Tags: cannabinoids; cannabis; CBD; fear extinction; nabilone; PTSD

 

Thumbnail: This review looked at a number of studies to determine the effects of using CBD to treat Post-Traumatic Stress Disorder (PTSD). Overall, the studies showed that cannabinoids can be an effective treatment option for patients with PTSD. The studies in this review found that cannabinoids relieve symptoms and were relatively well tolerated.

 

The problem: Post-Traumatic Stress Disorder (PTSD) is a disorder that some patients develop following a traumatic event, characterized by extreme anxiety and an elevated fear response. Current treatment options include various psychotherapies but not all patients respond to these therapies. Recently, different approaches have been tried: using cannabinoids to target the endocannabinoid system, with the goal of reducing the symptoms of PTSD and enhancing the extinction training used to overcome the associated fear memories.

 

The study: In this study, the authors review studies relating to the use of cannabinoids for the treatment of PTSD from the last 10 years, including: four cohort studies, four randomized clinical trials, one case report, and one case series. The studies analyzed were looking at the use of Cannabis extracts, tetrahydrocannabinol (THC) and cannabidiol (CBD), and synthetic cannabinoids.

 

Main Points:

• Cannabinoids were seen to improve various PTSD symptoms, including decreasing treatment-resistant nightmares, hyperarousal, daytime flashbacks, increasing sleep quality and general well being

• When used in conjunction with extinction training, cannabinoids increased the effectiveness of eliminating the fear memories and preventing their reoccurrences. This was particularly effective when the cannabinoids were given after the extinction training, rather than before it.

• Cannabinoids were usually well-tolerated, with minimal adverse effects (such as light-headedness, forgetfulness, dizziness, and headaches). Some patients occasionally experienced symptoms which caused them to discontinue treatment, but that was not a common occurrence

• Nabilone, a synthetic cannabinoid developed for medicinal purposes, was shown to provide the same benefits as the cannabis extracts but with fewer adverse effects

 

Conclusions: Overall, these studies showed that cannabinoids can help to improve overall PTSD symptoms, including sleep quality and quantity, hyperarousal, and treatment-resistant nightmares. When participants are undergoing extinction training, cannabinoids enhanced consolidation and retention of the training; this enhancement was effective when cannabinoids were given after the training rather than before.

 

Why this is a good study:

• This review provides a thorough review of the most relevant studies to date, detailing an overview of the potential use of cannabinoids to treat PTSD

• This review recognizes the limitations of the studies it surveyed, suggesting the results need to be further validated with additional studies.

 

Why this isn’t a perfect study:

• As might be expected (due to the difficulty of enrolling patients with chronic PTSD that meet study criteria), a common limitation of these studies was their small sample size. Therefore, any conclusions drawn from those studies and in this review should be interpreted with caution

• The conclusions drawn from these studies are limited by the weaknesses in the individual studies. For example, many studies excluded patients who also had other disorders (substance use disorders, mood disorders, psychotic disorders, etc), which accounts for a significant portion of those with chronic PTSD. Other studies failed to account for differences in the length of treatment between patients.

 

What this study adds:

• This study consolidates existing information on the risks/benefits of cannabinoid as therapy for PTSD

• It also shows that more comprehensive studies are needed to fully understand the effects of cannabinoids in the wider population of PTSD patients

 

What it doesn’t:

• The authors were unable to draw conclusions about the use of cannabinoids to treat PTSD patients with other co-occuring disorders, which is common in the population of those with PTSD

• This study does not add any new data about the risks or benefits of cannabis use in this context

 

Funder: None stated

 

Author conflicts: None stated