CBD for PTSD

Some experts theorize that PTSD may be an instinctive mechanism meant to help you avoid or survive future trauma. This is an example of a helpful tool becoming “maladaptive” once it prevents you from moving on from the trauma.

There is evidence that many people with PTSD have abnormal levels of stress hormones, which produce the “fight or flight” response in a crisis. When those stress hormones remain at high levels, people become locked in a state of hyperarousal and fear.

Other studies have shown that people with PTSD may have a smaller hippocampus. The hippocampus is the part of the brain responsible for emotional and memory processing. If the hippocampus malfunctions, memories and emotions are not easily worked through.

Building on animal research, which showed that CBD helps with fear extinction, this early clinical study put 48 participants through a Pavlovian fear-conditioning process ^{3 Das, R.K., Kamboj, S.K., Ramadas, M., Yogan, K., Gupta., V., Redman, E., Curran, V.C., Morgan, C.J.A. (2013).Cannabidiol enhances consolidation of explicit fear extinction in humans. Psychopharmacology, 226(4): 781-92. https://pubmed.ncbi.nlm.nih.gov/23307069/} . (They were conditioned via electric shocks to experience a fear response in connection to a colored box.)

Researchers found that CBD helped participants in the process of fear extinction – in which they were “unconditioned” to experience fear in relation to those sinister colored boxes.

This was, in the words of the researchers, “the first evidence that CBD can enhance consolidation of extinction learning in humans.” They further suggested that  CBD may be a helpful add-on to extinction-based therapies for anxiety disorders like PTSD.

This study details the treatment of PTSD in a 10-year-old girl who was the victim of sexual abuse and parental neglect ^{4 Shannon, S., & Opila-Lehman, J. (2016). Effectiveness of Cannabidiol Oil for Pediatric Anxiety and Insomnia as Part of Posttraumatic Stress Disorder: A Case Report. The Permanente journal, 20(4), 16-005. https://doi.org/10.7812/TPP/16-005} . While many treatments had proved to be mostly ineffective, CBD seemed to be the key to helping her both sleep better and deal with anxiety during the day.

According to the authors, “The main finding from this case study is that CBD oil can be an effective compound to reduce anxiety and insomnia secondary to PTSD.”

The authors theorize that “CBD may block anxiety-induced [rapid eye movement] sleep alteration via its anxiolytic effect on the brain.”

A 2018 review of the research to date on CBD for PTSD took a deep dive into the possible mechanisms by which CBD works ^{5 Bitencourt, R. M., & Takahashi, R. N. (2018). Cannabidiol as a Therapeutic Alternative for Post-traumatic Stress Disorder: From Bench Research to Confirmation in Human Trials. Frontiers in neuroscience, 12, 502. https://doi.org/10.3389/fnins.2018.00502} .

The authors of the review note that anti-depressants and anti-anxiety medications, which are often prescribed for PTSD, do not target the memory process at all. This may account for their low rate of success for those suffering from frightening memories.

CBD, on the other hand, does help extinguish the fear response associated with traumatic memories.

Of particular note to the authors was CBD’s action in blocking the endocannabinoid system’s CB1 receptor. This receptor has been shown to play a crucial role in the extinction of fear memories. Multiple studies (cited in this review)  have shown that CBD helps with the extinction of fear memories by activating the endocannabinoid system.

Additionally, the authors note that “chronic CBD treatment may facilitate neurogenesis (the creation of new cells) in the hippocampus, a structure well known for its important role in processing memories.”

The most recent of the published research on CBD for PTSD is an open-label case series, which looked at the effects of CBD on 11 adult patients in an outpatient clinic ^{6 Elms, L., Shannon, S., Hughes, S., & Lewis, N. (2019). Cannabidiol in the Treatment of Post-Traumatic Stress Disorder: A Case Series. Journal of alternative and complementary medicine (New York, N.Y.), 25(4), 392–397. https://doi.org/10.1089/acm.2018.0437} . The patients (who were diagnosed with PTSD) took CBD for eight weeks along with psychiatric care.

As a result of the treatment, ten of the eleven patients experienced a decrease in PTSD symptom severity – and several noted a reduction in nightmares and sleep disturbance.

There are certainly some clear limitations to the study since it was a small, open-label review that did not include a placebo or control group. However, it represents the first case series examining the effect of CBD on symptoms of PTSD in humans.

Of particular interest to the researchers was the effect of CBD in increasing the amount of anandamide, the body’s own endogenous cannabinoid. Anandamide, which is known as the “bliss molecule,” has known anti-anxiety effects and has been shown to decrease fear in otherwise stressful situations.