It’s not hard to find CBD these days -- it’s available everywhere, from grocery stores to doctors’ offices to online shops. People are using CBD to relieve symptoms of everything from anxiety to multiple sclerosis. One of the many serious conditions increasingly treated with CBD is post-traumatic stress disorder, or PTSD.
This illness, triggered by trauma, causes a wide range of debilitating mental, emotional and physiological effects. CBD and cannabis have been floated as solutions to the opioid crisis sweeping the nation’s veteran population thanks to their apparently positive effects on PTSD.
How does CBD interact with this complex and often devastating condition? What’s hype and what’s based in science? Let’s take a closer look.
What Is PTSD?
Post-traumatic stress disorder is the latest term for a medical phenomenon that has been around for a long time. World War I soldiers experienced “shell shock,” while World War II doctors observed “irritable heart” or “soldier’s heart.” Vietnam War soldiers experienced “Vietnam Syndrome,” and soldiers of other wars have shown signs of “battle fatigue,” such as the “thousand-yard stare.”
Many personal and cultural factors can affect how someone experiences PTSD, but its major symptoms have plagued humanity since civilization began.
Virtually everyone who experiences or witnesses a traumatic event, such as a car accident or a military battle, will show signs of distress and anxiety afterward. An estimated 5-20% of people will experience persistent and troubling mental, emotional and physical symptoms for a month after the event.
These “Acute Distress Disorder” sufferers may experience intrusive memories, inability to feel positive emotions, dissociation and disorientation, sleep disturbances or other disruptive symptoms.
Doctors diagnose PTSD when these symptoms last longer than a month. PTSD behaviors emerge from natural behavioral responses that evolved to help us avoid danger and survive trauma.
A prehistoric human who survived an animal attack, for example, might avoid experiencing another one by exercising heightened vigilance in a setting similar to that in which the attack happened. But PTSD goes far beyond normal anxiety, as survival responses turn into a disruptive and distressing array of symptoms that can last for months or even years.
The National Institute of Mental Health divides PTSD symptoms into four major categories. Re-experiencing symptoms include flashbacks and bad dreams, while avoidance symptoms involve a reluctance to talk or think about the event, resulting in avoidant behavior such as withdrawing from family or avoiding safe experiences that might remind them of traumatic ones.
PTSD sufferers often experience constant “arousal” symptoms such as irritability and difficulty sleeping due to constantly feeling “on edge.” Cognitive and mood-related symptoms include distorted memories of the event and difficulty feeling positive emotions.
PTSD symptoms are disruptive and can significantly reduce sufferers’ quality of life when left untreated. A whopping 80% of people with PTSD experience a comorbid disorder such as depression, anxiety or substance abuse. It has been linked to faster aging and earlier death, as well as learning and memory impairments.
PTSD does not just affect the person who has it; it affects the surrounding people as well: hypervigilance, irritability, withdrawal and loss of interest in hobbies and normal activities can all profoundly impact family relationships.
Terms such as “soldier’s heart” indicate that PTSD is especially common among soldiers and veterans, and combat-related PTSD can present unique treatment challenges. But PTSD can also stem from non-military traumas such as car crashes or assaults.
Witnessing a traumatic event happen to someone else, or even hearing about or dealing with the consequences of traumatic events, can also cause PTSD -- emergency room physicians, for example, experience PTSD at elevated rates comparable to rates among police officers and veterans.
Seven to eight percent of the population will experience PTSD at some point. And though the public imagination may picture PTSD as being largely a male illness due to its close association with heavily male professions such as soldier or police officer, women are much more likely than men to experience PTSD.
PTSD is treatable. The American Psychological Association strongly recommends cognitive talk therapy and exposure therapy, while also conditionally recommending medications such as selective serotonin reuptake inhibitors (SSRIs) and Eye Movement Desensitization and Response Therapy.
Though these therapies can be effective, PTSD treatment is not always easy or even successful. Prolonged exposure therapy has a 60% effectiveness rate treating PTSD, while SSRIs provide symptom improvement in 60% of PTSD patients but complete remission in only 20-30%.
Barriers to accessing care, stigmas surrounding mental illness and comorbid conditions such as depression can significantly complicate successful treatment.
Sometimes when two people experience similar trauma, only one will develop PTSD. Why the difference? While psychologists have identified numerous risk and resilience factors that can increase or decrease PTSD risk, such as prior mental illness or family support network, neuroscientists have also identified biological mechanisms that might make some people more vulnerable to PTSD than others.
Blood tests of PTSD patients often detect elevated levels of biomarkers of inflammation. Though correlation is not causation, many studies seem to agree that PTSD patients are more likely to experience chronic systemic inflammation than the general population.
Recent research now suggests that these inflammation biomarkers may predict PTSD risk -- one study found a correlation between certain inflammatory biomarkers in emergency room patients’ blood hours after trauma and the presence of PTSD symptoms several months later.
Studies show that genetics may also play a role in someone’s response to trauma. Brain imaging has shed light on the biological underpinnings of PTSD, detecting structural changes in PTSD sufferers’ brains, such as lower hippocampal volume. These brain changes may be associated with the well-documented learning and memory difficulties common among PTSD sufferers.
A definite correlation exists between the mental anguish and hypervigilance of PTSD and bodily wellbeing. This correlation implies that neurochemical intervention -- such as SSRIs -- can help PTSD victims recover. That doesn’t mean non-pharmaceutical interventions such as talk therapy aren’t vitally important for PTSD sufferers.
Studies show that cognitive behavioral therapy can change the physical structure of mentally ill patients’ brains while improving their symptoms. But for some PTSD sufferers, the therapies available to them -- whether those are talk therapy, antidepressants, EMDR, some combination of all three, or other treatments -- aren’t enough. More and more, these people with PTSD are turning to a new potential treatment: CBD.
The Potential of CBD
CBD is short for cannabidiol, one of the many cannabinoid compounds present in the cannabis plant. A few years ago, virtually no one had heard of CBD. Tetrahydrocannabinol, or THC, was by far the most-discussed cannabinoid. THC is responsible for the psychoactive “high” associated with marijuana.
Though research suggests that THC can help with a variety of medical conditions, such as glaucoma and nausea, most people are far more familiar with its recreational component. The intense sensations that make THC recreational use appealing for many people also often make it impractical for day-to-day medical use.
Medical THC also appears to be a double-edged sword -- while it has helped many users with chronic and debilitating conditions, it can increase some users’ risk of depression, anxiety and other mental illnesses, especially if heavy use begins in adolescence when the brain is still forming.
One of the most common misconceptions about CBD is that it creates a psychoactive “high” similar to THC. It does not, which makes CBD consumption more practical for day-to-day use. While many state laws allow medical or even recreational THC use, any cannabis plant or product with more than 0.3% THC by dry weight remains illegal under federal law.
Low-THC CBD products are federally defined as “industrial hemp,” a non-controlled substance. While the legality of low-THC CBD products remains murky and can vary from state to state, the CBD market is booming. Nearly 7% of Americans use CBD, and that percentage could hit 10% by 2025.
Because CBD has only recently become more accessible to scientific institutions, research on its health impacts is still preliminary. But early studies, as well as plenty of anecdotal evidence from CBD users, suggests that CBD can provide a number of medical benefits.
The CBD-based medicine Epidiolex is FDA-approved for its ability to control seizures, and scientific research has documented CBD’s ability to treat chronic pain, anxiety, depression, nausea and chemotherapy side effects, and acne.
Studies have also connected CBD to cancer cell death, lower blood pressure, diabetes prevention, addiction treatment and neuroprotective properties that address symptoms of epilepsy, multiple sclerosis, Parkinson’s Disease and Alzheimer’s.
CBD’s neuroprotective qualities, as well as its ability to fight comorbid conditions such as anxiety and depression, may explain why it is increasingly being used to address PTSD. While the exact usage rate among PTSD users remains unknown for both marijuana and CBD, polls show that military veterans are highly supportive of medical cannabis programs.
One study found that CBD alone -- though not THC alone -- can help rats reduce their fear response to frightening memories of electric shocks, effectively helping them “unlearn” fears of a prior unsafe situation in a similar but apparently safe situation.
A case study covering 11 adult humans who received both psychiatric care and regular oral CBD tracked significant improvement in PTSD symptoms, especially for patients with strong nightmares.
A 2018 literature review of studies on PTSD and CBD identified positive effects in rodent studies, including reducing response to trauma when CBD was administered beforehand, reducing behavioral and physiological responses to memories of trauma triggered by similar contexts and -- perhaps most significantly for PTSD treatment -- helping lessen the vividness and related emotions of fear-inducing memories themselves. The review also identified four human studies in which CBD reduced PTSD symptoms.
CBD interacts with the brain via a multitude of channels that are still poorly understood. But scientists do have a few hints as to why CBD can help with PTSD.
CBD appears to relieve anxiety by boosting some of the brain’s serotonin receptors, a mood-regulating neurotransmitter that’s also the main target of SSRI antidepressants. CBD’s well-documented anti-inflammatory properties may also play a role.
Studies have documented that CBD reduces inflammation and long-term damage in the immediate aftermath of brain injuries and strokes. Long-term CBD treatment has also been associated with growth in the hippocampus, a memory-processing portion of the brain that is often reduced in PTSD patients.
Finding a Treatment Plan That Works
It’s important to emphasize that CBD is hardly a cure-all for such a complex and often devastating condition as PTSD. Just as clinically backed treatments such as talk therapy and SSRIs may not work for all PTSD patients, CBD will not cause improvement for everybody.
While early findings on CBD and mental health are promising, the field still has a long way to go before CBD’s benefits for PTSD patients are fully understood or even completely established. No one experiencing PTSD symptoms or any other serious medical condition should stop an existing treatment plan or start using CBD without consulting their doctor, as some medications may interact negatively with CBD.
The American Psychiatric Association opposes medical cannabis for PTSD treatment due to inadequate evidence and risks of worsened symptoms, though they appear to draw conclusions from studies looking at synthetic THC and general cannabis rather than specifically low-THC, high-CBD cannabis products.
The APA points to a yet-to-be published study gathering randomized, controlled and blinded data comparing outcomes for PTSD patients who use high-THC cannabis, high-CBD cannabis, high-THC and high-CBD cannabis, and a placebo as a potential data source for comparing CBD and THC effectiveness at treating CBD.
CBD users are awaiting that study’s publication, and there will likely need to be more high-quality studies in the future to fully understand CBD’s impacts on mental health. But for PTSD patients and the people who love them, waiting is not an option, and many are turning to CBD as the medical, legal and cultural landscape continues to change.
In one survey of medical CBD users, PTSD was the sixth most common condition being treated. Veterans face extra complications when it comes to taking CBD due to legal and cultural stigmas surrounding cannabis usage, but groups such as the Veterans Cannabis Project are taking the lead on increasing access for this PTSD-vulnerable group.
Patients who do use CBD for PTSD symptoms need to be sure they’re using a high-quality supplier. Mislabeling is unfortunately common in the CBD marketplace -- one study found that nearly 70% of CBD products bought online have different THC, CBD or other cannabinoid content than advertised.
While there appears to be little ill effect from consuming CBD above therapeutic levels, PTSD patients who get less CBD than advertised may be losing out on CBD’s important therapeutic effects.
Perhaps more alarmingly, PTSD patients who unknowingly consume high THC levels along with their CBD may be putting themselves at risk of adverse outcomes described by the American Psychiatric Association.
As high-THC products remain illegal under federal law, these users also risk failing a drug test or facing legal consequences. Trustworthy CBD vendors provide third-party lab analysis of their products so consumers can be sure they’re getting the CBD and THC they expect.
PTSD is a devastating condition, but there are many treatment opportunities to help patients live better, happier lives. CBD is already part of that treatment arsenal for many people, and medical science is starting to catch up.