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PTSD: Overview and Treatment Options

Leslie kahn


Post-traumatic stress disorder (PTSD) can develop as a response to any traumatic event such as spending time in combat or living in a war zone, experiencing sexual, physical or emotional abuse, a serious accident or a terrorist attack or losing a loved one unexpectedly. While 70% of American adults have reported experiencing a traumatic event or situation at least once in their lifetime, most of them will not develop PTSD. In this article, I will identify the mental and physical symptoms of PTSD, factors that contribute to developing the disorder, its pathology, and the many different treatment options, including medical cannabis.

Factors That Contribute to the Likelihood of Developing PTSD

  • Age and Gender
  • Mental or physical health
  • Emotional response during trauma
  • Emotional support network
  • Additional stressors present post-trauma
  • Marital status
  • Type of trauma

Common Symptoms of PTSD

  • Flashbacks during the day while the mind is alert
  • Nightmares during sleep which may focus on the trauma or be unrelated to it
  • Avoidance of situations which reminds them of the trauma
  • Insomnia due to difficulty in quieting their minds, making sleep elusive
  • Detachment from others due to fear of behaving inappropriately in public; getting angry
  • Loss of interest and motivation in activities they previously enjoyed
  • Quick to anger often to a greater degree than before
  • Memory loss as a technique to temporarily or permanently block out the traumatic event
  • Hyperarousal where they are never entirely at ease. This is often caused by a frightening and life-threatening event like war
  • Self-Medicating with alcohol and dangerous drugs

The Pathophysiology of PTSD

PTSD causes structural and physiologic brain abnormalities in the following ways:

  • An increase in the activity of the amygdala or fear center
  • A reduction in volume in the prefrontal cortex where executive functioning originates
  • A decrease in volume in the hippocampus or memory center. This leads to an increase in the fear response, to intrusive thoughts, flashbacks, nightmares, impulsivity and hyperarousal
  • A decrease in the baseline cortisol level which leads to an increase in a negative feedback system of hyperarousal and hypervigilence
  • Dysregulation of neurotransmitters causes the stress response system to fail to function effectively. It should react, adapt and recover when presented with a stressful situation
  • The physical, mental and emotional symptoms are present due to an increase in norepinephrine and glutamate and a decrease in serotonin

Common Physical Symptoms Associated with PTSD

  • Chronic pain
  • Digestive disorders
  • Diabetes
  • Heart disease
  • Arthritis
  • Respiratory disorders

Treatment Options for PTSD

Cognitive Behavior Therapy (CBT)

CBT is a type of talk therapy which attempts to alter your thought patterns that are disruptive by:

  • Talking about the trauma
  • Analyzing the root of your fears

The long-term goal is to:

  • Reduce your symptoms
  • Teach coping skills
  • Restore self-esteem

For some individual sessions work best and for others group sessions are more effective

Cognitive Processing Therapy (CPT)
Talking about the traumatic event and how it impacts your life. You write down a detailed account of what happened.

Prolonged Exposure Therapy

  • Confronting the trauma
  • Breathing exercises are taught in order to reduce the anxiety when talking about the trauma
  • Make a list of all the avoidance techniques and learn how to address them
  • Record an account of the trauma to the therapist and listen to recording at home

Eye Movement Desensitization and Reprocessing (EMDR)
The therapist will have you recall a traumatic event while guiding you to think about pleasant thoughts using finger movements, hand or toe tapping or musical notes.

Stress Inoculation Therapy
Focuses on stress reduction techniques rather than on relating the trauma. These include breathing techniques, massage, exercise, relaxation techniques such as guided imagery, yoga, Tai Chi. 

Medications
With PTSD, brain neurotransmitters are not in the normal range. The sufferer is always in the fight or flight mode. The goal is to stop the thoughts about the trauma which will stop the reaction to it. A common first medication is for SSRIs and SNRIs that regulate your serotonin/norepinephrine levels. These include:

  • Prozac
  • Paxil
  • Zoloft
  • Effexor

Other medications include:

  • Anti-psychotics
  • Beta-blockers
  • Benzodiazepines
  • Monoamine Oxidase Inhibitors (MAOIs) which is a natural enzyme which breaks down serotonin, epinephrine and dopamine.

Medical Cannabis

In clinical human trials using medical cannabis, participants reported:

  • A reduction in the amount of time they spent re-experiencing the trauma
  • A decrease in the amount of time they spent in a hyperarousal state
  • A reduction in their avoidance of situations which caused flashbacks
  • A decrease in the volume of negative thoughts in their minds and an increase in positive thoughts to replace them
  • Were able to experience emotions appropriately vs feeling numb on prescription medications

In anecdotal evidence, those who used medical cannabis reported that it allowed them to forget the traumatic events, eliminating their emotional and physical response such as flashbacks and disturbing dreams. They were also able to get good quality sleep which is often fitful in those with PTSD.

PTSD is a classic example of Clinical Endocannabinoid Deficiency disorder where there is a deficit of natural endocannabinoids. The ingestion of medical cannabis replenishes the ECS and may deactivate patients' disturbing memories.

Many military veterans, who make up a significant pool of medical cannabis patients, have reported that they have been able to replace opioids with medical cannabis to control their PTSD symptoms. In some cases, it has been life-saving.   

Sources:
webmd.com, 6 Common Treatments for PTSD, 11/07/17
facty.com, 10 Symptoms of PTSD, Angela & Facty Staff, Updated May 21, 2019
apa.org, CBT for the Treatment of PTSD, 7/31/17
ncbi.nim.nih.gov, CBT for the Treatment of PTSD, Nilamadhab Kar, 4/04/11
verywellmind.com, The Rates of PTSD in Military Veterans, Dr. Matthew Tull, Nov 15, 2019