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Research: Cannabis as a Treatment for PTSD

Liquid Life Research: Cannabis as a Treatment for PTSD

Introductions and image by @SuperFunker.

1) In a review of research that explores Cannabis as a treatment for Post-Traumatic Stress Disorder (PTSD), Abizaid et al (2019) emphasized that a variety of stressor experiences can provoke neurobiological changes that result in PTSD. Of these changes, a low endocannabinoid tone contributes to amygdala hyperactivation and hyperarousal symptoms of PTSD:

  • Sleep disturbances.
  • Memory loss.
  • Cognitive impairments.
  • Neuroinflammation.
  • Altered pain sensitivity.
  • Depression.
  • Anxiety.
  • Emotional numbing.
  • Avoidance.
  • Re-experiencing.
  • Dissociation.
  • Suicidality.

Given that an endocannabinoid deficiency appears to play a roll in the development of PTSD, the capacity of Cannabis to manipulate the endocannabinoid system could be a potent therapy. Specifically, Abizaid indicates that cannabinoids can enhance sleep, reduce nightmares and suppress neuroinflammation. However, more work is needed to understand various PTSD conditions, functional dosing regimens, sex differences and efficacious phytochemical combinations.

Cannabis: A potential efficacious intervention for PTSD or simply snake oil?

Abstract
The ancient Egyptians used willow bark as a remedy for aches and pains, even though they were unaware that salicylic acid was responsible for its anti-pyrogenic and anti-inflammatory actions. Based on anecdotal reports and social media chatter, cannabis might yet displace salicylic acid as the most prolific cure-all. Like the bark of the willow, the marijuana plant and its derivatives have been used to diminish treatment-resistant epilepsy and to reduce chronic pain, even before it was understood that the active components of the cannabis plant, Δ9-tetrahydocannabinol (THC) and cannabidiol (CBD), contributed to these outcomes. Cannabis is also touted to be effective in attenuating a wide range of conditions, including asthma, inflammatory bowel disease, glaucoma, multiple sclerosis, menstrual cramps, AIDS, nausea and cancer. Beyond these effects on physical conditions, cannabis has been reported to improve neurocognitive and psychiatric conditions, such as Alzheimer disease, anxiety disorders and bipolar disorder.

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2) Lake et al (2019) assessed a survey of 24,089 respondents in an effort to understand the possible therapeutic value of Cannabis in the treatment of Post-Traumatic Stress Disorder (PTSD). Of the total participants surveyed, 420 reported being diagnosed with PTSD. Associated PTSD patients who engaged in low-risk Cannabis use, reduced the prevalence of severe depression and suicidal thoughts.

Does cannabis use modify the effect of post-traumatic stress disorder on severe depression and suicidal ideation? Evidence from a population-based cross-sectional study of Canadians.

Abstract
Background
Post-traumatic stress disorder sharply increases the risk of depression and suicide. Individuals living with post-traumatic stress disorder frequently use cannabis to treat associated symptoms. We sought to investigate whether cannabis use modifies the association between post-traumatic stress disorder and experiencing a major depressive episode or suicidal ideation.

Methods
We used data from the 2012 Canadian Community Health Survey-Mental Health, a nationally representative cross-sectional survey of non-institutionalized Canadians aged ≥ 15 years. The relationship between post-traumatic stress disorder and each outcome was modelled using logistic regression with an interaction term for cannabis and post-traumatic stress disorder, controlling for demographic characteristics, mental health, and substance use comorbidities. The ratio of odds ratios and relative excess risk due to interaction was calculated to measure interaction on the multiplicative and additive scales, respectively.

Results
Among 24,089 eligible respondents, 420 (1.7%) reported a current clinical diagnosis of post-traumatic stress disorder. In total, 106 (28.2%) people with post-traumatic stress disorder reported past-year cannabis use, compared to 11.2% of those without post-traumatic stress disorder (p < 0.001). In multivariable analyses, post-traumatic stress disorder was significantly associated with recent major depressive episode (adjusted odds ratio = 7.18, 95% confidence interval: 4.32–11.91) and suicidal ideation (adjusted odds ratio = 4.76, 95% confidence interval: 2.39–9.47) among cannabis non-users. post-traumatic stress disorder was not associated with either outcome among cannabis-using respondents (both p > 0.05).

Conclusions
This study provides preliminary epidemiological evidence that cannabis use may contribute to reducing the association between post-traumatic stress disorder and severe depressive and suicidal states. There is an emerging need for high-quality experimental investigation of the efficacy of cannabis/cannabinoids for the treatment of post-traumatic stress disorder.

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3) Orsolini et al (2019) explored perspectives on Post-Traumatic Stress Disorder (PTSD) by explaining PTSD, reviewing conventional therapeutic approaches and rationalizing both natural and synthetic Cannabis as possible solutions. Orsolini underscored several studies in which Cannabis was used to treat PTSD:

  • Patients with high PTSD scores successfully used medical Cannabis to reduce hyperarousal symptoms (stress and anxiety) and mitigate depressive symptoms.
  • A sample of United States combat veterans with PTSD, used Cannabis at least once per week and reported relief from disturbing thoughts, nightmares, insomnia, irritability, avoidance and emotional numbing.
  • 10 outpatients with chronic PTSD who used conventional medication, found that adding 5 mg of THC twice daily improved sleep and reduced the frequency of nightmares.
  • PTSD patients who used CBD for eight weeks reported a significant reduction in PTSD severity and intensity.
  • Nabilone (synthetic THC) treatment significantly reduced the presence and intensity of PTSD-induced nightmares and increased the number of hours of sleep per night among PTSD patients.
  • A study of 104 male inmates demonstrated that Nabilone significantly reduced PTSD-related insomnia and nightmares.
  • An assessment of 29 Canadian male military service members with PTSD, received Nabilone or a placebo. Distressing dream scores were significantly reduced in the Nabilone group compared to the placebo.

Use of Medicinal Cannabis and Synthetic Cannabinoids in Post-Traumatic Stress Disorder (PTSD): A Systematic Review.

Abstract
Background and Objectives
Post-traumatic stress disorder (PTSD) is a common psychiatric disorder resulting from a traumatic event, is manifested through hyperarousal, anxiety, depressive symptoms, and sleep disturbances. Despite several therapeutic approaches being available, both pharmacological and psychological, recently a growing interest has developed in using cannabis and synthetic cannabinoids stems from their consideration as more efficient and better tolerated alternatives for the treatment of this condition. The present paper aims to evaluate the clinical and therapeutic potentials of medical cannabis and synthetic cannabinoids in treating PTSD patients.

Methods
A systematic electronic search was performed, including all papers published up to May 2019, using the following keywords (((cannabis[Title/Abstract]) OR (synthetic cannabinoids [Title/Abstract])) AND ((PTSD[Title/Abstract]) OR (Posttraumatic stress disorder[Title/Abstract]))) for the topics ‘Cannabis’, ‘Synthetic Cannabinoids’, ‘PTSD’, and MESH terms, on the PubMed, Cochrane Library, and Web of Science online databases. For data gathering purposes, PRISMA guidelines were followed. Results were organized into two groups, considering cannabis and synthetic cannabinoids as different therapeutic approaches for PTSD.

Results
Present data show that cannabis and synthetic cannabinoids, both acting on the endocannabinoids system, may have a potential therapeutic use for improving PTSD symptoms, e.g., reducing anxiety, modulating memory- related processes, and improving sleep.

Conclusions
Even though the current literature suggests that cannabis and synthetic cannabinoids may have a role in the treatment of PTSD, there is currently limited evidence regarding their safety and efficacy. Therefore, additional research is needed in order to better understand the effectiveness and therapeutic usage of these drug classes and monitor their safety.

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