How CBD Can Help Patients with PTSD
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Here’s a surprising fact about our brains: They make their own internal cannabis molecules, known as endogenous cannabinoids. Anandamide (named after the Sanskrit word for bliss, "ananda") helps temper stress and balance the nervous system, so we do not spiral out of control on high sympathetic overdrive. Sympathetic overdrive takes a toll on the body that can eventually lead to a state of adrenal fatigue if left untreated.
Our endocannabinoid system, or ECS, is a system that modulates and interfaces with all of the other systems throughout your body. It regulates physical functions, such as movement, pain sensation, and immune responses, as well as cognitive or mental capacities, like perception, mood, and memory.
According to two different studies from NYU and Vanderbilt University, PTSD patients have been shown to have lower levels of the "bliss molecule," anandamide, compared to people without PTSD. Anandamide is the way our ECS helps clear painful memories and reduce our stress levels.
Take, for example, forgetting. The ability to forget is a crucial aspect of treating anxiety, stress, and PTSD. Research shows that trauma survivors have problems with neurotransmitter signaling of serotonin and glutamate, which also correlate with the fight-or-flight response. Excessive glutamate signaling will lock in painful fear-related memories. Cannabinoids can help release these painful memories by facilitating memory extinction. CBD helps survivors switch off those traumatic memories.
The chemistry behind CBD and THC
Cannabinoids mediate the neurotransmitter GABA, which signals to our body that we are safe and directs the body to relax. It helps to reduce anxiety, foster sleep, and relax the muscles. CBD and THC tell the brain to increase the flow of GABA, which creates a calming effect. My patients report it taking the edge off and turning down the volume on anxiety and stress. Once their racing thoughts and the"fight or flight" response tail off, patients say they feel better, or "more comfortable in their skin." They can often quell racing thoughts that paralyze them at work or cause them to lie awake at night.
Recent neuroscience research has shown that certain lucky people have a genetic variation in the brain that makes them inherently less anxious and more able to forget unpleasant experiences. These "more carefree" folks also have brains that produce higher levels of anandamide, the body's own version of THC. Normal endocannabinoid system functioning helps people's nervous systems reset and recalibrate more quickly after stress exposure. Researchers and clinicians agree that vulnerability to PTSD and stress resilience results from an interaction between ECS, genes, and the environment.
A revealing case study
Daniela is an ER nurse and worked the frontlines during the peak of the COVID-19 pandemic in New York City. Nearly two months later, she has been unable to shake the memories of the overwhelming COVID deaths and the emergency room's emotional and physical demands.
Daniela has the most trouble at bedtime. When she closes her eyes at night to sleep, she relives the trauma of treating and losing patients to COVID-19. If Daniela were lucky and her sleep medication worked, she could drift to sleep. A few hours later, she would wake up choking—like she was in a war zone. Daniela lies in bed in a cold sweat, out of breath, clenching her chest. During the day, she has trouble concentrating. She still works in the ER and feels anxious, stressed, and living in fear of spreading the disease to family members.
Daniela was diagnosed with PTSD and began seeing a therapist every week. Her psychiatrist prescribed an antidepressant, a benzodiazepine, and a sleep aid. After six months of trial and error, these medications' combination helped her with her daily jitteriness and debilitating panic attacks. However, she still has fear, exhaustion, and feelings of isolation.
Daniela's therapist suggested she try CBD to help ease her anxiety and forget the painful memories. As an ER nurse, she treats patients with drug overdose and substance abuse daily. When Daniela walked into my clinic, she said, "I don't want to smoke it, I don't want to get high, and I don't want to sit on the couch with the munchies."
I suggested a broad-spectrum CBD in Daniela's case because there is zero THC, thus no psychoactive effects. She can take it while working and not worry about failing a drug test for work. I also worked closely with Daniela's psychiatrist and psychotherapist to monitor her progress. She kept a detailed journal as well. After the first month, Daniela's therapist reported that she seemed less anxious, more clear-headed, and their sessions were more supportive for her. Daniela also noticed an improvement in the quality of sleep and her mood.
CBD’s impact on the brain
Recently, researchers from University College London conducted a study showing that a single CBD dose helped increase blood flow to the hippocampus. When vessels that supply blood to the brain are too clogged or damaged, it can result in a decline in cognitive function, memory loss, and difficulty in making executive decisions. Mobility and balance get impaired too. Increasing blood flow to areas in the brain helps maintain cognitive faculties as we age and perhaps increase memory in Alzheimer's disease patients. The mechanism of action for increased cerebral blood flow on the brain is unclear. This study is promising, and more research is needed.
According to researchers, the hippocampus is like our "flash drive" responsible for storing and retrieving memories. People who have experienced some damage to their hippocampus may have difficulty storing and recalling information. Along with other limbic structures, the hippocampus also plays a role in a person's ability to overcome fear responses. Brain areas implicated in the stress response include the amygdala, hippocampus, and prefrontal cortex.
Traumatic stress can be associated with lasting changes in these brain areas. It's important to mention that many people with PTSD, anxiety, and Alzheimer's might be on prescription medication or antidepressants. Be careful when you supplement cannabinoids, as they can interact with these medications and make their effects more powerful. Talk to your doctor to be sure you're not overconsuming one or the other (e.g., if the doctor increases your Zoloft, that doesn't mean you should also up your cannabis intake).