Many people use marijuana to help them relax or take the edge off after a stressful day. The cannabinoids in the plant can soothe your mind. Medical cannabis is often prescribed for mental health issues, including anxiety and post-traumatic stress disorder, or PTSD.
However, marijuana is not always the best option for managing symptoms associated with trauma. Some strains can make you paranoid and increase anxiety. Cannabidiol, or CBD, is one of the compounds found in the cannabis plant that has been shown to help with mental disorders such as PTSD. In this article, you’ll learn why it works on psychological and physical symptoms of the disorder.
What Is Post-Traumatic Stress Disorder?
Post-traumatic stress disorder, or PTSD, affects approximately 8 million American adults every year. To understand how CBD can help individuals with PTSD, it’s useful to review what the condition entails. PTSD is an anxiety disorder that affects those who have experienced or been threatened by a traumatic event.
Feeling scared, nervous or helpless is normal after a distressing occurrence, such as a violent attack, car accident or death of a loved one. This stress response helps you survive. Remembering the danger allows you to go into fight-or-flight mode next time you’re in a hazardous situation.
Traumatic stress is different than PTSD, though. Acute stress typically goes away in a matter of days or weeks. You may remember the event, but you stop responding to its memory with intense emotions. PTSD persists and produces recurring symptoms that interfere with daily functioning.
Some signs that you may have PTSD after experiencing a trauma or extreme emotional event include:
• Nightmares
• Flashbacks
• Sleep disturbances
• Intrusive, negative thoughts
• Detachment
• Anger and irritability
• Intense fear
• Guilt
• Emotional numbness
• Startle responses
• Trouble with memory or concentration
• Hypervigilance
You may feel out of control because you feel as though you can’t get a handle on your emotions. This is not a sign of weakness. It occurs because traumatic stress changes your brain.
Stress hormones change the communication circuits in the nervous system, including the hippocampus, which is involved in verbal declarative memory. Intense stress can affect learning. Traumatic experiences can also destroy brain cells and prevent the generation of new neurons.
Some people with PTSD have lower levels of cortisol, a stress hormone, on a regular basis. However, their cortisol response to stress is exaggerated, making them have intense reactions to triggers.
There are many neuronal circuits involved in expressing emotions and managing fear. Certain types of conditioning can change those circuits.
In many studies, humans or animals are conditioned to feel fear when they are shocked after touching a neutral object, such as a box. After this happens, they’ll show signs of anxiety whenever they see the box. They can be conditioned to stop feeling nervous if they stop getting shocked when they touch the box. This can take time, but it reflects the fact that your brain circuitry can be re-wired, so to speak.
People with PTSD experience changes to their neuronal circuitry that prevent fear conditioning to be released. That’s one reason that exposure to distressing reminders of the trauma can continue to cause an increase in PTSD symptoms.
Cannabinoids and the PTSD Brain
You might wonder why cannabis would be an option for treating PTSD. The main active compounds in marijuana are tetrahydrocannabinol, or THC, and CBD. Both exert effects on the endocannabinoid system, a network of receptors and neurotransmitters in the body that help you stay healthy. While THC produces psychoactive effects, CBD doesn’t alter your mind.
As scientists have looked into the causes of PTSD, they’ve noticed a few things. Many PTSD symptoms are produced by changes in the way that emotional memories are processed. Effective treatment should block the intensified association and retrieval of traumatic memories, enhance the extermination of those memories and diminish anxiety. Because the endocannabinoid system regulates emotions and contributes to the consolidation, recovery and elimination of memories, it might serve as a potential target for PTSD treatment.
The wide range of symptoms associated with PTSD point to the involvement of various neurotransmitter systems. CBD acts on some of these systems and may be able to help the cognitive and affective issues that characterize PTSD.
The endocannabinoid system consists of:
• CB1 and CB2 receptors
• Endocannabinoids
• enzymes that produce and destroy endocannabinoids
Cannabinoid receptors are spread throughout the central nervous system. They’re found in the same areas of the brain that display changes in patients with PTSD. Endocannabinoids regulate emotional behavior and mental functions. CB1 receptors are associated with processes that control neural communication. CB2 receptors are mostly linked with immune responses.
The involvement of the endocannabinoid system in PTSD could explain why women are more likely to develop PTSD than men. Women have a higher density of CB1 receptors.
When the endocannabinoid system operates properly, it helps you stay emotionally balanced. However, it can be influenced by a variety of factors, including events that happen to you or substances that you take. Administering exogenous cannabinoids, such as CBD, may restore certain processes that become maladaptive in people with PTSD.
Traditional Treatments for PTSD
PTSD is difficult to treat because it is often associated with other mental disorders, such as depression. The most common medications that are used to treat PTSD include:
• Serotonin reuptake inhibitors, or SSRIs
• Serotonin-norepinephrine reuptake inhibitors, or SNRIs
• Tricyclic antidepressants, or TCAs
• Monoamine oxidase inhibitors, or MAOIs
• Anticonvulsants
• Antipsychotics
• Benzodiazepines
Patients with PTSD are often prescribed more than one of these medications at a time. Polypharmacy inflates the risk of side effects and drug interactions.
SSRIs are used to treat the depression and anxiety that are associated with PTSD. They produce fewer side effects than other antidepressants, but they can still cause:
• Headache
• Nervousness
• Sexual dysfunction
• Blurred vision
• Diarrhea
Similar side effects can occur with MAOIs. These antidepressants can also negatively interact with some foods and beverages. People who take MAOIs or SSRIs can develop serotonin syndrome, which happens when serotonin levels are dangerously elevated.
Atypical antipsychotics have been used traditionally for treating schizophrenia, but evidence suggests that they’re helpful for treating some PTSD symptoms. They affect different neurotransmitters than SSRIs or MAOIs do. The side effects, however, include muscle spasm, movement problems, weight gain and diabetes.
Anticonvulsants have been found effective for reducing symptoms in veterans with PTSD. To this regard, it’s interesting that CBD is also being studies for its anticonvulsant properties. Many of the studies on anticonvulstants and PTSD have failed to show statistically significant effects of this type of medication. Anticonvulsants are also associated with adverse side effects, such as tremors and fatigue.
Benzodiazepines are commonly prescribed for inducing relaxation. They may help decrease symptoms of anxiety and reduce panic attacks in people with PTSD. They’re not ideal for long-term use because they produce physical dependence. Weaning off of benzodiazepines can produce uncomfortable or life-threatening withdrawal symptoms.
The pharmaceuticals may control symptoms of anxiety, but they don’t address maladaptive memory formation. Therefore, they don’t get to the source of the condition. Furthermore, some patients don’t experience symptom relief when they take these medications.
Other approaches, including various types of psychotherapy, are often used to help with the cognitive aspects of PTSD. CBD oil can be used along with other types of therapy to improve a wider range of symptoms that are associated with PTSD.
How CBD Can Improve PTSD Symptoms
PTSD is a complicated disorder that involves many brain regions and processes. It can produce many adverse effects that get in the way of a fulfilling life. CBD works on different areas of the endocannabinoid system to improve multiple symptoms.
CBD Helps Reconsolidate Memories
Memories are not just stored in the back of your mind after you’ve processed them. They’re stashed away dynamically, which means that they can come back up at any time. Your brain must sort them out each time that they’re reactivated.
When you remember an event, the stored information can be strengthened or extinguished. You might reconsolidate the memories, stabilizing them. Conversely, you might start associating other factors with those memories, weakening the original information. These opposing processes depend on biochemical activity as well as the age and strength of the memories.
If you’ve been conditioned to feel fear every time you enter a car because you were involved in a collision, you might relive the memory of the crash every time you get behind the wheel. Eventually, after driving repeatedly without having an accident, you’ll associate positive input with driving, and the fear should dissipate. In people with PTSD, this may not happen.
CB1 cannabinoid receptors are involved in the extinction of memories. Stimulating these receptors while memories are triggered has been shown to block the reconsolidation of memories and thereby snuff them out.
In one study, rats showed a reduction in fear behaviors when they were given CBD immediately after memory reactivation. The CBD was not as effective in extinguishing fear when it was administered 6 hours after memory retrieval, which is the typical time frame during which reconsolidation occurs. However, the memory disruption from CBD was long-lasting.
Many PTSD therapies involve confronting the emotions and memories associated with traumatic events. Patients learn how to face their fears by learning techniques to address the intrusive thoughts and emotions that come up when they talk about or concentrate on the stressful event.
Breathing, relaxing or performing certain eye movements while retrieving the memories can help extinguish them. CBD may be an ideal addition to this type of therapy because it can change the way that your brain reconsolidates and stores memories.
CBD doesn’t always have to be administered during memory retrieval, though. Activating the cannabinoid receptors immediately after a distressing event can prevent PTSD symptoms from coming on. This window of time may be short. Research shows that CBD thwarted maladaptive memory processes when it was administered within 24 hours of the event, but it didn’t have the same effects after 48 hours.
CBD Reduces Anxiety
Maladaptive memory formation is only one symptom of PTSD. People with the disorder may develop general or acute anxiety. Anxiety is more than worry or nervousness. It’s a devastating condition that can significantly impair an individual’s quality of life. It interferes with social functioning and can increase suicide risk.
In a 2008 study, researchers showed that CBD also facilitated fear extinction by making rodents less anxious. A 2015 review references several other studies on the anti-anxiety effects of CBD. In several preclinical, clinical and epidemiological studies, CBD has been shown to improve symptoms of anxiety, including panic attacks and social anxiety.
CBD May Improve Depression
One of the ways in which CBD may reduce anxiety is by binding to serotonin receptors. Serotonin is a neurotransmitter that can help boost your mood.
Many anti-depressants also influence serotonin. SSRIs, for example, prevent the body from reabsorbing the chemical after it’s released, leaving it in the bloodstream to exert its positive effects.
CBD is associated with fewer side effects than SSRIs. It may need to be used routinely to improve PTSD symptoms.
CBD Can Help You Sleep
Nightmares and sleep disturbances are prevalent in approximately 70 percent of people with PTSD. Antidepressants and other medications for PTSD may not reduce their intensity or frequency. The detrimental impact of nightmares can amplify the other symptoms of PTSD, including insomnia and anxiety.
In one study, participants with PTSD were given nabilone, a synthetic cannabinoid that mimics some of the effects of CBD. More than 70 percent of the patients experienced a reduction in nightmare frequency or intensity. Many said that they slept better and longer than they had previously. Some even had fewer daytime flashbacks.
Most of the research into using cannabinoids for nightmares has looked at cannabis products that contain THC. Few studies have been done to evaluate the effects of CBD alone on nightmares. However, the data shows promising results for regulating the severity of nightmares with cannabinoids.
That’s not surprising, because the endocannabinoid system is responsible for helping you maintain a healthy sleep cycle. It may even influence your dreams’ subject matter.
CBD May Prevent Abuse of Harmful Substances
People with PTSD might be desperate to relieve their symptoms and self-medicate with recreational drugs. Some use alcohol to numb the powerful emotions that are associated with PTSD. Many use marijuana to cope with the disorder. Although marijuana has many therapeutic effects, its use may be problematic for people with some psychological illnesses.
As THC binds directly to cannabinoid receptors, the entire endocannabinoid system responds by decreasing the number of receptors. Therefore, your body becomes less sensitive to the cannabinoid and you develop a tolerance. Over time, someone who smokes marijuana to manage anxiety from PTSD may need to use more to get relief.
Some clinicians avoid prescribing or recommending cannabis to people who are at a greater risk of abusing or misusing it. On the other hand, medical cannabis may serve as a substitute for alcohol, opiates and illicit drugs. Some researchers have found that PTSD symptoms may get worse in people who use cannabis frequently to improve sleep and to relieve negative feelings.
CBD may be a better option. Even if patients with PTSD find that marijuana helps their symptoms, they’re putting themselves at risk of increasing their anxiety symptoms or becoming dependent on the drug. CBD offers the same therapeutic effects as marijuana without the high or potential for addiction. CBD may even impede addiction to other drugs.
CBD for PTSD in Children
Although you might hear many stories and news articles about adults with PTSD, the condition also affects children. Kids don’t have to be directly threatened to develop a stress response. They may learn that a loved one was threatened or witness violence in person.
Children with PTSD may have nightmares related to the event. However, the subject matter of these frightening dreams may not seem to correlate directly with the trauma.
Youngsters with PTSD may also act socially withdrawn, stop doing the activities that used to interest them, have strong emotional or physical reactions to things that remind them about the occurrence or fail to express positive emotions. They can also have trouble falling and staying asleep.
In one case study, a 10-year-old child with PTSD didn’t get long-lasting relief for her symptoms from pharmaceutical medications. She also experienced significant side effects, such as hallucinations, from some of the drugs.
In addition to having trouble sleeping and experiencing anxiety, the child was acting up at school. Taking supplements such as magnesium, melatonin, fish oil and vitamin B8 improved some of her sleep issues, but she was still exhibiting inappropriate behavior and continued to have underlying anxiety.
When the child started using CBD supplements, many of these symptoms improved. The patient took 25 milligrams of CBD before bed and 6 to 12 milligrams of a sublingual CBD spray as necessary for anxiety during the day.
She began sleeping in her own bed, and her sleep quality improved. She also demonstrated less anxiety and started doing better in school. No side effects were noticed.
Some people are hesitant to use CBD on their children because of its association with cannabis. It has repeatedly been demonstrated as safe for use in humans.
Most other pharmaceuticals are associated with potentially serious side effects. Prescription medications may not be ideal for treating PTSD, especially in children. Antidepressants have been found to increase suicide risk in children and young adults.
How to Take CBD for PTSD
The available scientific literature does not provide a satisfactory foundation for recommending a particular dosage of CBD. The studies on CBD for epilepsy and Dravet Syndrome use extremely high dosages of about 600 milligrams per day.
One interesting finding is that high doses of CBD are not always the most effective for treating anxiety. Most studies show that moderate doses of more than 10 milligrams per kilogram but less than 100 milligrams per kilogram are the most effective.
It’s tough to predict the perfect dosage based on studies, though. Much of the research is done by injecting rodents with CBD. A dosage of 10 milligrams per kilogram would be far too much for the average human. That would be equivalent to about 680 total milligrams of CBD for a 150-pound person.
There is no recommended daily allowance for CBD, and doctors can recommend a dosage but cannot prescribe it. Most experts suggest that you take about 25 milligrams of CBD once or twice per day.
Observe the effects for a week. You can increase or reduce the dosage as necessary after that.
Keep in mind that different dosages may deliver varying effects based on your current health status. What works this month may not work next month. Moreover, because PTSD symptoms are so diverse, you may notice that regular administration of CBD improves some conditions, such as sleep, but taking it acutely is better for immediate anxiety.
Inhaling CBD delivers the fastest results and may be ideal if you’re having a panic attack. Keeping a CBD vape pen with you may give you an option for dealing with triggering memories when they occur.
When you take CBD by mouth in capsules or eat a CBD-infused food product, the cannabidiol takes longer to produce effects. Oral CBD produces longer-lasting effects than inhaling it. Taking it sublingually also helps it absorb into the bloodstream rapidly. You might want to try a few different CBD products to determine which ones work best for you.
