Research is still ongoing, but medical cannabis has shown real promise in the treatment of PTSD, writes psychiatrist and cannabis prescriber, Dr Niraj Singh.
Post traumatic stress disorder (PTSD) 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 act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury.
PTSD has been known by many names in the past, such as “shell shock” during the years of World War I and “combat fatigue” after World War II, but PTSD does not just happen to combat veterans.
PTSD can occur in all people, of any ethnicity, nationality or culture, and at any age. It is estimated that six per cent of the world’s population will have PTSD at some point in their lives.
People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear, or anger; and they may feel detached or estranged from other people.
People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.
A diagnosis of PTSD requires exposure to an upsetting traumatic event. However, the exposure could be indirect rather than first-hand. For example, PTSD could occur in an individual learning about the violent death of a close family or friend. It can also occur as a result of repeated exposure to horrible details of trauma such as police officers exposed to details of child abuse cases.
What are the symptoms?
Symptoms of PTSD fall into four categories. Specific symptoms can vary in severity.
Intrusion: Intrusive thoughts such as repeated, involuntary memories; distressing dreams; or flashbacks of traumatic events. Flashbacks may be so vivid that people feel they are re-living the traumatic experience or seeing it before their eyes.
Avoidance: Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that may trigger distressing memories. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it.
Alterations in cognition and mood: Inability to remember important aspects of the traumatic event, negative thoughts and feelings leading to on going and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); distorted thoughts about the cause or consequences of the event leading to wrongly blaming self or other; on going fear, horror, anger, guilt or shame; much less interest in activities previously enjoyed; feeling detached or estranged from others; or being unable to experience positive emotions (a void of happiness or satisfaction).
Alterations in arousal and reactivity: Arousal and reactive symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being overly watchful of one’s surroundings in a suspecting way; being easily startled; or having problems concentrating or sleeping.
Many people who are exposed to a traumatic event experience symptoms similar to those described above in the days following the event. For a person to be diagnosed with PTSD, however, symptoms must last for more than a month and must cause significant distress or problems in the individual’s daily functioning.
Many individuals develop symptoms within three months of the trauma, but symptoms may appear later and often persist for months and sometimes years. PTSD often occurs with other related conditions, such as depression, anxiety as well as alcohol and substance misuse.
Treatment of PTSD
Any of the following treatment options may be recommended:
- Watchful waiting – monitoring your symptoms to see whether they improve or get worse without treatment
- antidepressants – such as SSRIs
- psychological therapies – such as trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR)
- Treatment of other concomitant mental illness as well as alcohol/substance misuse.
How does medical cannabis help?
People with PTSD
- Have lower levels of the neurotransmitter anandamide, an endocannabinoid that binds to CB1. (1)
- More CB1 receptors in brain regions associated with fear and anxiety than volunteers without PTSD
- “If anandamide levels are too low the brain compensates by increasing the number of CB1 receptors” (2)
CBD prevents the breakdown of anandamide, which binds to the CB1 receptors potentiating endocannabinoid signaling.
CBD can reduce anxiety through its actions on several receptors, which are known to regulate fear and anxiety-related behaviours. 1
THC binds to the CB1 receptor directly helps reduce sleep latency and REM sleep which results in less nightmares.
THC also modulates threat related processing in trauma-exposed individuals with PTSD (3).
Therefore medical cannabis can be effective in treating symptoms of PTSD and complex PTSD.
As patients suffering from PTSD experience intrusive thoughts, flashbacks, sleep disruptions, and demonstrate avoidance behavior, these symptoms not only contribute to the persistence of PTSD, but also render treatment difficult.
The prolonged stressors and symptom persistence cause derangement in the central neurobiological process, particularly in the prefrontal cortex, hippocampus, amygdala, and cingulate gyrus, which can lead to nightmares, sleep disruptions, and anxiety.
Research is ongoing and medical cannabis has shown real promise in the treatment of PTSD. I have certainly observed this in my clinical practice. Where conventional treatment is unsuccessful, those who access medical cannabis may experience better quality of life, psychosocial functioning, and working ability with medical cannabis treatment alongside psychological therapies.
- Elevated brain cannabinoid CB1 receptor availability in post-traumatic stress disorder: a positron emission tomography study. Molecular Psychiatry, 2013; DOI: 10.1038/mp.2013.61
- (ScienceDaily. 2020. Brain-Imaging Study Links Cannabinoid Receptors To Post-Traumatic Stress Disorder: First Pharmaceutical Treatment For PTSD Within Reach. [online] Available at: <https://www.sciencedaily.com/releases/2013/05/130514085016.htm#:~:text=If%20anandamide%20levels%20are%20too,been%20shown%20to%20impair%20memory
- Cannabinoid modulation of corticolimbic activation to threat in trauma-exposed adults: a preliminary study. Psychopharmacology (Berl)
. 2020 Jun;237(6):1813-1826. doi: 10.1007/s00213-020-05499-8. Epub 2020 Mar 11.
How CBG has been a game changer for my ADHD
Stephan shares how CBG has helped him manage his symptoms of ADHD
Stephan Ryan shares how he has found cannabis, particularly CBG, helpful in managing symptoms of ADHD.
The number of people being diagnosed with ADHD has risen during the last two years of the pandemic, with three-quarters of newly diagnosed adults saying that the fallout from lockdown had encouraged them to seek an evaluation. Some of the reasons for this were listed as working from home, where there were more external factors for distraction, as well as the rise in ADHD-related social media channels.
Stephen Ryan, who is originally from Germany but now lives in Ireland, said: “Last year during Covid, I had a period where I was completely unable to focus. My partner at the time suggested I may have ADHD, and the symptoms completely fit, a lot of my behaviour started to make sense.
“I start a lot of projects that I never finish and go down a million rabbit holes. Work can present barriers that feel so insurmountable that I can’t focus or I can’t work on it for days before getting in trouble for not having done the work.”
Some of the other symptoms Stephen noticed were restless leg syndrome, which is associated with the dopamine deficit experienced by those with ADHD and periods of hyper focus. But as the pandemic progressed, he noticed that he was finding it increasingly difficult to focus.
Stephen has seen his GP and is now waiting on an official diagnosis of ADHD from a specialist. Covid has meant a long delays to services which has left a lot of patients in Ireland going private. Unfortunately, this can mean several hundred Euros to see a doctor before paying for any potential prescription.
Stephen has been told to expect at least three to six months waiting time or around €700 for an assessment. The cost of private diagnosis and prescriptions can be hugely daunting for patients.
Attention Deficit Hyperactivity Disorder (ADHD) is a neurological condition. It can affect people’s behaviour in that they can seem restless, they may have trouble concentrating and seem impulsive. While a lot of people are diagnosed at a young age, increasing numbers of adults are being diagnosed with the disorder.
ADHD can often be missed in childhood, especially for women, which has led to a rise in adult diagnosis. It can also present differently which makes it even more difficult to diagnose.
ADHD is often divided into three different types:
Inattentive: An individual may struggle to organise or complete tasks, pay attention to details, follow instructions or conversations. It also causes a person to be easily distracted or to forget parts of their daily routine.
Hyperactive: A person with hyperactivity may fidget or move or talk a lot. They can struggle with sitting still for a long period of time due to feeling restless. They also struggle with impulsivity and may interrupt frequently, speak at inappropriate times or fail to wait for their turn. They may be more accident-prone.
Combination: They present symptoms of both hyperactivity and inattentiveness.
ADHD and CBG
Stephen began consuming cannabis before he realised it may help his ADHD symptoms. While he saw some success with THC or CBD, he believes that cannabigerol (CBG) was more helpful for him.
CBG is another cannabinoid found in the cannabis plant alongside THC and CBD. It is sometimes referred to as ‘the mother of all cannabinoids’ because it is the precursor to CBD and other cannabinoids.
There is very little CBG in plants, often as low as one per cent, making it more expensive than CBD products, as CBD is much more available. CBG tends to be made from younger plants, which contain a higher percentage. THC and CBD both begin life as CBGA before maturing.
It is thought to work the same as CBD in that it interacts with our endocannabinoid system via receptors that are found all over the body. In particular, it may bind to the CB1 receptors in our nervous system or CB2 receptors in our immune system. In recent studies, CBG has been shown to have the potential for preventing Covid-19 infections from entering the body and shows promise as an ingredient for skincare aimed at helping dry skin conditions.
There are no direct studies on CBG for ADHD, although there are some which focus on CBD and CBN.
“I was emotionally drained and completely without energy, cannabis helped me to get the rest I needed,” Stephen said.
“I found a store that sold CBD so I tried that before trying THC but it wasn’t beneficial for me. I didn’t feel an effect until I started using CBG.”
He continued: “It was an instant change in the way my body and mind reacted to the cannabis. I started to mix CBD in there too. I no longer felt exhausted or tired, instead I found I was motivated, always excited and got lots of work done.”
Stephen began to join Irish cannabis activism, which is calling for reform to the medical cannabis access programme (MCAP) and for the legalisation of recreational use.
Currently, ADHD is not a condition which can be legally prescribed for under the MCAP programme. While in Northern Ireland and the UK, this is not the case and patients can apply for a prescription, Southern Irish patients who live in these regions, cannot take their prescription into Ireland without risking arrest or seizure at customs.
This situation has resulted in a lot of Irish patients emigrating to countries such as the UK or Spain.
The MCAP was introduced in 2019, but can only be accessed for three conditions: cancer nausea, multiple sclerosis and epilepsy.
CBG and stress
Unfortunately, during the first lockdown, Stephen experienced a break-up with his partner who he lived with at the time.
“It was incredibly stressful but for the first time with the cannabis and CBG, I was able to get some self-reflection during this chaotic time of my life. CBG has been an absolute game-changer for me. I felt this incredible motivation, positivity and creativity,” he said.
“One thing I noticed with my cannabis use before I knew about my ADHD , is that after a tolerance break, it had an amazing ability to put me in the zone.”
Stephen is conscious of the cannabinoids that he uses and how they make him feel, preferring to use a CBD flower, after finding that THC and CBD did not suit him. He is open to the idea of a prescription for medical cannabis but feels that it may be a while before ADHD is recognised by the MCAP.
“I would be happy to go on the system if it was available for me, I would be proud to have a prescription because it is a medicine and this is the first step of not being criminalised for it,” he said.
Stephen hopes that general awareness of ADHD Ireland will improve to help those who may need more support, especially in schools. He would also like to see less of a gap between the recreational and medicinal communities.
“I would love to see more awareness,” he said.
“When I was in school, the classes were too big for teachers to pay any attention to individual students, so there wasn’t much understanding of it.”
Stephen added: “Cannabis is medicine. The term recreational has been mixed up in that sense, as it means to recreate yourself mentally, physically and spiritually, but it’s become a negative storyline. People are getting the health benefits by consuming it. We need to change the narrative around this, that’s why we are becoming activists.”
How this US brand is helping veterans access free CBD
“U.S. military veterans are some of the most selfless individuals so we thought the project would be a perfect fit.”
US vaping supply brand, CCELL, has partnered with the Veteran’s Walk and Talk project to provide free access to CBD.
CCELL will be partnering with the Veterans Walk and Talk (VWAT) to gift its members with limited edition CBD vapes that highlight their military service.
Veterans Walk and Talk is a community project based in the US, offering support, psychedelic therapy and cannabis.
It was founded in 2016 by Colin Wells, who served in the US Army, as a way for veterans in Southern California, Sacramento and Oklahoma, to take control of their health journey.
The project now holds regular community outreach events that provide veterans with a one-on-one psychedelic or cannabis walk and talk therapy or group hikes. They also hold trail and beach clean-ups where the community come together to give back to nature along with book clubs and comedy nights.
To mark the firm’s fifth anniversary, the CCELL team decided to join forces with VWAT.
Speaking with Cannabis Health, Joe Strain, vice president of CCELL said: “VWAT started with veterans in mind. Founder Colin Wells, who served in the US Army and experienced withdrawal traumas, began posting on social media to see if anybody wanted to join him on his hikes as a means to relieve stress.
“On these hikes, he’d provide free cannabis, education and a safe space for people to talk. These hikes inspired him to start VWAT as a way to give back to his community, with the main goal of reducing the suicide epidemic among veterans. Now, VWAT has 12 chapters across the country, all carrying the same mission.”
Joe added: “US military veterans are some of the most selfless individuals, so we thought they would be a perfect fit. We heard about what VWAT is doing for veterans and decided to support the organisation on its mission to help improve the lives and health of veterans by providing them with CBD vaporisers. The alignment was undeniable, and we’re honoured to be a part of helping them further their mission.”
Mental health and veterans
Mental health conditions such as anxiety, depression and post-traumatic stress disorder (PTSD) can be common among veterans. The symptoms of PTSD can be debilitating causing flashbacks, nightmares or physical effects such as nausea or pain.
A study from 2017 highlighted the difference in PTSD between veterans and civilians. In the study of 5,826 veterans, researchers recorded a rate of 13 per cent with PTSD. This is almost double the seven per cent of the US population with a PTSD diagnosis.
Studies show CBD may help PTSD by interacting with the endocannabinoid receptors in the body.
Joe explained: “It’s known that many veterans deal with PTSD after they have served. Studies have shown that CBD can be effective in reducing PTSD symptoms. This can potentially afford members the opportunity to manage their symptoms without excessive pharmaceutical drugs, which often cause side effects.”
He added: “CCELL has produced limited edition CBD vapes which will signify that the users of the vapes are members of Veteran’s Walk and Talk. Not only is this great for the members, but it is also significant for this non-profit organisation as it helps to spread awareness about the great work that VWAT does and will help encourage more people in need to join.”
Can CBD help with feelings of sadness on blue Monday?
Blue Monday may or may not be a real thing, but feelings of sadness, anxiety and stress are.
The third Monday in January is often referred to as ‘blue Monday.’ But what is it and could taking CBD help with feelings of depression, stress or anxiety?
What is blue Monday?
Blue Monday is thought to be the most depressing day of the year.
It was created after psychologist Cliff Arnall was asked to create a formula for the holiday blues. It falls on the third Monday of January each year. While there is a lot of debate as to whether it is real or not, depression and anxiety can be difficult to cope with.
January can be a really hard time of year for those with seasonal affective disorder (SAD). It may be due to the increase in cold weather, post-holiday sadness and credit card statements.
Real or not, it can be an opportunity to start talking about how depression or anxiety affect us all.
Could CBD help to lift our mood during this difficult month?
CBD for depression
Symptoms of depression can include a persistent low mood, unhappiness, low self-esteem or feeling tearful. It can cause a loss of interest in things you used to enjoy, withdrawal, tiredness or sleep issues. In severe forms, it may also cause suicidal thoughts.
CBD may have a positive interaction with the hormone, serotonin in our brains. Serotonin is involved with different functions in our bodies but it can impact a person’s happiness or emotional well-being. Low serotonin levels are associated with depression.
A study examined how CBD could make a difference to people who struggle with seasonal depression. Participants in the study were given 400mg of CBD or a placebo. Researchers reported those given the CBD reported less anxiety than those on the placebo.
CBD for anxiety
Anxiety is a reaction to stress creating an apprehensive feeling about what may happen. Some people struggle with strong feelings of anxiety every day. These feelings of anxiety can be a symptom of post-traumatic stress disorder (PTSD), generalised anxiety disorder (GAD) or social anxiety disorder.
A study on CBD and sleep quality also found it may reduce anxiety. It involved 72 participants with 47 experiencing anxiety and 25 with poor quality sleep. Each participant was given a daily dose of 25mg of CBD then asked to report how they felt afterwards. The researchers recorded that 79.2 per cent recorded reduced anxiety and 66.7 per cent said their sleep had improved after the first month.
CBD for stress
Our bodies naturally produce a hormone called cortisol which is responsible for our feelings of stress. When we encounter fear or a stressful situation, our brain signals our nerve and hormone systems. Adrenaline and cortisol rush into our body causing a spike in blood pressure and heart rate.
Cortisol increases the glucose in the bloodstream and increases the availability of substances that can repair tissue. It controls mood, motivation and fear.
In one study, male participants with Parkinson’s disease were given CBD then asked to undergo a simulated public speaking test. Researchers reported that an oral dose of 300 mg of CBD given 90 minutes before the test reduce the participant’s anxiety and stress.
The best way to take CBD
There is no right or wrong way to take CBD if you are feeling blue.
The most common ways to take CBD are oils or tinctures, edibles or vaping. Each person may have an individual preference for one method over another. Oils or tinctures can be great if you need a quick, easy way to take a dose but vaping helps the CBD to reach the system faster. This could be a great choice if you are struggling with panic attacks and need a faster dose.
Edibles are a discreet way to take CBD and they also taste nicer than some oils. The best way to decide what is right for you is to try different methods until you find the one you prefer.
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