Posttraumatic Stress

The typical approach in dealing with post-traumatic stress disorder (PTSD) and co-morbid anxiety is exposure-based therapies that include talk therapy and eye movement desensitization and reprocessing (EMDR).  Current research is focusing on targeting neurotransmitters, the chemicals in the body that are released by the nerves (4) and affect a person’s thoughts, hormones, and more.

Through research, doctors have discovered a vast amount of information about the endocannabinoid system. The endocannabinoid system is composed of the cannabinoid receptors CB1 and CB2. They receive inputs from fat-based neurotransmitters that can be made in the body or introduced through medications or cannabis. The hippocampus is very rich in CB1 receptors; it is the structure in the brain responsible for learning, memory, and emotions (6).

When a person is exposed to a traumatic experience or stressful situations, the endocannabinoids being sent to the cannabinoid receptors change, creating a physical and mental stress response (6). Scientists believe that cannabinoids such as Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) help change the endocannabinoids being released, affecting a person’s mood and the stress hormone cortisol’s levels (4).  In addition, it can be an important tool during exposure therapy because of how these chemicals affect the hippocampus.

The activation of the endocannabinoid system during emotional processing helps extinguish or diminish fear responses an individual may have with a particular memory. It does not make the person forget the traumatic memory, but it helps remove the fear that is connected to and triggered by the memory (4).

At low doses, THC has an anxiolytic, or anxiety-reducing effect that is similar to serotonin and norepinephrine reuptake inhibitors (SNRIs) and anti-anxiety medications such as buspirone. In addition, CBD also decreases anxiety and isn’t dose size-specific (5). Using it alone does not cause any intoxication like that experienced from marijuana. To learn more about how medical marijuana affects the anxiety component of PTSD, please check out our page on anxiety.

In general, it is recommended that people take lower doses of THC because it can actually cause more anxiety and paranoia if it is taken in larger doses (2). Patients should choose between CBD only, high CBD, and 1:1 CBD to THC products to alleviate symptoms of PTSD. This should be in conjunction with their mental healthcare provider’s recommendations and care. Doses of medical marijuana generally begin between 2-20 mg before bedtime and can be used during the day once an effective dose has been determined. PTSD Patients who don’t want to feel impaired should start with CBD only (2).

It may be helpful to keep a log of your dose and its therapeutic effects if you are new to cannabis products and share that information with your providers. Cannabinoids may only be one part of your treatment plan between you and your provider, and cannot replace personalized mental healthcare. Always report any worsening symptoms right away to a qualified healthcare provider, or seek emergency medical care at an emergency room.

Vape concentrates and tinctures are commonly recommended for treating PTSD and anxiety because they are easy to dose and these products typically contain the amounts of both CBD and THC that are in the product (2). Vaping may not be suitable for all people, however, and may carry other health risks.

Concentrates such as wax or shatter are not recommended for treating PTSD because they contain high doses of THC that may cause increased anxiety, distress, and paranoia. Edibles are also not recommended because they are difficult to adjust doses on. In addition, edibles are metabolized in the liver, which has effects that vary for each person (2).

Because tolerance occurs over prolonged cannabis use, having less effect on the CB1 receptors, any benefits from taking it for mental health can exacerbate symptoms when a user is not using it. Taking a tolerance break can re-regulate the CB1 receptors if this is the case (7).

People who are receiving treatment of PTSD typically go through behavioral therapy that exposes them to the traumatic event or memory; this is called prolonged exposure therapy. After patients are exposed over and over again, when they recount the event, their anxiety and the feelings associated with the memory becomes more manageable. This is followed by a process called extinction, where the reduced fear level is used to create a new and present association with the traumatic stimulus (9). Prescription medications are also commonly used in conjunction with, or instead of, therapy only under the supervision of a licensed provider.

Researchers led by Christine Rabinak at Wayne State University in Detroit, MI are currently in the process of conducting a multi-phase study focusing on how THC and other chemicals in marijuana affect patients who have PTSD and are undergoing prolonged exposure therapy (9). The first phase of this study began in 2014 with rodents.

Rabinak discovered that when THC is given to patients before extinction learning, they experience less intense emotions than what was previously associated with the traumatic memory. In addition, patients were more likely to continue experiencing diminished emotions associated with the memory (9). The results here are currently being tested in a double-blind and placebo control group study, but this is promising for marijuana users who are PTSD sufferers. Essentially, ongoing research suggests that we not only can use cannabis to treat trauma-related anxiety, but that we can also utilize it as a tool in therapy sessions.

A 2020 study from Cannabis and Cannabinoid Research followed 150 patients over a year in order to compare PTSD in cannabis users versus patients who did not use it. Though this study did not set up controls on how cannabis was being taken or how frequently it was being used, it did evaluate patients every three months with self-administered PTSD assessments and logs that collected data on how often the patients used cannabis and the ingestion methods (10).

This observational study showed that patients using cannabis experienced a greater decrease of PTSD symptoms of the year evaluation period as well as were 2.57 times more likely to no longer meet the DSM-5 criteria for PTSD. The results show that cannabis that is available from dispensaries might hold promise as an alternative treatment for PTSD, although more randomized and placebo control studies are needed in order to determine how different methods of consuming it impact PTSD (10).

Ashley Priest is a cannabis writer who works for a variety of publications including Veriheal’s Cannabis Central blog. Check out Ashley’s author page here. She is a mother living with PTSD, anxiety, and depression. She recently shared insight into her use of medical marijuana use for these conditions: