PTSD and Cannabis: A Clinician Ponders Mechanism of Action

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Patients Out-of Time Perspectives
PTSD and Cannabis: A Clinician Ponders Mechanism of Action
By David Bearman, MD
One often intractable problem for which cannabis provides relief is post-traumatic stress disorder (PTSD). I have more than 100 patients with PTSD.
Among those reporting that cannabis alleviates their PTSD symptoms are veterans of the war in Vietnam, the first Gulf War, and the current occupation of Iraq. Similar benefit is reported by victims of family violence, rape and other traumatic events, and children raised in dysfunctional families.
Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder —once referred to as “shell shock” or “battle fatigue” — is a debilitating condition that follows exposure to ongoing emotional trauma or in some instances a single terrifying event. Many of those exposed to such experiences suffer from PTSD. The symptoms of PTSD include persistent frightening thoughts with memories of the ordeal. PTSD patients have frightening nightmares and often feel anger and an emotional isolation.
Sadly, PTSD is a common problem. Each year millions of people around the world are affected by serious emotional trauma. In more than 100 countries there is recurring violence based on ethnicity, culture, religion or political orientation.
Men, women and children suffer from hidden sexual and physical abuse. The trauma of molestation can cause PTSD. So can rape, kidnapping, serious accidents such as car or train wrecks, natural disasters such as floods or earthquakes, violent attacks such as mugging, torture, or being held captive.
The event that triggers PTSD may be something that threatened the person’s life or jeopardized someone close to him or her. Or it could simply be witnessing acts of violence, such as a mass destruction or massacre. PTSD can affect survivors, witnesses and relief workers.
Symptoms

for the rest of this article see:
http://ccrmg.org/journal/06spr/perspective2.html

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Jun-14-2007 00:02http://salem-news.com/graphics/print.gif (http://salem-news.com/printview.php?id=4785)http://salem-news.com/graphics/chat.gif (http://salem-news.com/articles/june142007/leveque_61407.php#comments)
Medical Marijuana: PTSD Medical Malpractice

Dr. Phillip Leveque Salem-News.com
For those afflicted, there is no escaping PTSD, but sufferers may have some relief in sight.




(MOLALLA, Ore.) - Post Traumatic Stress Disorder (PTSD) is like a camouflaged elephant in the living room. Those who want to see it do so; those who don’t want to see it, do not.
Even officials of the Veterans Administration admit to seeing the “elephant” and have stated that probably 300,000 veterans from the Iraq and Afghanistan war have PTSD or will develop it.
PTSD is an insidious mental disease. Hold on now, we who have it or have had it aren’t “crazy” but we do wonder why most of our doctors seem to think it might be “home-sickness” from playing “cowboys and indians” far from home. One afternoon in an artillery barrage would probably change their minds but physicians and psychologists are not likely to have had the privilege of being in an artillery barrage or anything like it.
Often emergency room personnel and severe trauma surgeons and nurses also suffer from PTSD. Luckily, they can get away from their stressors. A combat soldier cannot, unless he gets a “million dollar wound” and is sent home. By then he is most likely already suffering from PTSD and wondering why his caretakers; wife, family, non-veteran friends, etc. wonder why he won’t get over his nightmares, night sweats, crying-out in his sleep “Incoming!” or “Medic!”, running or thrashing about in his sleep or reaching for his rifle, which is never there (although many vets sleep with a pistol under their pillow).
I can understand, vaguely, why a wife or mother might be disconcerted by this behavior. After all, the soldier might be away the army for weeks, months even years, but during sleep all the memories of battle horror come back and almost never go away.
Frequently, some time during this post-trauma time, the PTSD patient discovers that alcohol “drowns ones sorrows”. Alcohol has been known for centuries as the poor man’s sleeping medicine or tranquilizer. Ask any one of the seven million members of Alcoholics Anonymous. Alcohol is the most common, most frequently available and used for medicine. That’s why there are seven million members of A.A.
Immediate care of physically or psychologically traumatized soldiers is said to be very good. If not, many of the military caregivers would learn the meaning of being “fragged”. It is known that these caregivers were stealing battle souvenirs from wounded soldiers. And why not? The soldier might die of his wounds anyway.

During this post-trauma time some caregiver will say to himself “let’s treat this patients PTSD” and here come a mélange of medications. Here is a list of some of the more commonly used medications. This list is from the article “Post Traumatic Stress Disorder among Military Returnees from Afghanistan and Iraq” by Matthew J. Friedman in the April 2006 edition of the American Journal of Psychiatry: (This listing is ridiculous and unbelievable.)

Paroxetine – antidepressant
for the complete story see:
http://salem-news.com/articles/june142007/leveque_61407.php

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Science: Endocannabinoids extinguish bad memories in the brain


Researchers at the Max Planck Institute of Psychiatry in Munich (Germany) have shown that the endogenous cannabinoid system plays a central role in the extinction of aversive memories.
Transgenic mice without the brain cannabinoid receptor (CB1) and mice treated with a CB1 receptor antagonist showed strongly impaired extinction of fear in experiments. The animals that were conditioned to associate a musical tone with an electric shock, produced a fear reaction, and continued to react even when the tone was not followed by a shock. Normal mice quickly stopped reacting to the tone once it was not associated with a shock, but the treated mice needed much more time to forget their fear.
Dr. Beat Lutz and his team found out that the amygdala, an area of the brain central to storing memory and fear, was flooded with endocannabinoids, when the mice were gradually forgetting the learned response to the shock. The use of cannabis would not produce the same effect in humans, Lutz said, because it overflows the whole brain and is not specific enough.
Dr. Pankaj Sah, a neuroscientist at the Australian National University in Canberra said in a comment the latest findings may explain why some people with psychiatric problems try to find relief with marijuana. He suggested that people with certain psychiatric problems perhaps are self-medicating in an attempt to help their brains extinguish some painful or traumatic memory or thought.
(Sources: Marsicano G, et al. The endogenous cannabinoid system controls extinction of aversive memories. Nature 2002 Aug 1;418(6897):530-4; Sah P. Neurobiology: Never fear, cannabinoids are here. Nature 2002 Aug 1;418(6897):488-9; Reuters of 31 July 2002; Seattle Times of 1 August 2002; Abstract of Giovanni Marsicano et al. at the 2002 ICRS Meeting

http://www.cannabis-med.org/english/bulletin/ww_en_db_cannabis_artikel.php?id=123#1

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Health, Science & Technology


Title: Cannabis for the Wounded - Another Walter Reed Scandal
Source: CounterPunch !
URL Source: http://www.counterpunch.org/gardner03122007.html
Published: Mar 12, 2007
Author: FRED GARDNER



Screaming Chris Mathews and the corporate media would have us believe that it's only the living conditions at Walter Reed Army Medical Center that are deplorable, not the medical care itself. Donna Shalala and Bob Dole have been assigned to investigate the situation. A superficial clean-up will ensue -rodents poisoned, moldy drywall replaced- while the quality of care gets lauded and prosthetic limbs are presented as proof that all is state-of-the-art.

Out in California, however, doctors in the Society of Cannabis Clinicians question the care doled out at Walter Reed and other military hospitals where wounded soldiers and vets are treated with toxic medications* while the safest painkiller known to man is systematically withheld. "If anybody needs and deserves cannabis-based medicine, it's the thousands of soldiers who have been seriously wounded in Iraq," says Philip A. Denney, MD. "Cannabis would help in treating insomnia, pain, PTSD, and a whole array of symptoms that wounded vets typically face."


Tod Mikuriya, Md, who has monitored cannabis use by more than 8,500 patients, reports that approximately 8% had a primary diagnosis of PTSD. His findings and observations are confirmed by every doctor in the field. Many PTSD patients, according to Mikuriya, "are Vietnam veterans whose chronic depression, insomnia, and accompanying irritability cannot be relieved by conventional psychotherapeutics and is worsened by alcohol. For many of these veterans, chronic pain from old physical injury compounds problems with narcotic dependence and side effects of opioids.


"Cannabis relieves pain, enables sleep, normalizes gastrointestinal function and restores peristalsis. Fortified by improved digestion and adequate rest, the patient can resist being overwhelmed by triggering stimuli. There is no other psychotherapeutic drug with these synergistic and complementary effects.


"Physical pain, fatigue, and sleep deficit are symptoms that can be ameliorated. Restorative exercise and diet are requisite components of treatment of PTSD and depression. Cannabis does not leave the patient too immobile to exercise, as do some analgesics, sedatives biodiazapenes, etc. Regular aerobic exercise (where injury does not interfere) relieves tension and restores control through kinesthetic involvement. Exercise also internalizes the locus of control and diminishes drug-seeking to manage emotional response. "PTSD often involves irritability and inability to concentrate, which is aggravated by sleep deficit. Cannabis use enhances the quality of sleep through modulation of emotional reactivity. It eases the triggered flashbacks and accompanying emotional reactions, including nightmares. The importance of restoring circadian rhythm of sleep cannot be overestimated in the management of PTSD. Avoidance of alcohol is important in large part because of the adverse effects on sleep. The short-lived relaxation and relief provided by alcohol are replaced by withdrawal symptoms at night, causing anxiety and the worsening of musculoskeletal pain... "Based on both safety and efficacy, cannabis should be considered first in the treatment of post-traumatic


for the rest of this article see:
http://www.libertypost.org/cgi-bin/readart.cgi?ArtNum=179973&Disp=11

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ISRAEL IDF TO TREAT SHELL SHOCK
WITH CANNABIS /MARIJUANA


Newshawk: Alun at LCA & www.ccguide.org.uk
Pubdate: Thu, 05 Aug 2004
Source: Jerusalem Post (Israel)
Copyright: 2004 The Jerusalem Post
Contact: http://info.jpost.com/C002/Services/Feedback/editors.html
Website: http://www.jpost.com/
Details: http://www.mapinc.org/media/516
Author: Associated Press
Bookmark: http://www.mapinc.org/mmj.htm (Cannabis - Medicinal)

IDF TO TREAT SHELL SHOCK WITH CANNABIS

The IDF will soon begin using cannabis to treat soldiers suffering from combat stress, the military said Wednesday.

An army statement said the military medical corps and the Hebrew University of Jerusalem would begin treating victims of post-traumatic stress -commonly known as shell shock - with THC, the active ingredient in the cannabis plant. It said the treatment would begin on an experimental basis. "The use of THC as part of the treatment for post-traumatic stress disorder
was approved by military and civilian committees relevant to the subject, the statement said.

An IDF spokesman said treatment would be given to both conscript soldiers and reservists.

Since September 2000, the Israeli military has been conducting day to day operations against the Palestinian terror infrastructure in the West Bank and the Gaza Strip.

During that time many soldiers have been treated for combat stress following service at military checkpoints and in military operations. The IDF continues to ban the use of all drugs on a leisure basis, including cannabis derivatives marijuana and hashish.