Tag Archives: Anxiety

Anxiety

Do anti-depressants or anxiolytics cause lower levels of vitamins and minerals?

Virginia Thornley, M.D., Neurologist, Epileptologist
November 4, 2019
A recent question prompted this literature search. We know that patients ho are depressed often complain of fatigue. But which came first the chicken or the egg?
Fatigue could be a result from not sleeping well due persistent thoughts and rumination at night. But can long-term anti-depressants and anxiolytics cause a lowering of vitamins and minerals leading to fatigue? We search the literature.
In one meta-analysis, folate levels were found to be lower in a small number of patients compared to those who were not depressed. However, it does not mention if the use of anti-depressants or anxiolytics were the cause of these lower values. This was an observation (1).
In another study, 355 patients were studied later in life, 60’s and higher in age. Lower levels were found to be lowered which could be a potential cause of later life depression. It is not clear if these patients were on anti-depressants leading to lower Vitamin D levels (2).
In one review, 4 studies were found that an improvement in the the thiamine status led to improved mood. The same study found that folate deficiency led to depression and iron deficiency anemia can lead to fatigue and depression (3).
The take home message is that it is not clear whether anti-depressants and anxiolytic agents used long-term can result in lower levels of minerals and vitamins.
However, it has been studied that lower levels of certain minerals and vitamins can lead to or be associated with depression.
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Reference
  1. Bender, A., Hagan, K.E., Kingston, N., The association of folate and depression: a meta-analysis. J. Psychiatric Res. 2017 Dec. 95:9-18
  2. Oude Voshaar, R.C.,Derks, W.J., Comiis, H.C., Schoevers, R.A., de Borst, M.H., Marijnissen, R.M. Antidepressants differentially related to 1,25-(OH)2 vitamin D3 and 25-(oH) vitamin D3 in laterlife depression. Transl Psychiatry. 2014, Apr. 15;4:e383
  3. Benton, D., Donohue, R.T. The effects of nutrients on mood. Public Health Nutr. 1999 Sep; 2(3A):403-409
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Medical Practice

Understanding the practical aspects of cannabidiol (CBD) and tetrahydrocannabinol (THC)

 

Virginia Thornley, M.D., Board-certified Neurologist, Epileptologist

@VThornleyMD

July 15, 2018

Introduction 

This serves as medical information for educational purposes only not medical advice. Please consult with your treating  physician.

In contrast to the rest of the blog which is more scientific, this gives more practical information in the day to day workings of recommending medical cannabis. It gives the behind the scenes processes that happens before a patient can even begin to start their medical product. It is not a magic pill but because it is unlawful in Florida, a physician cannot even write it on a prescription pad. It takes one hour or more to evaluate, counsel and go over the registration process when presenting for the first time to a doctor.

For more detailed information and scientific references for specific indications please refer to
https://neurologybuzz.com/

Medical cannabis is one of the most misunderstood and controversial medications in the world. Long suppressed for over a century, it is one of the most misunderstood medications known to mankind despite being used for thousands of years with medical intent.

This is to give a brief basic background of mechanisms, rationale for ratios, combinations, pitfalls of isolates and synthetics and legal implications.

Background

The endocannabinoid system is found naturally in our body. It is responsible for the runner’s high people get. It gives a sense of wellbeing, not endorphins like most people think, those molecules are too large to pass the blood-brain-barrier. There are 2 receptors:(1) the CB1 receptor found mostly in the nervous system and (2) the CB2 receptor which is more abundantly found in the immune system. Anandamide works on the CB1 receptor, tetrahydrocannabinol (THC) is similar to this and works on the CB1 receptor. CBD or cannabidiol is from the cannabis sativa plant and is also a phytocannabinoid. One needs 100 times the CBD to get the euphoria as THC. CBD is not intoxicating, legal and works on a wide variety of symptoms including pain, seizures and anxiety. CBD is similar to 2-arachidonoyl glycerol which is a natural cannabinoid. When the 2 are combined together, CBD will offset side effects of THC including paranoia, hyperactivity and agitation. This is a not known fact to those who self-medicate with pure THC.   Because of this THC is medically recommended in conjunction with CBD. Smoking is illegal and not medically recommended as most people think. https://neurologybuzz.com/2018/04/02/medical-marijuana-vlog-series-part-i-mechanisms-medical-benefits-of-non-intoxicating-cannabidiol-and-tetrahydrocannabinol/

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Pitfalls of self-medication

Sometimes patients self-medicate and smoke pure THC from dubious sources to alleviate symptoms, which is illegal and not medically recommended in Florida.  However, the intoxicating effects are not seen when recommended medically using oral forms, cream or patch. At low doses, as is done when recommended medically, THC is non-euphoric. When THC is combined with CBD the side effects of THC are offset. The dangers of patients who self-medicate is that they do not know where the products are coming from and it can be mixed with potentially dangerous substances that can be potentially fatal. In addition, there are highly potent synthetic illegal cannabinoids known as K2 and spice which at high doses can cause cardiotoxicity and fatalities. Self-medicating with THC from an unknown source is highly discouraged as there may be mold involved with the processing. https://neurologybuzz.com/2018/05/31/the-fatal-effects-and-mechanisms-of-synthetic-cannabinoids-including-jwh-compounds-used-recreationally/

Why is a CBD and THC combination important?

In regulated licensed dispensaries, CBD is combined to offset the side effects of THC allowing better tolerance. THC is not recommended by itself because of side effects including paranoia, agitation and hyperactivity.

CBD by itself

With pure CBD, there are certain medical symptoms that are alleviated.

It is legal. There are many companies with CBD products but it is difficult to know how pure these products are, even if you have a small amount of hemp it can be marketed as CBD hence, its ineffectiveness. Some of the most effective CBD products can be found from Colorado and California, anecdotally. Everything else is hit or miss.

In the state of Florida, there are very few medically beneficial CBD products, it’s trial and error. The purer the form such as full spectrum CBD oil the more expensive it will be because processing organic products are costly. A cheap product will likely not be as pure just because of the huge amount of work that goes into extracting the cannabidiol. In addition, some may have flavors, cutting agents and other agents to dilute it but because it’s unregulated.

Ratios

CBD alone has no psychoactivity but medical value. CBD is combined with THC in order to offset its side effects of paranoia, agitation and hyperactivity.

Time of onset and duration

There are different ways of trying it: vaporizer lasts 1 hour and takes about 10 minutes to get into your system. Because the vaporizer is inhaled into the lungs the onset is the fastest because of the rich supply of blood vessels in the lungs. It is advisable to try the vaporizer at home or at night before setting out to see how it affects you. Oral forms last 6 to 7 hours and takes about 1/2 hour to get into your system. Oral form comes in oil concentrate and tincture. Cream and patch last about 12 hours or longer depending on the preparation. Medical marijuana is NOT recommended by physicians to be smoked. Recreational marijuana by smoking is prohibited and unlawful in Florida. This law varies by state. When different parts of the plant are taken together including the terpenes it gives an entourage effect which is more medically valuable than when components are isolated for its use.https://youtu.be/Ir4rwgF2iNc

Are there any edibles in Florida?

As of July 2018, there are no edibles in the state of Florida. It will take an enormous amount of submitting documentation and providing capital before edibles will be implemented in Florida. The dispensaries are working on this.

Registration process: what to expect in Florida

The process includes an evaluation by a qualified licensed physician. https://neurologybuzz.com/2018/07/12/legalities-and-application-process-in-the-state-of-florida/A qualified physician undergoes a 2-hour course and holds a full medical license in the state of Florida. One is evaluated and if patient meets the stringent criteria, they obtain a registry number. The patient undergoes registration which takes between 2-4 weeks. An e-mail arrives before the card then one is instructed to call the office so that recommendations are placed in the system. Oftentimes, if you don’t hear back in 4 weeks it is advisable to give the registry a call. It may be a misentering of an e-mail causing a delay.

Regulated dispensaries in the Florida

In Florida, there are 13 medical marijuana treatment centers and 43 retail dispensaries as of July 2018. In the state of Florida, patients can only obtain the Cannabis products recommended from their treating physicians from these dispensaries. It is illegal to smoke. There are 4 ways of taking it: oral, vaporizer, cream and patch. It is advisable to visit one of the licensed dispensaries in person so that the exact instructions can be given. Physicians recommend orders which are entered into the system. So long as the product is within the number of mg dispensed and the way it is recommended (oral, vaporizer, cream or patch) patients are at the liberty to change the ratio or dosage so long as it is within the orders.

Once you are registered

An e-mail with the marijuana card number comes before the physical card. It is advisable to call the physician office so the orders are placed then physically visit the dispensary of your choice so specific instructions can be taken. Because this is not a pharmacy, doctors do not have immediate access to the dispensary. One should be aware of which product they are taking before their next checkup. This can be easily accessed through the website of the dispensary.

The orders will expire after 70 days after which there is a processing fee of renewal at the office. The certification for medical marijuana expires after 1 year. One must be re-evaluated by their physician before then.

CBD is purely cannabidiol, it is non-psychoactive and legal. THC at low doses is non-intoxicating. Dispensaries combine CBD and THC to offset side effects.  It is federally illegal. It is advisable to be registered under a medical doctor who is qualified to determine if one meets criteria. Medical cannabis products can only be dispensed from a regulated licensed dispensary. Medical marijuana products outside of the jurisdiction of Florida regulates licensed dispensaries cannot be advocated.

Legal implications of THC

In some states, such as Florida, medical use of cannabis is recognized. THC is still considered federally illegal. Recreational use of cannabis is illegal. Smoking THC is illegal. Physicians cannot prescribe it since it is a schedule 1 drug but can recommend it. Schedule 1 drugs are considered illicit and labeled as having no medical use. A statement before the qualifying course on medical cannabis states that the physician can be questioned at any time by the FBI and authorities.

In other states, medical and recreational use is allowed.

In other states, medical and recreational use is completely banned.

The law also varies regarding cultivation of the cannabis sativa plant.

Countries will vary in their marijuana laws.

The laws change very rapidly. Regulations are changed nearly every month with more documentation required from physician offices including consent, doctors’ notes, patient information with indication. As each month goes by another new document is required for submission from the physician office. There is increasing bureaucracy likely signifying resistance at some upper levels against its use related to economic and political reasons. Dispensaries have an equally challenging time. Even worse are small farms applying for licenses huge amounts of capital and documents are required.

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Legal implications of CBD

CBD is legal throughout the US. Countries may vary in their laws since they both come from the cannabis sativa plant.

FDA approved medications and products approved in Europe with CBD and THC

A medication called Epidiolex for seizures with CBD has recently been approved for seizures. Because it comes from a strain from the cannabis sativa plant, cannabis will need to be deregulated from the schedule I category before Epidiolex can be marketed to the public.

Dronabinol has long been approved for nausea and can only prescribed for patients with cancer with chemotherapy induced nausea. It is a synthetic THC and is FDA approved.

In Europe, the medication Sativex which is a combination of CBD:THC has long been used for spasms in multiple sclerosis. This is not available in the US.

In summary

For patients, it is beneficial to have a working understanding of the different strains, different forms that are available in order to obtain the best benefit.  Dispensaries have a huge breadth of products. It is easier to understand as much as possible before facing the overwhelming number of options. Patients must understand all the legal implications in your state as they change rapidly. It is not only a medication it is affected by state and federal laws that change in a blink of an eye which can affect the patient if they are not aware.  One must be mindful that there are different types of practices recommending medical cannabis. The best practices are those that are an already established practice which added medical marijuana to their repertory. Practices that are solely for medical marijuana may be of dubious quality. There are already horror stories of patients never getting a card after several months and phone calls not being advisef on what to do, being examined in a conference hall. As with any new innovative service, there will be legitimate practices and there will be those who meet the minimum requirement of care and service. http://www.tampabay.com/investigations/2018/05/04/floridas-medical-marijuana-program-is-attracting-troubled-doctors-its-like-the-wild-wild-west/

For doctors recommending, one must be well-versed in understanding the potential side effects, drug interactions, the latest scientific research since these are the only guidelines that are guiding us from a scientific level. Pre-clinical studies cannot be ignored nor studies on synthetics to have a better grasp of understanding how it works. One must have a basic understanding in the effects of the phytocannabinoids which is best taken in combination and not in isolation. Patients come with complex medical problems it is always prudent to do due diligence in understanding as much as possible before recommending a product that was never studied for medical purposes in medical school. Patients will ask tough questions, physicians should understand as much as possible and do their due diligence being up to date on legislations as well as the most recent research. The hard questions will come.

One must also follow the legal implications, current regulations which are frequently updated. It is the physician’s responsibility to understand the mechanisms, be current on the literature because this is a pioneering science. Those recommending right now are trailblazing and should still be mindful of the great role you play in understanding what literature is available and to read voraciously.

Last thoughts

While much is still unknown about CBD, THC and mechanisms, there is great anecdotal data from history and clinical anecdotal experience supporting its benefits. While many traditionally trained physicians scoff at the prospect of introducing alternative treatments, one must bear in mind cannabis was not an alternative medication before it was banned in 1830.

While scientists are working overtime in elucidating the mechanisms to combat diseases such as cancer, one must bear in mind that medical cannabis is beneficial when taken in combination with other terpenes found in the plant and the components are not isolated from each other. THC works best in combination with CBD and with other components from the cannabis sativa plant.

When components are isolated from each other and products become synthetic and manufactured much of the benefits are lost and significant side effects result. https://neurologybuzz.com/2018/05/31/the-fatal-effects-and-mechanisms-of-synthetic-cannabinoids-including-jwh-compounds-used-recreationally/

Once it becomes synthetic and components are isolated, the benefits will be substantially altered.

Now is a optimal time to try the benefits of medical cannabis while it is still all organic and being produced on farms and regulated for its use, unsullied by synthetic forms where the risk of side effects are greater.

While much is still to be learned, for a medicine that can easily cover 5 symptoms in one setting, it is an extraordinary time to be recommending and benefiting from medical cannabis while it is still organically natural and pure.

 

Introduction/Disclaimer

About

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Post-Traumatic Stress Disorder

Post-traumatic stress disorder and traumatic brain injury among military veterans and use of non-intoxicating medical marijuana as a treatment

 

Virginia Thornley, M.D., Neurologist, Epileptologist

@VThornleyMD

March 28, 2018

Introduction

Post-traumatic stress disorder occurs due to a single or a sequence of traumatic events which causes a great deal of anxiety when exposed to situations similar to the event. Flashbacks and nightmares may occur. In military veterans returning from the Iraqi or war in Afghanistan and even to this day in Vietnam War veterans, emotional disruption is noticeable. It is difficult to know if this is related to blast injury or is a symptom of post-traumatic stress disorder.

PTSD correlated with mild traumatic brain injury

In a retrospective study reviewing medical records of 27,169 military personnel of the U.S. Army Special Operations Command (USASOC), 2831 met criteria of mild traumatic brain injury using the Immediate post-concussion assessment cognitive test, PTSD checklist, and the post-concussion symptom scale. Of these, 28% exhibited symptoms of post-traumatic stress disorder. Military veterans of blunt, blast or a combination injury had a higher percent of meeting criteria for post-traumatic stress disorder than those without mild traumatic brain injury. Those with blast/combination injury had a higher percent of post-traumatic stress disorder and performed worse with visual memory and time for reacting compared the cohort without any blunt or mild traumatic brain injury.  Repetitive exposure to blast-type injuries may have a lingering effect (2). This study found a  high degree of PTSD symptoms in those with blast, blunt and combination injury compared to the cohort without it.

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In a study, disrupted emotional responses correlate with PTSD rather than blast-related traumatic brain injury

Another study tried to dissect whether the emotional responses of war veterans are due to PTSD or due to the mild brain injury itself.  In one study of 123 military veterans from the war in Iraq and Afghanistan, affective evaluations and psychological assessments were made in response to pleasant, neutral, unpleasant and war-related images.  Those with emotional disruption due to PTSD rated pleasant images as unpleasant and had increased physiological responses towards combat-related images. Symptoms of post-traumatic stress disorder included increased skin conductance responses, greater corrugator muscle electromyography responses, and reduced heart decelerations. There were no effects noted in veterans with mild traumatic brain injury.  This points towards the emotional disruption seen in military veterans as related with post-traumatic stress disorder rather than due to the mild traumatic brain injury itself. This study may help guide treatment as military veterans transition to civilian life (1).

Medical marijuana and mechanism of action, a non-intoxicating solution when cannabidiol is used alone or in conjunction with low dose tetrahydrocannabinol

Cannabidiol is a non-intoxicating endocannabinoid that works within the endocannabinoid system found naturally in our systems. It has only a weak affinity to the CB1 receptor which is found abundantly within the neurological system.  CB1 receptors are found to be increased in response to cerebral cell damage and seem to work as a repair mechanism for neural systems that are not functioning. Tetrahydrocannabinol at low concentrations has medical properties without the intoxication of high dose THC. THC should be used in combination with CBD to offset the possible side effects such as hyperactivity.

There are increasing studies showing the value of medical marijuana, especially in the central nervous system especially given the large abundance of the CB1 receptor within the nervous system. The receptors are found to be upregulated in the face of disease suggesting a cell repair role or a response to the abnormalities within the brain, For example, in patient with seizures, the CB1 receptor is found to be increased in the temporal lobe within the dentate gyrus compared to other cells almost as a response to the aberrant system within the cortex. The receptors are found to be increased in patients with Parkinson’s disease.

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Medical Marijuana as a solution for symptoms of cognitive impairment in war veterans

In one study, 24 patients were enrolled in a study for executive function and were registered medical marijuana users. After 3 months, 11 patients returned and using the Stroop Color Word Test, were found to have a higher level of executive function and increased speed completing tasks without being inaccurate. Patients reported less insomnia, less depression, better attention, less impulsivity and a better quality of life. There was less use of pharmacologic use and less use of opioid agents by 42% in conjunction with medical marijuana. Larger clinical randomized controlled clinical studies are needed.

Medical marijuana seems to be an excellent agent in those affected by traumatic brain injury.

Medical Marijuana as a solution for and PTSD symptom in war veterans

Cannabidiol works at the level of the 5HT1 receptor causing patients to feel less anxious and may be used in post-traumatic stress disorder. In addition, it has been found to have a role in modulating memory and instead of the learned fear response and may help with PTSD by modulating the conditioned response to a stimulus that normally begets anxiety and fearfulness. In other words, instead of the heart rate increasing or having flashbacks when a war scene is on TV, medical marijuana can exert its effect by modulating behavior by changing the learned response by not responding the same way and being calm in face of a previously anxiety-inciting war scene(4).

In conclusion

In summary, PTSD and traumatic brain injury are real problems faced by war veterans returning with blast injury, blunt-injury or combination type combat-related injuries. Medical marijuana may be an excellent non-intoxicating solution when cannabidiol is taken or combined with low dose tetrahydrocannabinol which can help with depression, anxiety and help modulate responses to post-traumatic stress disorder. Medical marijuana can help with executive function and attention and may be beneficial in treating war veterans suffering from mild traumatic brain injury.

https://neurologybuzz.com/

Introduction/Disclaimer

About

References

  1. Marquardt, et al, “Symptoms of Post-traumatic stress rather than mild traumatic brain injury best account for altered emotional responses in military veterans,” J. Trauma Stress, 2018, Feb., 31 (1):114-124.
  2. Kontos, et al, “Residual effects of combat-related mild traumatic brain injury, “J. Neurotrauma, 2013, Apr., 15, 30 (8):680-6.
  3. Gruber, et al, “Splendor in the Grass? A pilot study assessing the impact of medical marijuana on executive function,” Front. Pharmacology, 2016,. Oct., 13 (7):355.
  4. Uhernik, et al, “Learning and memory are modulated by cannabidiol when administered during trace fear-conditioning,” Neurobiology of Learned Memory, 2018, Feb., 9, 149:58-76. doi: 10.1016/j.nlm.2018.02.009 (Epub ahead of print)
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Anxiety, cannabidiol

Anxiety: the science behind anxiety and effectiveness of cannabidiol and tetrahydrocannabinol in anxious patients

Virginia Thornley, M.D., Neurologist, Epileptologist

March 27, 2018

Introduction

Anxiety is a state of unease, the sense of restlessness you feel when you are out of sorts. It may be due to the simple circumstances of being late for a charity dinner to feeling scared out of your wits when your car is trembling on the highway because your wheels are not balanced. Everybody has experienced it at some point in their life. Some more chronically and severely than others. In primitive times, one must redirect their attention from the task of scavenging for food in the jungle to suddenly be alert to imminent danger from the bear prowling behind you. In modern times, one must react quickly to that bus coming at you as you try to cross the street on 51st Street and 5th Avenue. You suddenly look up startled redirecting your focus to the imminently life-threatening event. For someone with clinical anxiety, this would be akin to being fearful every time you try to walk and cross the street despite no threats just the usual fast-paced taxicabs waiting for that green light. There is a chronic response of fearfulness that is not befitting to the situation. Threats are perceived more frequently harboring frequent fearful responses.

Current approach to anxiety

The current armamentarium of a physician includes prescribing anti-anxiety agents, referring to a therapist, recommending relaxation techniques such as yoga, Tai Chi or meditation, or any physician’s all-time fallback choice which is to refer to a psychiatrist. Many medications take weeks to take effect and after all that, not all of them are effective requiring several trials of medications to get to one that may even partially work. A therapist is beneficial, however, cons include the patient not having enough time or resources. In some patients it may help in others, similar to medications, it does diddly squat. In addition, some patients must cope with anxiety through natural means due to the prohibitive nature of their occupation. Some highly sensitive occupations disallow any use of anti-anxiety agents which might be potentially sedating in a patient’s history which could cost them their jobs.  Medications may be helpful in certain populations but it often takes time to find the right agent and the right dose.

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The science and mechanisms behind anxiety

The mechanism of anxiety and its complexities are studied. At the chemical level, it is thought to be due to the lack of serotonin. Many anti-anxiety agents work at the level of the serotonin receptor.  But the thought processes underlying anxiety are far more complex than at a single chemical level which likely is the reason why many medications do not work given the complexity of the emotional response.

Neuroimaging studies have elucidated that anxiety may be attributed to the involvement of an amygdala to prefrontal cortex circuit. Instead of the normal fear response one has to certain stimuli, the amygdala is overly responsive to the threat. This leads to an abnormal attentional and interpretive response level that is consistently fearful.  For instance, your bakery might be the best in town but if the client is highly anxious, any little mistake on that wedding cake may be perceived as a personal slight giving rise to an extremely anxious response causing them to want their money back. In other words, the level of anxiety is greatly out of proportion to the situation. There is nothing that bakery could have done to ease that person’s anxiety over the cake.

Patients with anxiety are selectively attentive to threat-related situations. Anxious patients perceive neutral events with negative connotations and potentially threat-related. Stimuli with conditioned threat significance may elicit attention and lead to physiologic responses including increased heart rate, sweating, heavier breathing. This may be the reason why in dealing with an anxious person, no matter what has been said that individual has a hyperalert response and has a very low threshold for a fearful response to a threat-perceived situation when the situation is very neutral (1). For example, you could be the most highly skilled neurosurgeon in the world, if your delivery of the prognosis is a 60% chance of recovery, that could be a source of great angst. The clinically anxious person will hear how she or he  will have the 40% chance of not recovering.

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Cannabidiol 

Cannabidiol is the non-intoxicating phytocannabinoid from the Cannabis sativa plant. It has a weak affinity for the CB1 receptor and one needs 100 times the amount to get the same euphoria as tetrahydrocannabinol. Cannabidiol is found to help with anxiety. It works at the level of the 5HT-1 receptor to exert its anxiolytic properties. A combination of cannabidiol and tetrahydrocannabinol often called Indica is often used for anxiety and insomnia. It is often used by patients with anxiety primarily at night due to its calming and sedating properties.

In one study of 24 patients with anxiety who were about to give a presentation, cannabidiol was given at 600mg. The anxiety, cognitive impairment, and alert arousal response were much lower compared to the control group who had a placebo. The placebo group had much higher anxiety, greater discomfort, and alert responses (2).

Although federally illegal in many states despite medical marijuana laws and dispensaries popping up around the nation, medical marijuana is an alternative agent that should be considered in patients who are medically refractory to medications, psychotherapy, and other techniques. It has a valuable place in the physician’s medicine bag in treating anxiety and illnesses related to anxiety-related disorders.

References

  1. Bishop, et al, “Neurocognitive mechanisms of anxiety: an integrative account,” Trends in Cognitive Behavior, article in press.
  2. Bergamaschi, et al, “Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naive social phobia patients,” Neuropsychopharmacology, 2011, May, 36 (6): 1219-26.
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Anxiety, Depression, Post-Traumatic Stress Disorder, Uncategorized

Cannabidiol and tetrahydrocannabinol: effectiveness in post-traumatic stress disorder, anxiety and depression

Virginia Thornley, M.D., Neurologist, Epileptologist

March 20, 2018

Post-traumatic stress disorder is the silent disorder that could be affecting the co-worker who sits one cubicle over from you. When one hears of post-traumatic stress disorder, one thinks of traumatizing incidents such as war, abuse or some other devastating event but can occur even in situations such as car accidents or a spouse of many decades suddenly leaving. It is the quiet disorder that if you do not expound on it, nobody really knows about it. Because of the stigma surrounding psychological disorders, often times, help is not sought in a timely manner.

It is often characterized by nightmares waking someone up in the middle of the night or sudden flashbacks when placed in a situation similar to the traumatic event.  Management includes working with a psychiatrist using conventional medications and a psychologist using behavioral therapy. It is not uncommon for a patient to have to go through many different anti-depressants or anxiolytics before one finds the correct drug and titration. But sometimes even the best medications fail to treat someone with Post-traumatic stress disorder adequately. Psychotherapy may be helpful in some patients depending on the patient. In others,  there is less benefit and some dislike the thought of reliving the experience in order to learn coping mechanisms.

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Alternatives include non-pharmacologic measures including relaxation techniques such as doing yoga, Tai Chi or meditation. Exercise can often boost the mood and doing enjoyable activities may help alleviate symptoms without the addition of pharmacologic agents. Doing something one enjoys or taking joy in the simple activities in life such as writing poetry, art therapy, taking up a sport may help alleviate some of the stress. Great tips can be found on Psychiatrist, Dr. Welby’s site found here: https://drmelissawelby.com/exercise-depression-get-started-want-stay-bed/

More and more patients are turning towards alternative measures, finding that conventional medications are not always optimal. Cannabidiol works through the endocannabinoid pathway and modulates its effect through the CB1 receptor which is predominantly found in the nervous system. The CB2 receptor is found mostly in the immune system. In some studies, it was found that cannabidiol may help reduce fearful memory if taken in the conditioning phase so that rather than reacting to the stimulus with fear, the stimulus is then associated with a different reaction and may help mitigate the symptoms of post-traumatic stress disorder through this mechanism (1). In another study, it was found to influence synaptic dendrites and may contribute towards learned memory in the hippocampus (2).

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Cannabidiol interacts with the 5HT-A receptor which is an important receptor in mitigating the symptoms of anxiety. Serotonin works through the 5HT1-A receptors. Some anxiolytics and anti-depressants work through an increase in serotonin which boosts the mood. Cannabidiol itself is known to have a calming effect with none of the euphoria found in THC alone.   Cannabidiol is non-intoxicating and when combined with low dose tetrahydrocannabinol has great medical effects.

In summary, when medications and therapy are found to be ineffective for post-traumatic stress disorder, anxiety or depression, cannabidiol which is non-intoxicating may be an effective therapeutic option alone or in conjunction with low dose THC and should be considered.

Introduction/Disclaimer

About

https://neurologybuzz.com/

References

  1. Uhernik, et al, “Learning and memory are modulated by cannabidiol when administered during trace fear-conditioning,” Neurobiology of Learned Memory, 2018, Feb., 9, 149:58-76. doi: 10.1016/j.nlm.2018.02.009 (Epub ahead of print)
  2. Lee, et al, “Cannabidiol regulation of emotion and emotional memory processing: relevance for treating anxiety-related and substance abuse disorder,” British Journal of Pharmacology, 2017, Oct., 174 (19): 3242-3256. doi: 10.1111/bph.13724. (Epub. 2017 Mar. 9.)
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