Post-Traumatic Stress Disorder, Its Symptoms, and the Use of Cannabis as a Treatment
By Zachariah Finning
PTSD is a serious and often common mental disorder that arises in survivors of traumatic events. It is seen in veterans of war, rape victims, even extreme car accidents that can cause PTSD symptoms to arise in individuals. It has been acknowledged in the field of psychology for some time and has remained to be treated primarily by means of pharmaceuticals. Since the boom of the Medicinal Marijuana industry, there has been a high demand for the plant as treatment. In this blog, we will discuss what PTSD actually is along with its multiple symptoms. We’ll also quickly touch upon the common forms of treatment and their adverse side effects. Lastly, we will take a look at parts of a case study that examines cannabis as an approach to treating the illness.
According to the American Psychiatric Association, PTSD – which stands for post-traumatic stress disorder – is a “psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist attack, war or combat, a rape, and those who have been threatened with death, sexual violence or serious injury” (S1). The condition has most likely been around since the beginning of human history. The origins of what is now called PTSD can be traced back as far as Ancient Greece. The first indications of “combat stress” can be found in the historical literature of Lucretius and Hippocrates (S2). Evidence of “battle trauma” and “flashback-like dreams” are mentioned in the poem De Rerum Natura, and this was written around 50 BC (S2). The status quo of explaining and treating these afflictions were mostly primitive, cruel, and stagnant until the early 1900s. The First World War along with The Second unveiled an awareness of the traumatic effects of war that had not been previously acknowledged. 1915 saw the term “shell shock” introduced to the medical literature of the day (S2). This condition described the exact same symptoms as PTSD and would go on to become the predecessor of the official diagnosis of today (S2). In 1980 PTSD was officially adopted into the DSM-III, or Diagnostic Manuel of Mental Disorders, which is the definitive text used by psychologists for diagnosing patients.
PTSD does not only affect combat veterans; the affliction can manifest in people of any nationality, ethnicity, culture, and age. Figures gathered by the American Psychiatric Association show PTSD affects 3.5 percent of U.S adults yearly (S1). It is also estimated that 1 in 11 people will develop the condition at some point within their lifetime (S1). Statistics show that women are twice as likely as men to have PTSD and three ethnic groups – US Latinos, African Americans, and Native Americans – are disproportionately affected with higher rates of the affliction (S1). As mentioned previously a diagnosis does require exposure to an extremely traumatic event, but that exposure could be indirect rather than first hand. For example, symptoms could arise in individuals such as police officers, EMTs, social workers, social media moderators, etc. These are individuals who may be repeatedly exposed to details, images, and scenes of a traumatic event due to their professions. Symptoms may even arise in an individual learning the details of a family member’s untimely and violent death – a parent learning of the passing of a child for instance (S1). PTSD has no discretion in who or why it manifests itself. Once it does the symptoms and their effects can be debilitating.
The main symptoms of PTSD fall into four generalized categories; however, an individual’s specific symptoms can vary drastically. The main symptoms attributed to PTSD would be an intrusion, avoidance, alteration in cognition and mood, and lastly alteration in arousal and reactivity. The intrusion has to do with thoughts including repeated involuntary memories, discomforting dreams, or vivid lucid-dream like flashbacks of the exact event (S1). Avoidance references the diagnosed individual “actively avoiding places, activities, people, and even objects that may trigger distressing memories” or the intrusive thoughts to occur. Resisting talking about what happened to them or how they feel about the event is another classic component of avoidance (S1). Alteration in cognition and mood is where the symptoms seem to get more complex. It encompasses an “inability to recall important information about the traumatic event along with negative thoughts or feelings directly leading to inaccurate beliefs” about oneself, others, and the cause and effect of their trauma. This will usually end up leading to “ongoing fear, horror, shame, guilt, detachment from others, and loss of positive emotions” (S1). The last symptom, alteration in arousal and reactivity, weighs heavily on the afflicted. This symptom may include “being easily irritable” and in a state of constant anxiety, “having angry outbursts”, an increase in dangerous or otherwise self-destructive behavior, “increased suspicions of one’s surroundings, and the problem with concentration or sleep” (S1). These four different generalized symptoms, which include multiple sub-symptoms of their own, are only the tip of the iceberg that is the actual consequence of long-term PTSD on an individual. It is not hard to see why a human mind plagued with PTSD can become easily overwhelmed, incoherent, or broken down.
Original Treatments for PTSD, “shell shock” at the time, ranged anywhere from psychoanalysis and isolation to electric shock therapy (S2). It wasn’t until the 1950’s that treatments started to become more humane in their approach. This was “ushered in by the advent of group therapy and, at the time, newly created psychotropic pharmaceutical medications” (S2). Therapy and pharmaceuticals have remained the primary treatments for PTSD since the ’90s. Alongside therapy, the common pharmaceuticals used to combat PTSD include antidepressants, anti-anxiety medications, mood stabilizers, and alpha-1 Blockers (S3). Antidepressants are the most common medication used for the treatment of depression and anxiety related to PTSD. They work by raising the levels of serotonin in the brain. This chemical regulates mood, sleep, appetite, and helps to improve the communication between nerve cells. Usually resulting in improvement to the overall mood and decreased anxiety (S3). Some of the side effects of these specific medications can include “nausea, constipation or diarrhea, sexual dysfunction, and insomnia” (S3). Mood stabilizers along with anti-anxiety medications may be prescribed to those individuals who do not respond beneficially to antidepressants (S3). Mood stabilizers work by balancing out chemicals in the brain that are related to the regulation of emotions. They typically help to quell the anger, agitation, or general irritability that comes with PTSD. “Vomiting and drowsiness” are common side effects of mood stabilizers. Anti-Anxiety medications work on a short-term basis by calming the communications along with the central nervous system. In other words, they stop the nerve cells from communicating. The side effects of anti-anxiety medications range from “fatigue and dizziness” to feelings of extreme sedation (S3). Lastly, alpha-1 blockers are mostly administered to those who are experiencing extreme cases of night terrors or insomnia. They work by decreasing the brain’s fear and startle responses reducing the occurrence of night terrors and insomnia (S3). Side effects may include low blood pressure and even fainting (S3). With all the side effects of these medications, it is sometimes more harmful than rewarding to an individual struggling with PTSD to continue taking them. It is due to these adverse side effects that many PTSD survivors look towards cannabis and other holistic approaches as viable options for of treatment.
Cannabis as a treatment for PTSD is still in its infancy. Demand for the plant as treatment has been increasing ever since the Medicinal Marijuana boom in the U.S. Surely more scientific testing and studies are needed on this, but there are some promising outlooks related to the treatment of PTSD with cannabis. In a joint study by Alfonso Abizaid, Zul Merali, and Hymie Anisman, all PhDs in their field, there was some pivotal information indicating that cannabis may be a viable option for some of PTSD’s conditions. In their study, it states that “low endocannabinoid tone [the overall state of one’s endocannabinoid system] contributes to the hyper-activation as well as the anxiety and hyperarousal symptoms characteristic of PTSD” (S4). They go on to state that “hyperarousal anxiety may be fundamental in promoting many of the most debilitating aspects of PTSD” including but not limited to “sleep disturbances, memory, and cognitive impairments, depression and anxiety, and emotional numbing” (S4). In other words, our endocannabinoid system, and how trauma affects it, plays a direct role in the manifestation of PTSD. They go on to state that there are “indications that cannabis or some of its components, primarily THC and CBD, diminish particular symptoms of PTSD” (S4). In a small study, it was shown that “5mg [of THC] twice a day as an add-on treatment enhanced sleep quality and reduced the frequency of nightmares, PTSD hyperarousal, and global symptom severity” (S4). In layman’s terms, THC proved to help quell some of the overall symptoms of PTSD. The study goes on to talk about how the anti-inflammatory component of Cannabis may benefit some PTSD patients. The study states “cannabis also mitigates the propensity for inflammation and may be useful in psychological conditions that involve elevated inflammatory processes within the brain.” They continue to conclude that “cannabinoids could potentially act against PTSD by activation of cannabinoid receptor CB2 which promotes anti-inflammatory actions through microglia” or cells that are located throughout the brain and spinal cord (S4&S5). The study does go on to state that although promising “much still needs to be assessed concerning the efficacy and safety of cannabis in treating PTSD” (S4). Individual endocannabinoid systems and different dosing for certain conditions are clear hurdles that would need to be taken into consideration. Never the less it seems there is some scientific evidence to promote Cannabis as a treatment for PTSD.
Social stigmas surrounding mental health used to keep those suffering from seeking not only medicinal but psychological and holistic treatments as well. Luckily in today’s evolving world mental health is not as taboo to speak about or let into the open. As we evolve in how we perceive these afflictions we must also advance how we look to treat them. For decades the treatments for PTSD have remained mostly pharmaceutical. Although there is some relief found in these treatments those who continue this path are often met with lasting side effects that are not only unpleasant but create problems of their own. Looking towards cannabis as treatment provides not only hope for those burdened but also some new scientific understandings of how PTSD comes to manifest itself.