The Role of CBD and THC in Post-Traumatic Stress Disorder (PTSD) Recovery
The Role of CBD and THC in Post-Traumatic Stress Disorder (PTSD) Recovery
Post-traumatic stress disorder (PTSD) is a chronic psychiatric condition that can develop after experiencing a traumatic event. This can manifest in various ways, including sleep disturbances, changes in cognition, mood, and emotion, and reduced social skills. Current treatments for PTSD, such as anxiolytics and antidepressants, can be inefficient and have considerable side effects. This has led to exploration of alternative treatments, including components from Cannabis sativa, such as cannabidiol (CBD) and tetrahydrocannabinol (THC).
Understanding PTSD and the Endocannabinoid System
PTSD is characterized by symptoms like intrusive re-experiencing of the traumatic event, avoidance of reminders, negative alterations in cognition and mood, and marked alterations in arousal and reactivity. These symptoms can significantly impair daily life and overall well-being.
The endocannabinoid system (ECS) plays a crucial role in regulating emotional behavior and is essential for synaptic processes that determine learning and emotional responses, especially those related to traumatic experiences. This system includes cannabinoid receptors (CB1 and CB2), endogenous cannabinoids (endocannabinoids), and the enzymes that synthesize and degrade them.
CB1 receptors are mainly located in the brain and modulate neurotransmitter release, preventing excessive neuronal activity, thus calming and decreasing anxiety. They also play a role in reducing pain and inflammation, regulating movement and posture control, and regulating sensory perception, memory, and cognitive function.
CB2 receptors are primarily found in the immune system and are involved in regulating inflammation and immune responses.
CBD and THC: Two Key Cannabinoids
CBD is a non-psychotomimetic cannabinoid compound. It has multiple physiologic mechanisms of action, including 5-HT1A serotonergic agonism, adenosine and opioid receptor modulation, activation of the endogenous endocannabinoid system, antagonism at GPR55 receptors, and activation of transient receptor potential channels. CBD's activity at 5-HT1A receptors may drive its neuroprotective, antidepressive, and anxiolytic benefits.
THC is known for its psychoactive properties. THC and CBD exert opposing effects (anxiogenic vs anxiolytic respectively) and vary in concentration depending on the strain of cannabis.
Potential Therapeutic Effects of CBD in PTSD
Preclinical research has suggested that CBD may have a beneficial effect in rodent models of PTSD. This effect is believed to be due to the action of CBD on the endocannabinoid system. Studies in rodent models have shown that pharmacologic activation of the endocannabinoid system through CB1-receptor agonist agents leads to decreased behavioral response to aversive memories in rodent models through the inhibition of memory reconsolidation and enhanced extinction.
Recent studies have confirmed the ability of CBD to alter important aspects of aversive memories in humans and promote significant improvements in the symptomatology of PTSD. CBD may facilitate PTSD recovery via symptom management (i.e., anxiolytic effects and coping), by altering memory consolidation/reconsolidation, or by enhancing fear extinction learning.
Clinical Evidence and Studies
One case report showed that administration of 12–37 mg of oral CBD daily was associated with a reduction in anxiety symptoms and sleep disturbances in a 10-year-old patient with PTSD due to sexual trauma.
Another study showed that 32 mg of inhaled CBD resulted in consolidation of aversive memory extinction and attenuation of explicit fearful responding in healthy human subjects.
A retrospective chart review of adult psychiatric patients with a diagnosis of PTSD who consented to treatment with CBD as augmentation to routine psychiatric treatment at an outpatient psychiatric clinic showed a decrease in PTSD-specific symptomatology.
Potential Therapeutic Effects of THC in PTSD
THC, known for its psychoactive properties, and CBD, known for its calming properties, exert opposing effects (anxiogenic vs anxiolytic respectively) and vary in concentration depending on the strain of cannabis.
Individuals with PTSD often report using cannabis to manage symptoms; intrusive reexperiencing, sleep difficulties, and anxiety or hyperarousal are most frequently cited as motivating cannabis use. Furthermore, cannabis use increases with PTSD symptom severity. Coping-oriented cannabis use motives are more common in individuals with clinically significant levels of PTSD symptoms compared to those without.
Risks and Considerations
Individuals who use cannabis with PTSD symptoms compared to those without PTSD symptoms report more cannabis-related problems, greater withdrawal severity and cravings, as well as a greater likelihood of meeting diagnostic criteria for CUD, suggesting an increased likelihood of problematic use. The co-occurrence of PTSD and cannabis use is also associated with other negative outcomes including higher alcohol use, more suicidal ideation and depression symptoms, and less financial and employment stability than a diagnosis of PTSD without co-occurring cannabis use.
Although epidemiological naturalistic studies suggest that both THC and CBD are reported as anxiolytic, clinical studies show that while CBD is reliably linked to anxiolytic effects in both animal and human studies, THC is associated with anxiogenic, or anxiety increasing, effects, especially in high doses.
Conclusion
Both CBD and THC have shown potential in managing PTSD symptoms, although their mechanisms and effects differ. CBD appears promising for its anxiolytic and memory-processing benefits, while THC is often used by individuals for symptom management, albeit with a risk of adverse effects. More research is needed to fully understand the therapeutic potential and risks of both cannabinoids in PTSD recovery.
