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Posttraumatic stress disorder (PTSD) affects a large portion of our population, in particular veterans and victims of sexual or physical assault. While the current standard is to treat PTSD with antidepressants, these medications are not always effective and are associated with low remission rates. This is especially true for combat veterans who are notably resistant to pharmacotherapy. As cannabinoid receptors play a big role in PTSD, the use of medical cannabis offers a novel mechanism of treatment.
“Cannabinoids help the mind with the natural process of forgetting painful memories. This has been extremely positive for those who have experienced traumatic events. The ability to forget the trauma helps with anxiety, night terrors, and depression. Many times, patients suffering from PTSD treat those symptoms with multiple medications that have their own side effects. Access to medical cannabis has helped patients improve their quality of life after major trauma,” says Nikki Wright, the COO and co-founder of Medical Marijuana 411.
Changes in brain pathophysiology are linked to PTSD, in which activity in the fear center of our brains, the amygdala, increases while areas associated with executive function and memory decreases, upsetting the body’s ability to respond to stress. PTSD is further marked by an imbalance of important neurotransmitters, such as serotonin and norepinephrine, and symptoms present as intrusive memories, avoidance, negative changes in thinking or mood, and alterations in arousal and impulsivity.
The active ingredient in cannabis is a class of compounds called cannabinoids. While we most often associate cannabis with tetrahydrocannabinol (THC), there is another cannabinoid at play that deserves our attention. Cannabidiol works to minimize the “high” from THC with neuroprotective and anti-inflammatory properties that help mediate pain, nausea, muscle spasms, and anxiety.
Our body has its own endocannabinoid system loaded with receptors that help us maintain homeostasis in response to change; they affect memory, mood, appetite, stress, sleep, metabolism, immune function, and more. Stimulation of cannabinoid receptors has been shown to increase behaviors that allow us to cope with stress, as well as fire off serotonin and norepinephrine, facilitating the release of both excitatory and inhibitory neurotransmitters needed to maintain balance.
In PTSD, the role of cannabinoid receptors should not be underestimated. A decrease in active cannabinoid receptors has been observed in patients with PTSD, and using medical cannabis provides a different mechanism of action in which receptors found in altered regions can be activated. Stimulated cannabinoid receptors in the amygdala, for example, potentially decrease unpleasant memories, fear, and anxiety, while receptors in the hippocampus decrease hypervigilance and hyperarousal.
Medical cannabis shows promise to provide significant relief from PTSD symptoms, but the concern of developing a cannabis use disorder should be weighed, especially among a vulnerable population. Additional hurdles for the medicinal use of marijuana is differences in state eligibility, non-standardized distribution policies among dispensaries, and financial barriers in which medical cannabis is not covered by insurance.