Cannabidiol as a Therapeutic Alternative for Post-traumatic Stress Disorder: From Bench Research to Confirmation in Human Trials
Post-traumatic stress disorder (PTSD) is characterized by poor adaptation to a traumatic experience. This disorder affects approximately 10% of people at some point in life. Current pharmacological therapies for PTSD have been shown to be inefficient and produce considerable side effects. Since the discovery of the involvement of the endocannabinoid (eCB) system in emotional memory processing, pharmacological manipulation of eCB signaling has become a therapeutic possibility for the treatment of PTSD. Cannabidiol (CBD), a phytocannabinoid constituent of Cannabis sativa without the psychoactive effects of Δ 9 -tetrahydrocannabinol, has gained particular attention. Preclinical studies in different rodent behavioral models have shown that CBD can both facilitate the extinction of aversive memories and block their reconsolidation, possibly through potentialization of the eCB system. These results, combined with the currently available pharmacological treatments for PTSD being limited, necessitated testing CBD use with the same therapeutic purpose in humans as well. Indeed, as observed in rodents, recent studies have confirmed the ability of CBD to alter important aspects of aversive memories in humans and promote significant improvements in the symptomatology of PTSD. The goal of this review was to highlight the potential of CBD as a treatment for disorders related to inappropriate retention of aversive memories, by assessing evidence from preclinical to human experimental studies.
Post-traumatic stress disorder (PTSD) is a chronic psychiatric condition that may develop after experiencing a potentially traumatic event. The disorder manifests itself at different levels, through symptoms such as sleep disturbances; changes in cognition (e.g., repeated recall of the event), mood (e.g., depression, anxiety), and emotion (e.g., psychological instability); and reduced social skills. Through the fourth edition of the DSM-IV, post-traumatic stress was classified as an anxiety disorder; however, the latest edition, DSM-V, includes PTSD in a new category called “trauma- and stress-related disorders.”. In this brand-new category, we consider disorders with poor adaptation to a traumatic experience. Maladaptive responses to trauma may trigger, among others, PTSD (Passie et al., 2012; Berardi et al., 2016).
At some point in their lives, approximately 10% of people will be affected by PTSD, resulting in an enormous economic and social impact. This impact is aggravated by the scarcity of psychological and, above all, pharmacological approaches to PTSD treatment (Hidalgo and Davidson, 2000; Yule, 2001; Jurkus et al., 2016). At present, approved treatments for PTSD involve anxiolytics and antidepressants, which are inefficient and have considerable side effects (Berger et al., 2009; Shin et al., 2014; Bernardy and Friedman, 2015).
The eCB system can provide more efficient and better tolerated alternatives to the standard treatments for PTSD. The eCB system plays an important role in the regulation of emotional behavior and is essential for synaptic processes that determine learning and emotional responses, especially those related to potentially traumatic experiences (Castillo et al., 2012; Riebe et al., 2012). Among the possible alternative approaches, the use of components from Cannabis sativa such as CBD is particularly promising. Recent reviews have reported promising results of CBD treatment of several neuropsychiatric disorders, including PTSD (Mechoulam, 2005; Izzo et al., 2009; Passie et al., 2012). What began as a possibility discovered in a study of an animal model of aversive conditioning (Bitencourt et al., 2008) gained strength through results obtained in humans (Das et al., 2013) (see Figure Figure1 1 for a brief history of CBD in PTSD). Because the compound has been proved to be well tolerated by humans, both in overall safety and possible side effects (Bergamaschi et al., 2011), CBD is now considered a new therapeutic possibility for treating PTSD.
Brief history of advances in research on the use of CBD in PTSD.
This paper reviews the therapeutic potential of CBD in the treatment of PTSD. It starts from the first evidence obtained in animal studies (“bench research”) and proceeds to knowledge gathered in human trials (“confirmation in human trials”).
Cannabinoids and Trauma-Related Disorder
Cannabis sativa contains over 100 compounds called phytocannabinoids. Two of them demonstrate considerable therapeutic potential: Δ9-tetrahydrocannabinol (Δ 9 -THC), considered the main component responsible for the psychoactive effects of the plant, and CBD, the main non-psychotomimetic constituent of Cannabis (Adams et al., 1940; Mechoulam and Shvo, 1963; Gaoni and Mechoulam, 1964). CBD constitutes about 40% of the active substances of the plant (Crippa et al., 2009). However, its pharmacological effects are different from, and often even opposite to, those of Δ9-THC, and are not related to the development of tolerance and withdrawal syndrome (Mechoulam et al., 2007; Bergamaschi et al., 2011).
In this context, it is also important to highlight the eCB system, discovered in the 20th century and responsible for a revolution in the understanding of numerous neuropsychological functions related to the modulation of emotional responses (Lutz, 2009). The eCB system comprises two different cannabinoid receptors, their endogenous ligands, and enzymes involved in the synthesis and degradation thereof (Di Marzo, 2009). eCB signaling is distributed throughout the CNS and peripheral tissues, regulating presynaptic release of both excitatory and inhibitory neurotransmitters. Cannabinoid type 1 (CB1) receptors are expressed by peripheral and central neurons, particularly in the central regions known to play important roles in anxiety and aversive learning, such as the amygdala, hippocampus, and cerebral cortex (Childers and Breivogel, 1998). In contrast, CB2 receptors are expressed mostly in immune cells, while also being present in the brain (Van Sickle et al., 2005).
The two major endogenous ligands for CB1 and CB2 receptors are AEA and 2-AG. These eCBs are synthesized on demand, mainly postsynaptically, and act as retrograde messengers regulating the presynaptic release of various neurotransmitters, as mentioned above. AEA acts as a partial agonist of both CB1 and CB2 receptors, with a higher affinity for the former. In the CNS, 2-AG is the most abundant eCB, and non-selectively activates CB1 and CB2 receptors. AEA, 2-AG, and Δ 9 -THC, have been shown to exert their effects mainly through activation of CB1 receptors (Di Marzo, 2009; Castillo et al., 2012). In the case of eCBs, the effects are rapidly terminated through carrier-mediated uptake followed by intracellular enzymatic degradation. AEA and 2-AG are metabolized by monoacylglycerol lipase and FAAH, respectively. The eCBs regulate neuronal activity and plasticity by depolarization-induced suppression of inhibition or excitation (Wilson and Nicoll, 2002). Both phenomena are forms of short-term synaptic plasticity that contribute to the regulation of a number of physiological functions, including memory and emotion. Additionally, eCBs appear to modulate the memory process by changing synaptic plasticity and mediating more persistent forms of synaptic plasticity (e.g., LTP and depression) in several brain areas (Maldonado et al., 2006; Di Marzo, 2009; Sidhpura and Parsons, 2011).
These findings have established the importance of the eCB system in a number of neurophysiological functions and led to an emerging interest in the eCB-mediated modulation of emotionality. The first study to address the role of the eCB system in fear memory, specifically in its extinction, was published at the beginning of the last decade by Marsicano et al. (2002). In this study, the authors showed that genetic deletion of the CB1 receptor or its pharmacological blockade strongly impaired extinction of auditory-conditioned fear and that eCBs were released in the BLA during extinction. This discovery revealed that the eCB system has a central function in the extinction of aversive memories and may therefore be a promising target for the treatment of disorders related to inappropriate retention of such memories (for details see Marsicano et al., 2002). Precisely what processes underlie this function of the eCB system is presently unclear, raising the question whether CBD exerts its effects through a different pathway(s). Previous reports on eCB system involvement in CBD-induced effects have been equivocal. Because the endogenous ligands (e.g., AEA) and Δ 9 -THC act directly on the CB1 receptor, it is possible that some of the effects of CBD are also mediated by this receptor, albeit indirectly. Indeed, CBD may exert its therapeutic effect on PTSD through inhibition of the uptake or enzymatic degradation of eCBs (Bisogno et al., 2001), as suggested by some recent studies (Bitencourt et al., 2008; Do Monte et al., 2013; Elmes et al., 2015; Stern et al., 2015). However, if this is the case, what is the advantage of using CBD over agents that act directly on the CB1 receptor? The answer is simple: fewer complications (specifically, anxiogenic side effects). Agents that target the eCB system directly, such as THC, CB1 agonists, and FAAH inhibitors, have a biphasic effect, in which low doses are anxiolytic, but higher doses can be anxiogenic, in both preclinical models and humans. In contrast, CBD, when administered in acute systemic doses in models of general anxiety, does not cause anxiety even at high doses. However, few studies have examined chronic dosing effects of CBD in models of generalized anxiety, and such studies are needed for the safe long-term use of CBD (Blessing et al., 2015).
Trauma-related disorders may involve dysregulation of the learning process of aversive memories. This process is fundamental for the individual to survive, because through it we avoid potentially dangerous situations without having to respond in a way that damages mental health (Quirk and Mueller, 2008). Consistent with this concept, neural circuits that support fear conditioning are related to circuits that are affected in clinical conditions such as PTSD (Davis and Whalen, 2001). That the available drugs (such as antidepressants and anxiolytics) do not specifically target the memory process may be one of the reasons that pharmacological treatment of PTSD is so difficult (Singewald et al., 2015). Currently approved treatments for PTSD include SSRIs and serotonin/noradrenaline reuptake inhibitors, both with low efficacy (Bernardy and Friedman, 2015). The response rate for SSRIs rarely exceeds 60%, of which less than 30% represents complete remission (Berger et al., 2009). Moreover, the available treatments have considerable side effects, which may limit tolerance or even decrease adherence to the treatment (Shin et al., 2014). In this regard, interventions that act on the eCB system have shown promise since they can affect both the emotional (e.g., relieve PTSD symptoms) and cognitive (e.g., increase the efficiency of psychological approaches) aspects of the disorder (Izzo et al., 2009; Steckler and Risbrough, 2012; Trezza and Campolongo, 2013).
Two important observations led to the consideration of cannabinoids for the treatment of PTSD: (i) patients with PTSD appear to be more likely to smoke Cannabis; and (ii) patients with PTSD have increased levels of cannabinoid receptors and reduced peripheral levels of AEA, suggesting that the CB1 receptor upregulation may be a result of low receptor occupancy caused in turn by the deficiency of AEA (Hauer et al., 2013; Hill et al., 2013a; Neumeister, 2013; Neumeister et al., 2013; Loflin et al., 2017). Consistent with these observations, studies have made use of treatment with cannabinoids in animal models of traumatic event exposure to reduce the appearance of PTSD-like behavioral responses. These studies have demonstrated great potential of cannabinoids in the mitigation of maladaptive responses to trauma (for a more detailed review, see Zer-aviv et al., 2016).
When administered after a traumatic situation, cannabinoids may interfere with the acquisition and consolidation of memories of the event, thus mitigating the risk of subsequent symptoms. However, intervention at this stage may be inadvisable because not all people exposed to a traumatic situation will later manifest PTSD. Alternatively, cannabinoids may reduce traumatic memory by affecting its retrieval or reconsolidation, or by stimulating the process of aversive memory extinction. The latter mechanism may hold the most therapeutic promise, especially when taking into account exposure-based psychotherapies, which extinction mechanisms are thought to be engaged (reviewed in Berardi et al., 2016).
Additionally, studies have shown CBD, in its isolated form, to be a constituent of Cannabis with enormous therapeutic potential not only for trauma-related disorders, but also for various other psychiatric and neurological disorders (Campos et al., 2012b). Among the advantages of CBD are its high efficacy, lack of psychotomimetic properties or anxiogenic effects caused by eCB transmission activation, inability to induce tolerance and dependence, and safety at high doses both in humans and in animals (Bergamaschi et al., 2011). However, an alternative view must also be considered, according to which the therapeutic effects of Cannabis result from the interaction of all the compounds present in the plant (particularly THC and CBD) rather than the isolated action of a single compound. Such interaction, called in the pharmacology the “entourage effect” (Ben-Shabat et al., 1998), still needs to be better studied (for further discussion of the use of the term “entourage effect” on plants effect, see Rosenberg et al., 2015). In this review, we will focus on CBD effects in isolation.
CBD and PTSD: “From Bench Research…”
The fear-conditioning paradigm has been widely used in animals to better understand the processes of acquisition, consolidation, retrieval, reconsolidation, and extinction of aversive memories (LeDoux, 2000; Maren and Quirk, 2004). Parallels can be drawn between the expression of fear and anxiety in humans (e.g., those suffering from PTSD) to the expression of conditioned fear in animals (Brewin, 2001). Many studies use variations of this model (e.g., contextual fear conditioning) to better understand the effects of CBD on behavioral responses related to the recall of traumatic events. Briefly, this model involves the pairing of a neutral stimulus (called CS) with an aversive US, usually a mild foot shock. After successive rounds of pairing (or, in some cases, a single pairing), the animal learns that the CS precedes the US, leading to a series of physiological (e.g., cardiovascular responses) and behavioral (e.g., freezing) responses (for a more complete description of the fear conditioning paradigm, see Myers and Davis, 2007; Maren, 2008; de Bitencourt et al., 2013).
Intervention in the processes of acquisition and consolidation of aversive memories is not promising, since this approach can only be effective when closely following the traumatic event, that is, when it is not yet possible to know if the event will result in a disorder. However, intervention in the processes of retrieval, reconsolidation, and, especially, extinction may be a more promising alternative. Briefly, when reactivated by re-exposure (retrieval), an aversive memory enters a transitional state, where the original memory trace can be reconsolidated or extinguished. This process may be influenced pharmacologically (e.g., by administration of CBD) in order to block reconsolidation or facilitate extinction. The process involves repeated exposure to the CS without the US, which will lead to the formation of a new, US-free memory trace that will override the old (CS + US) trace and, consequently, cause a decrease in the behavioral and physiological responses related to fear (reviewed in Berardi et al., 2016).
Animal studies have shown that CBD can affect every stage of the process of aversive conditioning. In addition, exposure to traumatic stress is essential for the development of PTSD, and CBD is effective in reducing both the cardiovascular responses and anxiogenic effects caused by stress (Resstel et al., 2006, 2009; Gomes et al., 2011; Campos et al., 2012a, 2013). For example, CBD lowered responses related to trauma when administered before the acquisition (Levin et al., 2012) or retrieval (Lemos et al., 2010) of aversive memories. CBD also proved to be effective in reducing responses to aversive memories by blocking the process of reconsolidation (Stern et al., 2012). However, the most promising alternative, suggested by exposure-based psychotherapies, may be through enhancement of the extinction process by CBD (Bitencourt et al., 2008; Do Monte et al., 2013). Before discussing the facilitating effects of CBD on the extinction of aversive memories, it is necessary to highlight the role of the eCB system in this process.
The process of extinguishing an aversive memory requires the participation of CB1 receptors, which was discovered in a classic study by Marsicano et al. (2002). The authors showed that blocking the action of CB1 receptors, either by pharmacological antagonism or genetic deletion, in previously conditioned mice resulted in strongly impaired short- and long-term extinction in fear-conditioning tests (the function of CB1 receptors in the process of extinction of aversive memories is detailed in Wotjak, 2005; Lutz, 2007). This finding raised a new question: Would potentialization of the eCB system facilitate the extinction process? The answer was not surprising, and several studies were published showing that eCB system potentialization could in fact facilitate fear extinction in different behavioral tasks (Chhatwal et al., 2005; Bitencourt et al., 2008, 2014; de Oliveira Alvares et al., 2008; Pamplona et al., 2008; Abush and Akirav, 2009; Lin et al., 2009). From the answer to the previous question, another arose in Takahashi’s lab – one that would raise CBD as a therapeutic possibility for the treatment of trauma-related disorders: Given that, according to Bisogno et al. (2001), CBD acts through potentialization of the eCB system, could CBD alone also facilitate the extinction of aversive memories? The answer once again was affirmative, and since then studies have shown that CBD can facilitate the extinction of aversive memories not only in animals (Bitencourt et al., 2008; Do Monte et al., 2013), but also in humans (Das et al., 2013). However, it is important to note that some studies suggest that the reduced expression of fear caused by CBD may result mostly from blocked reconsolidation of an aversive memory than its increased extinction (Stern et al., 2012, 2015; Gazarini et al., 2015). Regardless of which stage of aversive memory processing CBD affects, it appears that, at least in animals, this compound interferes with memory processing in a way that potentially mitigates damaging responses.
In addition to the possibility of CBD affecting different processes involved in aversive memory, animal studies also show favorable effects of this compound in the control of other frequent manifestations of PTSD symptomatology, such as sleep disorders. Studies in rats indicate that CBD may contribute to an increase in sleep duration and depth, and a decrease in anxiety responses induced by sleep disturbance (Monti, 1977; Hsiao et al., 2012; Chagas et al., 2013). In the case of anxiety, another frequent manifestation of PTSD symptomatology, therapeutic potential of CBD has also been reported. However, a thorough review of CBD and anxiety lies beyond the scope of this paper. The interested reader may want to see recent reviews by Blessing et al. (2015) and Lee et al. (2017). Even when all evidence from animal studies suggests an enormous therapeutic potential of CBD CBD for treating PTSD symptoms (for a summary, see Table Table1 1 ), it will still be limited if the results are not replicated in humans. Research has also been moving in this direction, as we will see in the next section.
CBD Oil for PTSD – February 2022
Post-traumatic stress disorder , also known as PTSD, is a psychiatric condition that occurs in people who have witnessed or experienced a traumatic event . It affects an estimated 3.5% of adults in the United States , with women twice more likely to develop PTSD than men (5) .
According to the U.S. Department of Health and Human Services, post-traumatic stress disorder is one of the five major types of anxiety disorders (6) .
People with PTSD have sensations of intense, disturbing feelings and thoughts associated with their experience. These symptoms can last long, even after the encounter has ended.
Reliving the event may result in nightmares, severe anxiety, fear, anger, and emotional detachment in PTSD patients .
The psychological trauma could also lead to long-term detrimental effects on cognitive functioning (7) .
PTSD is diagnosed once a person experiences symptoms for at least a month after a disturbing event. However, its signs may not show up for months or several years (8) .
Individuals who have post-traumatic stress disorder are conventionally treated using medications, psychotherapy, or both. Patients are prescribed antidepressants, while psychotherapy involves talking with a mental health expert to treat the condition (9) .
Serotonin reuptake inhibitors ( SSRIs ), sertraline, and paroxetine are the only drugs approved by the United States Food and Drug Administration ( FDA ) for PTSD treatment (10) .
This limitation in pharmacological medications has necessitated the testing of other medicines that can provide the same therapeutic effects as these drugs.
Cannabidiol ( CBD ), a constituent from Cannabis sativa plants, could be a potential treatment for PTSD.
Preclinical studies in various rodent models have revealed that cannabidiol made it easier for the subjects to forget aversive memories and block their reconsolidation (11) .
Researchers also learned that CBD might facilitate the decrease of the salience of ordinarily significant stimuli, which are processes relevant to the psychopathology of PTSD (12) .
Researchers assumed that CBD ‘s interaction with the endocannabinoid system (ECS) is what allows it to express its psychiatric effects (13) .
The ECS, which is present in all mammals, is responsible for maintaining homeostasis or balance.
CBD ‘s association with the ECS has led experts to believe that the compound may perhaps be used to alleviate the symptoms of PTSD .
One study in 2013 provided the first e vidence suggesting that CBD enhances the consolidation of extinction learning in humans (14) .
Extinction learning is the gradual decrease in response to a conditioned stimulus, which is frequently linked to post-traumatic stress disorder therapy.
The trial participants received 32 mg of CBD , after which successful conditioning, extinction, and recall were observed in the subjects.
Consistent with the results from animal studies, the findings showed that CBD could be used to complement exposure therapy (15) . Exposure therapy is a psychological approach developed to help individuals face their fears.
Meanwhile, CBD has shown to be a promising compound due to its possible effects as an anxiolytic and antidepressant (16) .
A review published by the journal Medicina found that cannabidiol displayed promising signs as an enhancer of fear extinction and consolidator of emotional memories (17) .
The authors reviewed several studies in which CBD was shown to positively affect PTSD patients , mainly because of its anxiolytic effects.
The review also analyzed a report wherein a ten-year-old sexually abused patient experienced reduced anxiety and sleep symptoms related to PTSD after taking 12 to 37 mg of CBD daily (18) .
In 2019, researchers learned that post-traumatic stress disorder patients who were given CBD along with psychiatric care showed a pattern of decreased PTSD-related symptoms (19) . They also hypothesized that CBD might have anti-anxiety and extinction learning properties that could benefit people with PTSD.
Despite these positive findings, no clinical trial that evaluated the effectiveness of CBD in reducing human PTSD symptoms has been completed.
How CBD Oil Works to Help with PTSD
The symptoms of post-traumatic stress disorder involve changes in memory processes, mood, and anxiety. Its symptomatology has led researchers to study a new class of substances called cognitive enhancers (20) .
Experts believe that these chemicals could modulate PTSD processes and improve the outcome of patient psychotherapies. It is in this perspective why drugs that act on the endocannabinoid system (ECS) are receiving much attention in pharmacological research.
The ECS, a system found in mammals, is said to regulate memory processes, anxiety, and depression.
A study published by Frontiers in Neuroscience declared that the ECS provides more efficient and effective alternatives to the conventional treatments for PTSD (21) .
The authors consider this system to be essential in regulating emotional behavior, especially one that involves traumatic experiences.
Psychiatric agents that influence the endocannabinoid system may potentially be used to alleviate the symptoms of post-traumatic stress disorder . The main non-psychoactive compound from cannabis, CBD , could be one of them.
Authors of a 2020 study believe that one way CBD expresses its anti-anxiety and antidepressant effects is through its interaction with 5-HT1A receptors (22) . The 5-HT1A serotonin receptors have been closely linked to anxiety and depression (23) .
A review of studies involving animal models showed that CBD possesses anxiolytic-like effects and interacts with 5-HT1A receptors (24) . The authors also noted that CBD engages with the CB1 and CB2 receptors of the ECS.
Cannabidiol binds to CB1 and CB2 receptors . This interaction triggers CBD’s ability to reduce anxiety (25) .
Researchers believe that the activation of circuitries involving these cannabinoid receptors may affect the neurobiological pathways and symptoms of PTSD .
For instance, the CB1 receptors , which are found in high levels throughout the brain, have shown modulating effects on mood, stress, learning, and memory (26) .
The researchers theorized that the stimulation of CB1 receptors could decrease hypervigilance and intrusive memories, both of which are common in post-traumatic stress disorder (27) .
Furthermore, a study in 2013 found that patients with PTSD have much lower levels of a neurotransmitter known as anandamide (28) .
This fatty acid has been implicated in both animal models of stress and neuropsychiatric disorders (29) .
Researchers hypothesized that, based on scientific evidence, CBD could be used to elevate levels of anandamide and potentially treat anxiety-related disorders (30) .
The Pros and Cons of CBD Oil for PTSD
- CBD could be used to treat the symptoms of post-traumatic stress disorder . Several studies have shown that CBD has several neuropsychiatric effects, such as its anti-anxiety and antidepressant properties, that may benefit patients with PTSD.
- The compound has been found to work with various receptors of the endocannabinoid system . This system is believed to contribute to maintaining biological balance in the body.
- Compared to THC ( tetrahydrocannabinol ), CBD is non-euphoric and does not cause psychoactive effects upon intake.
- Many states in America (like Colorado ) allow the purchase and consumption of cannabidiol . In places where it is legally sold, users can get CBD products even without a doctor’s prescription.
- Government branches, such as the Food and Drug Administration ( FDA ), acknowledge CBD ‘s potential as a therapeutic agent. The FDA is highly interested in CBD because of its supposed health benefits (31) .
- In 2018, the World Health Organization published a report stating that they have found cannabidiol to be well-tolerated in clinical trials. The WHO also learned that the compound is non-addictive, as the use of CBD did not exhibit effects indicative of substance dependence in human subjects (32) .
- The positive findings on CBD as a potential treatment for traumatic stress is overshadowed by the fact that there is a distinct lack of human clinical trials on its effectiveness in treating PTSD.
- The medication known as Epidiolex is the only CBD product that has been approved by the FDA . The agency has yet to allow a marketing application for cannabis derivatives for treating any condition or disease (33) .
- A 2017 review on the safety of CBD use mentioned that the compound could lead to adverse reactions in individuals when taken with other medications. Despite its favorable safety profile, CBD may still cause side effects , such as diarrhea, fatigue, and loss of appetite (34) .
- The growing demand for CBD has led to an increase in mislabeled products, especially those sold online and in some dispensaries (35) . Purchasing CBD through these channels brings a higher risk of consuming more or less of the compound in each product.
How CBD Oil Compares to Alternative Treatments for PTSD
Given that PTSD is an anxiety disorder (36) , experts have come up with alternative treatments that could alleviate anxiety and depression in patients.
Lavender, lemon balm, and chamomile are herbal remedies that are believed to help with anxiety-related disorders (37) .
There is an extensive anecdotal history surrounding the anxiolytic benefit of using lavender essential oils. Researchers believe that its terpenoid constituents produce anti-anxiety effects by reducing serotonin receptor activity (38) .
According to a review, several clinical trials support the effectiveness of lavender oil extract in treating anxiety disorders . Lavender essential oils were found to improve sleep duration and quality in patients with anxiety (39) .
Preliminary research data on lemon balm revealed that the herb might be capable of reducing some of the symptoms of anxiety (40) .
Early reports on chamomile studies have also shown that the plant exerts anti-anxiety and antidepressant effects upon use (41) .
These findings, together with CBD ‘s purported health benefits, have led brands to develop products that combine these herbal solutions.
CBD and lavender are often available as tinctures that people can apply sublingually (under the tongue). Brands are also selling CBD rubs that contain lavender, which is advertised to help soothe discomfort.
There are CBD products made with lemon balm available as teas, gummies , and ointments. CBD companies promote these c ombinations to promote calmness and reduce anxiety.
The infusion of cannabidiol and chamomile is often found in teas that people can enjoy for relaxation. Brands also sell a combination of the two compounds as tinctures , which are said to help with sleep disorders.
In a clinical trial, CBD was shown to enhance sleep in subjects (42) , while chamomile is known for its calming effects on the nerves (43) .
How to Choose the Right CBD for PTSD
To select the most appropriate CBD product for post-traumatic stress disorder , people should know the three types of cannabidiol available.
CBD is sold in three forms, namely as isolates, broad-spectrum , and full-spectrum .
Cannabidiol , in the form of isolates, is the purest form of CBD sold today. These are products that undergo a thorough extraction process that removes all the compounds of cannabis, except for CBD .
Pure CBD isolates are usually found in crystallized or powdered form and do not have a distinctive taste compared to the other types of CBD .
Broad-spectrum is the CBD variant that has all of the cannabinoids of cannabis plants . The only compound that is removed in broad-spectrum CBD is the THC content.
People who want to consume CBD and other cannabinoids (but without THC ) often choose the broad-spectrum products. THC is the opposite of CBD since it is a psychoactive compound that can cause mind-altering effects in users.
The third type of CBD is known as full-spectrum , as it contains all of the phytocannabinoids present in cannabis. Besides CBD , one can expect to find terpenes , flavonoids, and THC in the full-spectrum variant.
CBD in the full-spectrum form is known for its “ entourage effect .” All the cannabinoids work better together than when they are taken separately.
Whichever type of CBD one decides to get, it is vital to select only the best quality product available to leverage the benefits of CBD oil .
The following tips can help buyers choose only the safest and most reliable cannabidiol for PTSD:
- Get the certificate of analysis (COA) or the third-party lab report of the CBD product chosen. The COA is a document that is particularly important since it indicates that the item has undergone testing and contains precisely the specifications listed on its label.
- Read up on store and product reviews if buying CBD from an online shop. If purchasing from a physical dispensary, check if they have the proper authorization to sell cannabidiol products.
- Choose organic cannabidiol derived from industrial hemp . This plant is the most reliable source of high-quality CBD .
- Make sure that the legalities concerning CBD are observed in the state where the product is going to be bought and used.
- Consulting a health care professional is important before using CBD . Talk to a doctor who is experienced in medical cannabis use.
Additional Tips to Get the Best CBD Oil Products
- Avoid buying from CBD companies that claim to sell cannabidiol derived from the seeds and stalks of hemp plants. The reason for this is simple: non-GMO industrial hemp stalks have very little CBD , while its seeds do not have cannabidiol .
- It is vital that interested buyers first assess the quality of CBD edibles, such as gummies , before purchasing. Be wary of brands that sell CBD snacks that contain sub-standard or artificial ingredients.
- Feel free to contact CBD brands for inquiries or questions regarding their products. It is best to choose another CBD company if they fail to respond promptly.
CBD Dosage for PTSD
The FDA has not approved a CBD product as a treatment for patients with post-traumatic stress disorder . Therefore, CBD users do not have official guidelines to know the right dosage for their condition.
Some individuals, however, believe several factors can help a person determine the right CBD dose for their needs. The amount of CBD present in a product and the body weight of the user are two of the most commonly cited factors.
People may also stand to benefit by looking at past clinical trials. These studies may provide them with hints of the right dosing range for post-traumatic stress disorder and other anxiety-related conditions.
A review published in 2020 revealed that 400 mg of oral CBD significantly reduced the primary symptom of patients with social anxiety (44) .
The same report analyzed another trial wherein participants were given a 600 mg oral dose of CBD and found that it reduced anxiety and cognitive impairment significantly.
Meanwhile, a study noted that chronic use and high doses of CBD oil , reaching as much as 1,500 mg per day, is well-tolerated by humans (45) .
Among the subjects, no psychomotor slowing, adverse mood effects, or vital sign abnormalities were reported.
These findings are likewise supported in the 2018 review published by the WHO (46) .
The agency assessed a study in which healthy volunteers took 200 mg of oral CBD . The WHO noted that the dose did not cause impairments of motor or psychomotor performance in the subjects afterward.
How to Take CBD Oil for PTSD
Perhaps the most direct way to consume CBD hemp oil for post-traumatic stress disorder is to take the compound as edibles or in capsule form.
The most well-known edibles are CBD gummies . These products are great for both beginners and experienced users because they are relatively easy to apply.
CBD in the form of tinctures or drops allows people to apply CBD sublingually. This type of application is where liquid droplets of the compound are placed under the tongue.
CBD tinctures come with droppers that make it very easy to measure the correct amount of CBD needed.
Administering cannabidiol in this manner is a suitable approach for individuals who want to control their CBD dosage.
Some CBD brands sell topicals, like balms, salves, creams, and lotions, which may benefit people with PTSD. These CBD products can be used in massage therapies to help users relax and relieve the physical tension in their bodies.
Meanwhile, some individuals may want to inhale CBD by using compatible vaping products. However, this CBD delivery format is not recommended for people with lung disorders, as it may worsen their conditions (47) .
It is essential to consult a physician before applying any form of CBD to avoid complications. Users are highly advised to seek help from a doctor who is experienced with cannabis use.
What is Anxiety?
Anxiety is a feeling of fear or apprehension and is the body’s natural response when experiencing stress. It is an essential way of helping individuals avoid potentially dangerous places or situations.
However, anxiety that does not go away and starts to affect day-to-day life could be an indication of an anxiety disorder . Anxiety disorders affect approximately 40 million adults every year in the United States alone (48) .
The five major types of anxiety disorders are generalized anxiety disorder , obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder , and social anxiety disorder (49) .
People with anxiety disorder often exhibit the following symptoms:
- Experiencing an increased heart rate
- Feeling nervous, restless, or tense
- Having a sense of impending danger
- Hyperventilating or rapid breathing
- Feeling weak or tired
- Having issues with concentration or thinking
- Experiencing sleep disorders
- Finding it hard to control worry
- Feeling the urge to avoid situations that could trigger anxiety
Experts believe that anxiety disorders are caused by many factors, such as ongoing stress, physical health concerns, genetics, or traumatic events .
Individuals experiencing anxiety disorder symptoms should consult a doctor. A physician can diagnose anxiety disorders and help people manage their difficulties.
What is Post-Traumatic Stress Disorder ?
Post-traumatic stress disorder , also known as PTSD, is a psychiatric condition that can occur in individuals who have experienced or witnessed a traumatic scenario.
These events can be in the form of a natural disaster, a significant accident, rape, or other violent personal assault.
People who have PTSD experience intense and disturbing thoughts associated with their experience, lasting long after the traumatic event has ended.
They may avoid certain situations that remind them of a troubling scenario and react strongly to something most people would consider ordinary.
The following are some conditions that are related to post-traumatic stress disorder :
Acute Stress Disorder
Similar to PTSD, acute stress disorder can happen as a reaction to a disturbing event. However, its symptoms often appear a few days to about one month later.
People with acute stress disorder may persistently relive the trauma, experience nightmares or flashbacks , and may feel detached from other people. These symptoms can lead to significant distress and cause problems in their day-to-day lives.
Psychotherapy and cognitive behavior therapy may help control acute stress disorder, while potentially preventing it from developing into PTSD. Doctors may also prescribe antidepressants to help ease patient symptoms.
This type of disorder happens in response to a stressful event or series of traumatic scenarios. A person with an adjustment disorder may react more severely to a stressor than what would be reasonably expected.
The most common symptoms of the condition include hopeless, sad, or tense feelings. Individuals with the disorder may withdraw from other people and display physical manifestations, like headaches, tremors, and palpitations.
These symptoms can lead to significant problems in an important aspect of someone’s life, such as in school or at work.
The signs of adjustment disorders often start within three months of a traumatic event and last no more than six months.
The stressor for adjustment disorder may be a single event or more than one situation with a cumulative effect. Stressors may affect one person, an entire household, or a community (such as in the case of a natural disaster).
About 5% to 20% of people in outpatient mental health treatment are diagnosed with adjustment disorder (50) .
Disinhibited Social Engagement Disorder
Disinhibited social engagement disorder is a condition that occurs in children who have been severely neglected or deprived of social interaction before two years of age.
This condition develops when a child lacks the fundamental emotional needs for comfort, affection, and stimulation.
Children need to have at least two of the following symptoms to be diagnosed with the disorder:
- Intense excitement when meeting or interacting with strangers or other unfamiliar adults
- Behaviors with strangers are overly talkative, friendly, or physical and are not culturally acceptable or age-appropriate
- Desire or willingness to leave a safe place with a stranger
- Lack of interest in checking in with a trusted adult before leaving a safe place
Psychotherapeutic treatment is the standard approach in treating disinhibited social engagement disorder. The plan may include expressive therapies, such as art or play therapy.
The goal of this treatment is to strengthen the bond between the child and their primary caregivers while advancing their social and emotional development.
The prevalence of disinhibited social engagement disorder is not known. Experts believe it to be quite rare, as most severely neglected children do not appear to develop disinhibited social engagement disorder.
Reactive Attachment Disorder
This type of condition is similar to disinhibited social engagement disorder as it also occurs in children who have experienced severe social deprivation during their early years.
Children lacking the basic emotional needs for affection, comfort, and stimulation can develop reactive attachment disorder.
Subjects that have this disorder are emotionally withdrawn from their caregivers and rarely turn to them for support.
Individuals with reactive attachment disorder show minimal positive emotions and may exhibit unexplained sadness or fear.
Although it can occur in severely neglected children, reactive attachment disorder is uncommon. Treatment mostly involves the child and their family working together to strengthen their bond.
PTSD is a psychiatric disorder that affects an estimated 3.5% of adults in the United States . Women have a higher probability of developing post-traumatic stress disorder than men.
PTSD is one of the five major types of anxiety disorders and is characterized by intense and disturbing feelings associated with a troubling experience.
A person with post-traumatic stress disorder reliving an event may develop severe anxiety, fear, nightmares, and emotional detachment.
Individuals with PTSD are conventionally treated with medications, psychotherapy, or both. Antidepressants are often the prescribed form of drugs, while psychotherapy involves talking to a mental health expert.
There are only a few drugs that the FDA has approved for treating PTSD. This limitation has necessitated the testing of other treatments that offer the same therapeutic effects as these medications.
CBD is considered a potential treatment for post-traumatic stress disorder because of its anti-anxiety and antidepressant properties.
Several preclinical studies have shown that cannabidiol allowed subjects to forget aversive memories and block their reconsolidation . Researchers believe that CBD ‘s interaction with the endocannabinoid system enables it to exert its psychiatric effects.
The ECS is a unique system found in mammals believed to maintain the biological balance in the body. Its association with cannabidiol has led experts to theorize that perhaps CBD may be used to help people with PTSD.
Studies discussed above have shown CBD to have a positive influence on PTSD patients by providing an anti-anxiety effect upon intake.
In a report, CBD reduced anxiety and sleep disturbances after being taken daily. One study found that CBD decreased PTSD-related symptoms in post-traumatic stress disorder patients.
Despite these positive findings, no clinical trials evaluating the effectiveness of CBD for PTSD have been accomplished.
Interested users should consult a doctor before purchasing any CBD product for their condition.
Seeking advice from a physician knowledgeable with cannabis and its constituents is highly recommended.