Post traumatic stress disorder (PTSD) is a serious mental condition that affects more than 44 million Americans. One in 11 people will be diagnosed with PTSD in their lifetime. According to estimates, 70% of adults in the U.S. have gone through some type of traumatic event at least once in their lives – equivalent to 223.4 million people. At least 20% of these people eventually develop PTSD. [R]
PTSD does not discriminate against men, women, adults or children. It can happen to anyone. The disease is not limited to a personal traumatic experience. Events such as the unexpected death of a loved one can also cause PTSD. [R]
One out of every nine women develops PTSD – twice as likely as men. Rape and child abuse are two of the most common experiences that lead to PTSD in women.
While men tend to manifest anger, hostility, and unpredictable, uncontrollable outbursts as PTSD symptoms, women often become depressed, exhibit anti-social behavior, and engage in self-harm. [R]
What is PTSD?
Post traumatic stress disorder (PTSD) is a psychiatric disorder that can develop in people who have witnessed or experienced a traumatic event. These include rape, violent personal assault, serious accidents, natural disasters, war or combat, and terrorist acts.
In the past, PTSD was known as "shell shock" during World War I and "combat fatigue" after World War II. Today PTSD does not only affect war veterans. People of any age, gender, profession, nationality, and ethnicity can suffer from this mental condition. [R]
PTSD often manifests itself in the following reactions:
- Emotional indifference
- Personality change
- Exaggerated startle and fear
- Inability to control emotions
- Recurring nightmares
- Inability to sleep
- Acute anxiety
- Hyper vigilance
- Substance abuse
People with PTSD often have intense, disturbing thoughts long after the traumatic event has ended. They relive their experience through flashbacks or nightmares. They feel great sadness, anger or fear. They react negatively even to the most mundane like a loud noise or an accidental touch. The most alarming thing about PTSD is that patients are at a higher risk for self harm and suicide.
How to diagnose PTSD
PTSD symptoms last for more than a month and sometimes years. Although many individuals develop symptoms around three months after the traumatic event, some symptoms may appear at a later time. [R]
One common symptom of PTSD is reliving the traumatic experience through flashbacks or nightmares. Words, objects, or situations are sensory cues that can act as trigger. They tend to bring back the original intense feelings of fear and horror when the event happened.
People with PTSD may try to avoid places, situations or even people that remind them of the traumatic event. This can lead to estrangement and disinterest in activities they once enjoyed. One might even change routine such as avoiding cars after a car accident.
Arousal and reactivity symptoms.
Another symptom of PTSD is lashing out due to irritability. Difficulty in concentrating, sleeping and eating can lead to stress, anger, and violent outbursts.
Cognition and mood symptoms.
Loss of enjoyment, negative and pessimistic thoughts, distorted feelings, and trouble recalling significant pieces of the event are all symptoms of PTSD.
Individuals who suffer from PTSD are always on the edge and tend to overreact to unexpected stimuli. Most patients are unable to fight off the fear when something triggers a reaction – such as the explosion of fireworks for a war veteran or speeding car for an accident survivor. The fear can be so overwhelming that daily activities are disrupted and functioning normally becomes impossible.
How to treat PTSD
Psychotherapy is one of the oldest methods for treating PTSD, dating back to as early as the 1800s. [R] Antidepressants and other psychiatric drugs are also a popular option for controlling PTSD symptoms. Studies however suggest that traditional pharmaceuticals may not be the safest or most effective course of treatment. Most prescription drugs for PTSD only treat the symptoms and not the root cause. They are also not designed for trauma treatment. For example, Prazosin is prescribed to help PTSD patients combat sleep problems even if it is actually intended for treating high blood pressure.
Antidepressants may be helpful in providing relief but they can be addictive. Psychotherapy helps victims work through the trauma by addressing the root cause of the symptoms but it can be a long and arduous process – not to mention expensive. Results also vary on a case by case basis.
In recent years, cannabis has emerged as a suitable, safe and accepted method of treatment for PTSD. Studies have shown that cannabinoids are able to reduce the emotional impact of traumatic events, lower anxiety levels, eliminate flashbacks and nightmares, fight depression, and improve sleep and stress tolerance without the risk of possible substance abuse.
The cannabis compound THC has long been championed as an option for PTSD treatment. THC however is illegal in most states because of its psychoactive effects. On the other hand, its sibling CBD which is derived from hemp is legal in all 50 states and is easy to purchase online.
CBD provides the same medical benefits of THC without the high. Although clinical trials are still lacking, findings have shown that CBD could help PTSD patients manage the three core symptoms of the disease: re-experiencing, avoidance, and arousal.
For military veterans and assault victims, PTSD can be a completely debilitating mental illness. It can ruin family life, ability to work, maintain social relationships, and even handle daily tasks.
PTSD is one of the most difficult mental illnesses to treat. And while there is no cure for post traumatic stress disorder, CBD shows great promise as a reliable and safe substitute for pharmaceuticals and psychotherapy in controlling and treating PTSD symptoms.
What is CBD?
The chemical compounds in the cannabis plant are called cannabinoids. Scientists have isolated at least 113 cannabinoids from the three species of cannabis – indica, sativa, and ruderalis.
THC (tetrahydrocannabinol) and CBD (cannabidiol) are the two most dominant cannabinoids, and the most studied too. CBD makes up 40% of the cannabis plant, which makes it second to THC in concentration.
Other valuable cannabinoids include:
- Cannabicitran (CBT)
- Cannabigerol (CBG)
- Cannabichromene (CBC)
- Cannabigerovarin (CBGV)
While THC may have many medicinal benefits, it is primarily known for its euphoric and psychoactive effects. CBD, on the other hand, is a non-psychoactive compound with more medicinal properties than THC.
Hemp CBD vs. marijuana CBD
CBD is found in hemp and marijuana – which are both part of the cannabis plant family. The main difference between marijuana and hemp is the amount of THC in each strain.
THC is responsible for the psychoactive high that marijuana creates when people smoke or ingest weed. It is also the reason why many are hesitant to choose cannabis as a treatment option despite its therapeutic potential.
Hemp contains little to no THC, and it has lots and lots of CBD.
The legal distinction between hemp and marijuana lies in the percentage of THC in the compound. THC levels from 0.3% to 15% that are found in marijuana plants are considered illegal. Industrial hemp is a legal category given to cannabis plants that contain less than 0.3% THC.
CBD oil from hemp is 100% safe and 100% legal. CBD oil from marijuana is only legal where that specific plant has been approved for medicinal or recreational use in a particular state.
How is hemp CBD oil made?
For CBD to be legal, cannabidiol must be extracted from the stalks and stems of the hemp plant.
CBD is often produced through carbon dioxide extraction. In CO2 extraction, the plant is filtered through a series of chambers exposed to high pressure and low temperature. Stripping away other cannabinoids, terpenes, trichomes, and other chemical compounds, the system is able to isolate cannabidiol at a 90% efficiency rate.
CBD, PTSD, and the human endocannabinoid system
As early as 2007, scientists have been looking at how the human endocannabinoid system might be a valuable therapeutic target for the treatment of psychiatric disorders such as phobia, generalized anxiety disorder (GAD), and post traumatic stress disorder (PTSD). These conditions involve aberrant memory processing and impaired adaptation to altered environmental conditions. [R]
Discovered in 1992 by Israeli researcher Dr. Ralph Mechoulam, the endocannabinoid system is a vast network of receptors in the human body that is responsible for regulating immune response, sleep, pain, neuron generation, and neuroplasticity. Its two main receptors – CB1 and CB2 – are configured to accept cannabinoids, especially tetrahydrocannabinol (THC) and cannabidiol (CBD).
CB1 and CB2 receptors have been found to modulate the release of neurotransmitters and produce a wide range of effects on the central nervous system, including pleasure and memory. When CBD binds to these receptors, they block the retrieval of traumatic events and reduce the fear and anxiety associated with them.
One important endocannabinoid related to PTSD is anandamide. Also known as the bliss molecule, anandamide is the neurotransmitter responsible for the release of serotonin. When anandamide binds to the CB1 receptor, it creates a calming effect that puts the body at ease. CB1 signaling deactivates traumatic memories – essentially forgetting those experiences. Researchers found that people with PTSD all have lower levels of anandamide. Defective CB1 signaling due to anandamide deficiency results in impaired fear extinction, aversive memory consolidation, and chronic anxiety. CBD can help correct this deficit by replacing anandamide levels.
Constant state of fear is a common problem experienced by people living with PTSD. The CBD cannabinoid helps to reduce "learned fear" so it attacks the root of the problem unlike prescription medication that only treats symptoms.
A report published in 2012 revealed how the endocannabinoid system could provide an avenue for evidence‐based treatment of PTSD. Dr. Alexander Neumeister, professor of psychiatry and the director of the Molecular Imaging Program for Mood and Anxiety Disorders in New York University Langone Medical Center, evaluated brain mechanisms that contribute to the development of PTSD, depression and addiction disorders. His research focused on the manipulation of the endocannabinoid system, specifically anandamide and 2-arachidonoyl-glycerol, to promote neurogenesis in conditions that are associated with fear and anxiety.
Dr. Neumeister found that CB1 signaling plays a key role in fear extinction. Defective CB1 signaling results in failure to expunge aversive memories and leads to chronic anxiety and depression. [R]
Also in 2012, Italian researchers evaluated animal models of PTSD focusing on three elements: stressor exposure, memory for the stressor, and anxiety-related behaviors. The study also outlined current therapeutic directions with a focus on cannabinoid and glucocorticoid compounds. [R]
In 2013, researchers looked at endocannabinoid concentrations in PTSD patients. PTSD appears to be associated with changes in plasma endocannabinoid concentrations that may have pathophysiological and diagnostic consequences. [R]
Scientific evidence: CBD as possible therapy for PTSD
There is much talk about cannabinoids – particularly CBD – emerging as a possible treatment option for anxiety-related disorders such as PTSD. Studies involving cannabis compounds have been extremely promising as scientists discover how CBD might be able to help PTSD patients manage the three core symptoms of the disease: re-experiencing, hyper-arousal, and avoidance and numbing.
In 2009, an open label clinical trial reviewed the charts of 47 patients who have been diagnosed with PTSD, had been seeing a psychiatric specialist from 2004 to 2006, and continue to experience nightmares despite taking conventional antidepressants and practicing hypnotics. The objective of the trial was to evaluate the effects of nabilone, an endocannabinoid receptor agonist, on treatment-resistant nightmares. An incredible (72% of the patients who took nabilone experienced either cessation of nightmares or a significant reduction in nightmare intensity. Patients also reported improvement in sleep time and quality of sleep, as well as reduction of daytime flashbacks and night sweats. These results indicate the potential benefits of cannabinoids in patients with PTSD who experience poor control of nightmares with standard pharmacotherapy. [R]
Two years later, rat models of PTSD were injected with the CB1/CB2 receptor agonist WIN55, 212-2 (WIN) systemically or into the basolateral amygdala (BLA) at different time points following single-prolonged stress (SPS) exposure. SPS enhanced conditioned avoidance and impaired extinction while enhancing ASR, negative feedback on the HPA axis, and anxiety. The subjects were tested a week later for inhibitory avoidance (IA) conditioning and extinction, acoustic startle response (ASR), hypothalamic-pituitary-adrenal (HPA) axis function, and anxiety levels. The results showed that WIN administered after SPS prevented the trauma-induced alterations in IA conditioning and extinction, ASR potential, and HPA axis inhibition. These findings suggest that cannabinoids could serve as a pharmacological treatment of stress- and trauma-related disorders. [R]
In a 2014 study by Greer, Grob, and Halberstadt, the New Mexico Medical Cannabis Program collected 80 psychiatric evaluations of patients from 2009 to 2011. The patients were given marijuana for their PTSD, and the results indicated a 75% reduction in symptoms according to the Clinician Administered Posttraumatic Scale for DSM-IV (CAPS). [R]
Another study found enough preclinical evidence to support CBD as a legitimate treatment for anxiety disorders and PTSD when administered accurately and securely. [R]
Most recently, a study published in Frontiers in Pharmacology in 2016 showed that CBD could be an effective treatment for specific phobias and PTSD by reducing fear memory. The research team injected 10mg of CBD to rats that had been exposed to strong fear conditioning. Rats are prey animals that often exhibit a ‘freeze response’ when under attack. After the injections, CBD both acutely inhibited fear expression and enhanced extinction to produce longer lasting reductions in fear. [R]
In Israel, where the rate of PTSD is three times that of the United States, a nonprofit organization called Multidisciplinary Association for Psychedelic Studies (MAPS) has been focusing on the study of medical marijuana in treating anxiety disorders. In its most recent clinical trial, scientists found that treatment with cannabis led to a 40% decrease in PTSD scores. Another survey of patients found cannabis to be more effective and preferred than pharmaceutical medications in lowering symptoms. [R]
Psychiatrist and New York University researcher Dr. Esther Blessing confirmed that "there is good evidence to suggest that CBD could be an effective treatment of anxiety and addiction but we need clinical trials to find out."
Dr. Blessing and her team have secured funding from the National Institutes of Health for a new clinical trial on how CBD might be able to treat people with PTSD and alcohol addiction. It will involve 50 participants who will be given placebo or 400 milligrams of CBD daily. The objective of the study is to find out if CBD could lead to alcoholics drinking less and whether that provides relief for PTSD symptoms. Start date for the study is November 15, 2018 and estimated completion date is August 31, 2019. [R]
How can CBD help treat PTSD?
A review of published evidence found that cannabinoids can help PTSD patients manage re-experiencing, avoidance and numbing, and hyper-arousal symptoms. CBD can also help improve sleep in PTSD patients who are suffering from insomnia and nightmares. [R]
When cannabinoids activate human endocannabinoid receptors, they modulate neurotransmitter release and produce a wide range of central nervous system effects – including increased pleasure and alteration of memory processes. Those effects provide a pharmacologic rationale for the use of cannabinoids to manage the three core PTSD symptoms. Cross-sectional studies on cannabis use by military veterans with PTSD have found a direct correlation between more severe PTSD symptoms and increased motivation to use cannabis for coping purposes, especially among patients with difficulty in tolerating stress or regulating emotion. Data from four small studies have suggested that cannabinoid use was associated with global improvements in PTSD symptoms or amelioration of specific PTSD symptoms such as insomnia and nightmares. While further research into cannabinoid treatment for PTSD symptoms is required, existing evidence indicates that substantial numbers of military veterans with PTSD use cannabis to control PTSD symptoms, with some patients reporting benefits in terms of reduced anxiety and insomnia and improved coping ability. [R]
Regulating fear memory
One incapacitating effect of PTSD is the prevalence of fear memory or fear conditioning. For example, some soldiers return from the war with an overwhelming fear of loud noises. This fear reaction was conditioned by repeated exposure to bombs, artillery, and other noises on the battlefield. When they come home, even the benign sound of fireworks may trigger an unmanageable emotional or physical outburst.
Targeting this particular symptom, one 2016 study conducted in Canada explored how CBD might regulate learned-fear response in mice. Researchers introduced a predator (cat) to condition the mice and elicit a typical freezing reaction. After seven days of CBD treatment, the mice demonstrated remarkably reduced fear memory symptoms. After presenting the cat to the mice, the latter did not show the usual conditioned fear response of freezing. The study concluded that CBD may regulate mesolimbic [reward pathway] activity and modulate the formation of associative emotional memories. [R]
Another similar study in 2012 by German researchers concluded that there is increasing evidence that cannabinoids might play a role in fear extinction and anti-depressive effects. Further studies are warranted in order to evaluate the therapeutic potential of cannabinoids in PTSD. [R]
Bedtime is another difficult period for PTSD patients as they often experience traumatic nightmares and have difficulty sleeping.
Those who are suffering from post-traumatic stress disorder (PTSD) often complain of sleep disturbances such as insomnia and rapid eye movement (REM) sleep abnormality. The anti-anxiety properties of CBD can help increase REM sleep while keeping the patient calm. [R]
In 2016, an actual case was presented Dr. Scott Shannon of the University of Colorado School of Medicine. One of his patients was a 10-year-old girl who was sexually abused and had minimal parental supervision as a young child under the age of five. Among her symptoms were sleep disturbances, anxiety, and emotional outbursts at school. Pharmaceutical medications provided partial relief, but results were not long-lasting and there were major side effects. Before starting CBD oil therapy, the child underwent a Sleep Disturbance Scale for Children and the Screen for Child Anxiety Related Disorders to provide a baseline of measurement. She took CBD oil sublingually before bed for five months. After this period, the researchers reported that the girl was able to comfortably sleep in her own room and slept much better throughout the night. She also had decreased anxiety, and her emotional outbursts at school had disappeared. The researchers did not discover any significantly measurable side effects associated with CBD. [R]
Compared to sleeping aids, CBD seems to treat insomnia without the sedative side effects. Some research even links CBD to increased alertness during daylight hours.
The anti-anxiety properties of CBD are well documented. The continued study of CBD and how it works with the human endocannabinoid system presents an exciting new area for anxiety researchers.
CBD produces anti-anxiety effects in both animal trials and small human trials on people with social anxiety disorders. Time and time again, CBD has proven to reduce daily stressors for PTSD patients. [R] [R]
How to take CBD for PTSD
There are many different ways to consume CBD. The most common are:
CBD sublingual drops
The most common and most effective method of administering CBD is sublingually or under the tongue. CBD drops are known to produce long-lasting effects as they allow the body to metabolize the cannabidiol and deliver relief where and when it is needed.
CBD extracts in oil form are also the most accurate in dosing and best in quality.
To take CBD through sublingual administration, place a few drops under the tongue and hold it there for several seconds before swallowing.
For those who cannot tolerate the taste of hemp, CBD oil can be added to food or beverage to make it more appealing to the palate. CBD oils can also be mixed with MCT oil but this solution should NOT be vaped.
The fastest way to stop a panic attack is to vape CBD. This could mean a world of difference between a slight increase in stress and a full blown anxiety attack.
CBD oils that are specifically designed for vaping are now available in many vape shops.
Although it is a fast and effective way to take CBD for PTSD, vaping does not have the same long-lasting effects as other methods do.
For those who are not fond of the taste of oil, pills may be easier to swallow. CBD is now available in capsule or soft gel form.
One of the most enjoyable ways of consuming CBD is by adding it to your favorite food and drinks. Mix CBD oil drops with smoothies, shakes, and other liquids. You can also add CBD isolates to baked goods such as cookies and brownies. CBD is great for cooking because it is tasteless, odorless, and highly soluble. Mix it with coconut oil, butter or honey to make pasta dishes, dips, and desserts.
CBD topical creams
CBD can also be applied directly to the skin. This is the most ideal method if you are taking CBD for pain because it targets the specific muscle. CBD topical creams are often mixed with other essential nutrients such as aloe, tea tree, and lavender to enhance the benefits of cannabidiol.
The term dabbing refers to the flash vaporization of CBD concentrates when applied to a hot surface. CBD isolates are 99% pure cannabidiol so they are very potent when inhaled. Dabbing is one of the best ways to achieve immediate and effective relief from CBD.
Some people take CBD through the most unusual of entry points – the rectum.
Suppositories are an effective way to take medicine because of their bioavailability – the degree and rate at which a substance is absorbed into the body. The bioavailability of CBD through rectal absorption is more than double that of taking it through the mouth. When CBD is taken orally, much of it is lost as it passes through the body. The effects of a CBD suppository may take longer to set in than vaping but will last for up to eight hours.
Why is CBD oil the most ideal form of CBD for treating PTSD?
CBD oil is one of the best ways to take CBD for PTSD because it is convenient and discreet. Topical creams often give off a strong scent. Dabbing and vaping release visible "smoke" into the air. Of course you cannot insert a suppository when you are in public. All of these methods attract unwanted attention. With CBD oils, you simply need to squeeze a drop or two directly under your tongue or mix it with your favorite food or drink. Take your CBD bottle with you wherever you go so you do not miss a dosage.
Does CBD oil get you high?
No, CBD oil will not get you high as long as it is extracted from hemp. Cannabidiol is a non-psychoactive compound with no mind-altering effects.
Full spectrum CBD may contain a little THC but it will not affect you in the way that THC from marijuana does. If you do not want to take any THC at all, then CBD isolates are best for you. Pure 99% CBD from hemp can provide you with all the medical benefits of cannabis without any high.
Does CBD oil get you hooked?
No, hemp CBD oil is not addictive. When CBD binds to your receptors, it does not turn them on. When THC binds to your receptors, it turns them all the way up to create a very powerful psychoactive high. It is this high that makes it so addictive.
What are the side effects of CBD oil?
Based on studies, CBD is well tolerated by the human body. It does not present any serious side effects like those associated with antidepressants.
Cannabidiol is generally safe for human consumption with minor side effects such as:
- Dry mouth
- Change in appetite
- Upset stomach
- Low blood pressure
If you are taking prescription medication for diabetes, heart problems, and other medical conditions, do not use CBD without consulting your doctor. CBD can interfere with your liver and might negate the effects of your existing medications.
The anti-inflammatory effects of CBD and other cannabinoids may also cause lung problems. A review published in Frontiers in Pharmacology in 2016 suggested that cannabinoids may be reducing inflammation too much that it could modify the defense system of the lungs against possible infection. [R]
Your doctor might not recommend vaping CBD oil if you are suffering from asthma or any other type of lung disorder. [R]
In a 2014 study published in Epilepsy Currents, 10% of patients showed changes in liver function and 3% had to stop taking CBD due to possible liver damage. [R]
Make sure you talk to your doctor first before adding CBD to your treatment plan.
Is CBD oil legal?
CBD is legal when it is derived from hemp. According to the 2014 Federal Farm Bill, a substance is classified as industrial hemp if it contains less than 0.3 percent of THC.
The Farm Bill allows companies to source domestic hemp products under appropriate licensing from state departments of agriculture in Colorado and Kentucky.
Will I fail a drug test if I take CBD?
Full spectrum CBD products contain less than .3% THC. Non-psychoactive cannabinoids such as CBD, CBG, and CBN do not usually cross-react with THC in a drug screen. However, there are rare cases of false-positive results when CBD is taken in large doses from 1000mg to 2000mg.
If you are concerned about drug screening, please do additional research before taking any CBD product.
How much CBD oil should you take?
PTSD treatment requires highly individualized planning. There is no magic pill for everyone. When treating any type of mental disorder, it is recommended to start low and work your way up until you feel the effects from a proper dosage. Pay attention to the way your body reacts before increasing your dose.
Size matters when it comes to treatment dosage. Large people most likely need higher dosing compared to smaller ones. A good starting point is 2.5mg to 10.5mg daily.
It is important to always consult with a physician before making drastic changes to a treatment program. Although CBD continues to show promise in alternative PTSD treatment, it may not be for everyone.
From what we know so far from existing studies, endocannabinoid deficiency in PTSD patients could open the door for a variety of cannabis treatments. The ability of CBD to block memories associated with emotional distress can also help PTSD patients “unlearn” the trauma of the trigger event.
CBD also regulates sleep hormones, stress hormones, and mood receptors. These are all major trigger points for PTSD. Reducing stress levels, improving quantity and quality of sleep, and consistent mood alignment over extended periods of time can go a long way in reducing PTSD symptoms. PTSD patients who take CBD oil have reported a revival of emotional expression, an improvement in relationship stability, and a reduction in opiate dependency.
CBD hemp oil is now widely available and 100% legal in all states. Because endocannabinoid deficiencies play a significant role in PTSD, cannabinoids such as CBD has become one of the better treatment options out there with little to no risk of dangerous side effects.