participants who consumed cannabis reported a greater decrease in the severity of hyperarousal symptoms over time compared to the controls, and they were 2.57 times more likely to no longer meet the diagnostic criteria for the PTSD at the end of the study compared to the controls.

Last year, researchers conducted the first randomized, placebo-controlled trial comparing the therapeutic potential of THC and CBD for PTSD symptoms.

They used a double-blind, cross-over design to compare the effects of three different concentrations of THC and CBD-containing cannabis:

• high-THC (12% THC and <0.05% CBD)
• high CBD (11% CBD and <0.05% THC)
• and THC+CBD (7.9% THC and 8.1% CBD)

Cannabis at all concentrations showed good tolerability and resulted in symptom improvements during the three weeks of treatment. All treatment groups reported statistically significant reductions in PTSD severity, but this difference was more dramatic among participants who received high-THC or THC+CBD cannabis.

In another recent study led by Carrie Cuttler, a Washington State University assistant professor of psychology, people suffering from PTSD report that cannabis reduces the severity of their symptoms by more than half.

Cuttler and her colleagues analyzed data of over 400 people using Strainprint. An app developed to help users learn what types of medical marijuana works best for them - this group used it 11k times during a 31 month period leading up until publication date.

“A lot of people with PTSD do seem to turn to cannabis, but the literature on its efficacy for managing symptoms is a little sparse,” Cuttler said.

The results of this study imply that it is some combination of THC, CBD and perhaps some of the other molecules present in cannabis that create the therapeutic effect. Cannabis has many molecules that can create a biological effect, including up to 120 cannabinoids, over 150 terpenes and around 50 flavonoids. This further underscores the need for more studies that look at whole plant cannabis, as this is what people are using much more than the synthetic cannabinoids.

Inhaled cannabis acutely reduced PTSD symptoms by more than 50%

PTSD and the Endocannabinoid System

A growing body of research indicates that the endocannabinoid system (ECS) may be directly involved in the development and maintenance of PTSD symptoms and that augmenting this system may offer therapeutic potential. The ECS is a complex neuromodulatory system located in the brain and throughout the body that is implicated in many critical functions, including emotional learning and memory processing.

Cannabinoid receptor type 1 (CB1) is involved in regulating most neuronal activities and acts in numerous brain regions that affect fear memory extinction, including the amygdala and prefrontal areas.

When someone experiences an acute stressful event, this impacts their autonomic nervous system functioning, causes changes in gut microbes, triggers the release of certain hormones and neurotransmitters, affects neutrophil function and microglia activity, and results in elevated levels of inflammatory cytokines in the brain.

Chronic stress experiences are thought to sustain many of these dynamic processes, eventually causing excessive neuronal activation that increases the development of psychological pathologies. Researchers believe that PTSD may evolve through these processes, and that there is a phase after the trauma during which features of the disorder incubate and emerge based on the sensitization of neuronal functioning.

The exact processes that govern PTSD have not been fully identified, but the main neurological hallmarks of the disorder include hyperactivity of the amygdala and hypoactivity of the medial prefrontal cortex. These features may result from deficiencies in ECS signaling and likely account for symptoms such as heightened anxiety, heightened startle response, attentional bias to fear and trauma cues, and impairments in extinguishing traumatic memories. Hyperactivity in the amygdala is positively correlated with the degree of symptom severity, while hypoactivity of the medical prefrontal cortex is negatively correlated with symptom severity.

Researchers believe that this hyperarousal anxiety is a fundamental aspect of several PTSD symptoms, including memory and cognitive impairments, sleep disturbances, altered pain sensitivity, emotional numbing, depression, anxiety, and suicidality. It may also be responsible for those re-experiencing their trauma or being compelled to avoid triggers.

PTSD is associated with increased expression and availability of CB1 receptors, which is in turn associated with excessive threat processing and anxious arousal. Two prevalent endogenous cannabinoids, AEA and 2-AG, are present in reduced concentrations in those with PTSD, further supporting the idea that this disorder is caused by abnormal CB1 receptor signaling.

Evidence shows that THC and CBD can both positively influence the processes underlying PTSD pathology, either directly or indirectly by activating the eCB. In animal studies, administering CBD in rats and mice dampens their cue-elicited fear responses, THC and THC+CBD both block reconsolidation of fear memory, and THC or CBD administered alone can facilitate fear extinction learning. This suggests that these cannabinoids may help alleviate symptoms by changing how people experience and respond to reminders of the trauma.

The Best Cannabis Strains for PTSD

Cannabis products are classified as specific strains based on the plant’s chemotype (chemical profile), phenotype (physical appearance), and therapeutic properties. Most people with PTSD prefer indica or indica-dominant strains or those with high levels of CBD because they tend to promote relaxation, alleviate stress, relieve pain, reduce depression, and improve sleep quality.

These strains are either indica-dominant or contain CBD and all come highly recommended:

• Black Mamba – indica-dominant hybrid, mid-high THC, ideal for bedtime.
• ACDC – balanced hybrid, high CBD and low THC, ideal for daytime.
• Northern Lights – indica, high THC, helps with insomnia, ideal for bedtime.
• Pennywise – indica-dominant hybrid, 1:1 CBD to THC, ideal for the afternoon.
• OG Kush – balanced hybrid, high THC, ideal for the evening.
• Sour Kush – indica-dominant hybrid, mid-high THC, known for euphoria.
• Granddaddy Purple Kush – indica-dominant hybrid, known for aiding sleep.
• Harlequin – sativa-dominant hybrid, 1:1 CBD to THC, ideal for daytime.

You can also look out for strains containing the limonene terpene as it’s known for its uplifting effects.

Here are some Verano strains high in limonene you can try:

Clementine

sativa, high in limonene, energizing and uplifting

G Nana

sativa-dominant hybrid, high in limonene, relaxing

Motorbreath

balanced hybrid with high limonene, known for relaxation

Thai -G

sativa-dominant hybrid with many key terpenes, very uplifting

Keep in mind–many dispensaries carry only a few high-CBD flower strains for some key reasons. First, high-potency THC strains have been the breeding focus for many growers for decades, and CBD has only recently become a focus as more benefits are revealed. Dispensaries also prioritize strains that sell well, most of which are higher in THC. For these reasons, products like tinctures, edibles, and vapes are often much better medicating options for PTSD–they can be formulated with higher amounts of CBD and are typically well-stocked in quality dispensaries like Zen Leaf. 

Recent studies have shown that cannabis could help ease the symptoms of PTSD. If you or someone you know is struggling with PTSD, contact our customer care department or visit a Zen Leaf dispensary near you. Our team would be more than happy to answer any questions and help find the perfect strain for your needs.

References:

1. Abizaid, A., Merali, Z., & Anisman, H. (2019). Cannabis: A potential efficacious intervention for PTSD or simply snake oil?. Journal of psychiatry & neuroscience: JPN, 44(2), 75–78. https://doi.org/10.1503/jpn.190021
2. Bonn-Miller, M. O., Sisley, S., Riggs, P., Yazar-Klosinski, B., Wang, J. B., Loflin, M. J., Shechet, B., Hennigan, C., Matthews, R., Emerson, A., & Doblin, R. (2021). The short-term impact of 3 smoked cannabis preparations versus placebo on PTSD symptoms: A randomized cross-over clinical trial. PLOS ONE, 16(3). https://doi.org/10.1371/journal.pone.0246990
3. Bonn-Miller, M. O., Brunstetter, M., Simonian, A., Loflin, M. J., Vandrey, R., Babson, K. A., & Wortzel, H. (2022). The long-term, prospective, therapeutic impact of cannabis on post-traumatic stress disorder. Cannabis and Cannabinoid Research, 7(2), 214–223. https://doi.org/10.1089/can.2020.0056
4. Zaske, S. (2020, June 9). Study shows cannabis temporarily relieves PTSD symptoms – WSU Insider. WSU Insider. https://news.wsu.edu/press-release/2020/06/09/study-shows-cannabis-temporarily-relieves-ptsd-symptoms/