Cannabis for posttraumatic stress disorder: A neurobiological approach to treatment

At least in New Mexico you can get it - medical marijuana, for your PTSD but not for any of the other uses research has proven useful. That is why we need total legalization. Otherwise study up on the symptoms of PTSD.

My 13 reasons for marijuana use post-stroke. Don't follow me but I will figure out some way to get some after my next stroke.

Treating brain diseases with marijuana

Cannabis for posttraumatic stress disorder: A neurobiological approach to treatment

Krumm, Bryan A. MSN, RN, CNP, BC

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Article Outline

Author Information

Bryan A. Krumm is a Psychiatric Nurse Practitioner at Sage Neuroscience Center, Albuquerque, N.M.

The author has disclosed that he has no financial relationships related to this article.

Abstract

Abstract: The endocannabinoid system is intricately involved in regulation of the neurobiological processes, which underlie the symptomatology of posttraumatic stress disorder (PTSD). This article discusses the neurobiological underpinnings of PTSD and the use of cannabis for treating PTSD in the New Mexico Medical Cannabis Program.

The State of New Mexico has approved posttraumatic stress disorder (PTSD) as an indication for its Medical Cannabis Program, and patients with PTSD currently comprise the largest segment of any approved indication.

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Cannabis remains in Schedule I of the Controlled Substances Act (CSA) in the United States, making it illegal to use under federal law. In the case of Krumm vs. Holder, the Drug Enforcement Administration argued that they did not need to defer to state laws regarding scheduling decisions for controlled substances.¹ Due to the federal prohibition against cannabis, research looking into its therapeutic value has faced significant barriers, rendering it nearly impossible to conduct controlled clinical trials of cannabis in treating PTSD. However, the U.S. Supreme Court has upheld that practitioners have a right to recommend cannabis to patients when it is deemed appropriate.²

PTSD can occur when a patient is exposed to one or more traumatic events leading to the development of characteristic symptoms following exposure. Patients may exhibit fear-based re-experiencing with emotional and behavioral symptoms. Others may present with anhedonic or dysphoric states and negative cognition. Patients may exhibit arousal and reactive-externalizing, while others may exhibit dissociative symptoms. Some individuals may have combinations of symptom patterns.³ PTSD is considered the fourth most common psychiatric disorder, affecting 10% of all men and 18% of women, with rates approximately 40% in high-trauma populations, such as soldiers in combat, low-income individuals, and those living in inner cities.⁴ PTSD often occurs comorbidly with other psychiatric disorders.⁴ Originally, PTSD was considered a normative response, related primarily to stressor intensity, but individual response to trauma depends on stressor characteristics as well as neurobiological factors.⁵

The endocannabinoid system appears to be involved in the extinction of aversive memories, and patients with PTSD claim that cannabis use helps alleviate their symptoms.⁶ Cannabinoids stimulate receptors in the prefrontal cortex, amygdala, and hippocampus, activating signaling pathways, which appear to inhibit anxiety.⁷ Alterations in the endocannabinoid system are seen in depression, including changes in levels of cannabinoid 1 (CB1) receptors and endogenous CB1 receptor ligands.⁸ Stimulation of cannabinoid receptors enhances stress-coping behaviors and increases spontaneous firing of serotonergic and noradrenergic neurons in the midbrain.⁹ Phytocannabinoids, including delta 9 tetrahydrocannabinol (THC), cannabidiol (CBD), and cannabichromene exert antidepressant-like actions and may be useful in the treatment of mood disorders.¹⁰

High rates of suicidal behavior have been found among patients with PTSD.¹¹ It appears that sensitization of CB1-receptor-mediated G-protein signaling in the prefrontal cortex contributes to the pathophysiology of suicide and likely contributes to suicidal behavior.¹² The role of the endocannabinoid system in the pathophysiology of PTSD suggests that cannabinoids may be an effective modality to treat both PTSD and suicidal behavior in patients with PTSD.¹¹ Many patients in New Mexico's Medical Cannabis Program for PTSD have reported reductions in frequency and severity of suicidal thoughts at Medical Advisory Board meetings. Some reported complete cessation of suicidality.