Post-Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder (PTSD) is when an extremely traumatic, stressful, distressing, or frightening experience is relived. Nightmares, flashbacks of the traumatic event(s), feelings of isolation, withdrawal, guilt, and irritability are common signs and symptoms. Those with PTSD have a dysregulated flight-or-fight response. Those with PTSD can feel stressed and frightened, even if there is no danger present.

Approximately 12 million adults in the U.S. have PTSD during a given year. An estimated 6% of adults in the U.S. will develop PTSD during their lifetime. Women are more likely to develop PTSD compared to men. This could be due to several different reasons, such as the type of trauma, differences in how trauma is processed, and men’s symptoms not typically following the diagnostic criteria for PTSD as it is currently defined.

PTSD is often, but not always, grouped with anxiety disorders, as they share many common signs and symptoms. People suffering from PTSD often also experience depression. Those who have faced a series of traumatic events or one traumatic event over a long period are more likely to be diagnosed with complex PTSD (cPTSD). PTSD is usually related to a single, briefer traumatic event.

Medical cannabis and cannabidiol (CBD) have been noted to help manage PTSD symptoms, especially anxiety, insomnia, and recurring nightmares.

PTSD Causes

PTSD is typically caused by experiencing one or more traumatic events. These can include:

• Serious accidents, such as a road accident.
• Physical or sexual assault.
• Abuse, including childhood or domestic abuse.
• Exposure to traumatic events at work, including remote exposure.
• Serious health problems, such as being admitted to intensive care.
• Childbirth experiences, such as losing a baby.

Those with chronic PTSD have a smaller hippocampus, the part of the brain associated with memory, learning and emotions. There also seems to be an abnormality in the hypothalamic-pituitary-adrenal (HPA) axis which regulates the body’s stress response and can lead to an over-consolidation of specific memories. Those with PTSD also have chronically low serotonin levels, a chemical messenger which affects mood.

PTSD Symptoms & Health Effects

Common signs and symptoms of PTSD include:

• Constantly feeling on edge, on guard, tense, and/or anxious.
• Being easily shocked or startled.
• Difficulty focusing or concentrating.
• Difficulty falling or staying asleep (insomnia).
• Recurring nightmares or sleep disturbances.
• Flashbacks to the traumatic event.
• Irritability and/or angry or aggressive behavior and outbursts.
• Engaging in risky, reckless, or destructive behavior.
• Comorbidities such as anxiety, depression, headaches/migraines, insomnia, and substance use disorder (SUD) are more common in those with PTSD.

PTSD Diagnosis

Signs and symptoms of PTSD tend to develop within three months of the traumatic event, but sometimes they may take longer to appear. Symptoms need to last at least one month, cause significant distress or impairment, and not be attributable to another condition like depression or Substance Use Disorder (SUD). PTSD is typically diagnosed by a professional psychiatrist.

What Patients Say About Their Diagnosis

PTSD Prognosis

Those with PTSD have a reduced quality of life and studies have shown that the disorder can reduce life expectancy quite significantly, with some sources suggesting a decrease of up to 20 years for some types of trauma and PTSD.

Although many treatment methods for PTSD are effective, some types of PTSD are particularly difficult to manage or treat. Approximately two-thirds of veterans with PTSD remain with the disorder after treatment, so effective long-term treatments still need to be found for those with treatment-resistant PTSD.

PTSD Treatments

Non-medication first-line treatments include psychological therapies such as trauma-focused cognitive behavioral therapy (CBT) or eye movement desensitization and reprocessing (EMDR). Following a healthy diet, engaging in exercise and practicing good sleep hygiene is also highly recommended. Effective relaxation techniques include focused breathing, meditation, and Yoga.

When it comes to prescription medications, antidepressants like paroxetine, sertraline, escitalopram, mirtazapine, amitriptyline or phenelzine are common first-line treatments.
While antidepressants may be effective for PTSD, there do seem to be some marked differences in terms of how biochemical changes in the brain and body occur when compared to depression. So, while PTSD can share similar symptoms with anxiety and depression (and could well be a comorbid condition), there are differences between the conditions and how they are treated.

Other medications prescribed for PTSD include anticonvulsants like pregabalin and benzodiazepines like diazepam (Valium). These have varying levels of efficacy, and those with PTSD should avoid long-term use of benzodiazepines.

First-Line Treatments

First-line treatments usually include psychological therapies and maintaining a healthy lifestyle. If medications are prescribed, they are typically antidepressants to help manage stress, depression, and anxiety.

Other Treatments

Should first-line treatments not work, sedative medications like benzodiazepines may be prescribed for short-term use.

Adjunctive Therapy & Alternative Treatments

Focused breathing, meditation, and Yoga are often recommended for those with PTSD.

Cannabis for PTSD

There are several possible benefits of cannabis over prescription medications, such as:

1. Antidepressants can take several weeks to take effect. Many people have to try several different antidepressants before finding one that is effective. Medical cannabis, meanwhile, has same-day effects, allowing patients to quickly determine if medical cannabis is suitable for them.
2. Fewer negative side effects compared to prescription medications. Many current prescription medications may actually cause or worsen side effects (e.g. nausea/vomiting, agitation, insomnia, headaches/migraines, addiction) the patient is seeking relief from in the first place.
3. When it comes to prescription benzodiazepines for PTSD, there is little evidence for their efficacy. Worse still, some research suggests benzodiazepines should not be used for PTSD, yet are still prescribed: “Benzodiazepines might be effective if they selectively inhibited the stress and anxiety centers of the brain that are often hyperactive in PTSD,” researcher Jeffrey Guina, MD, Wright State University, Dayton, Ohio, said in a statement. “Instead, they indiscriminately target the entire brain–including areas that are already hypoactive in PTSD, such as the cognitive and memory centers.”
4. Cannabis contains many anti-inflammatory and stress-busting compounds (cannabinoids, terpenes, flavonoids) that can help alleviate anxiety and aid relaxation.
5. Medical cannabis can help reduce or replace intake of several different classes of drugs, including antidepressants, anxiolytics, anticonvulsants, benzodiazepines, and other sedatives and opioids: “Pain medication was the most prevalent prescription drug substituted with CaM [cannabis as medicine], followed by antidepressants and arthritis medication.” (S.L. Kvamme et al., ‘Exploring the use of cannabis as a substitute for prescription drugs in a convenience sample’, Harm Reduction Journal, 2021)
6. Cannabinoids from cannabis (phytocannabinoids) may help regulate endocannabinoid transmission in those with PTSD. The endocannabinoid system is involved in body functions including memory, stress response, social behavior, sleep, and appetite. Those who experience trauma in childhood demonstrate decreased levels of endocannabinoid ligands and receptors. While those who experience trauma in adulthood demonstrate decreased levels of endocannabinoid ligands, but increased levels of cannabinoid receptors.

What Patients Say About Cannabis for PTSD

PTSD Prognosis

Additional Information for Cannabis Patients

There are many resources for those with PTSD, especially if it is to do with military/seeing combat. You can find support from the Veterans Association (VA) and charities like the PTSD Foundation of America, Stay Safe Foundation, Headstrong Project, Heroic Hearts Project, and Wounded Warrior Project. Other charities with less of a focus on veterans include the CPTSD Foundation, and Erase PTSD Now.

PTSD FAQs

What everyday struggles do people with PTSD face?

Those with PTSD may struggle with trusting others, closeness, communication, learning, sleep, and problem solving. This can severely impact one’s quality of life.

What’s the difference between PTSD and anxiety?

Although many of the signs and symptoms of PTSD and anxiety overlap (intrusive thoughts, persistent worry, agitation, etc.), PTSD can be tied to a specific event or series of events, whereas anxiety is not. PTSD has been listed as an anxiety disorder in some mental health diagnostic manuals in the past, but nowadays PTSD is categorized as a trauma- and stressor-related disorder.

Are there any specific compounds in cannabis that may help manage PTSD?

There are many compounds in cannabis that may be useful for managing stress, anxiety, insomnia, and other symptoms associated with PTSD. These include cannabinoids like:

• Tetrahydrocannabinol (THC) = appetite stimulant, pain-relieving, sedative and may help reduce the intensity and frequency of nightmares. However, too much THC may prompt anxiety in some, so low-to-moderate doses may be ideal.
• Cannabidiol (CBD) = anti-inflammatory, anxiolytic (anti-anxiety) and can help buffer some of the psychotropic effects of THC.
• Cannabigerol (CBG) = may enhance pleasure and motivation and regulate sleep and appetite.
• Cannabinol (CBN) = has sedative effects that may help manage insomnia.

Terpenes for PTSD:

• Limonene = help uplift mood and relieve anxiety & depression.
• Linalool = has relaxing properties that can help aid sleep and reduce stress.
• Bisabolol = has neuroprotective properties and may help manage anxiety.
• Myrcene = has sedative properties that can help manage insomnia.
• Beta-caryophyllene = has anti-inflammatory properties.
• Humulene = has sedative properties.

Flavonoids that could be useful for managing PTSD symptoms due to their anti-inflammatory and stress-busting effects include:

• Cannflavin A, B and C
• Quercetin
• Kaempferol