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The Endocannabinoid System as a Possible Target 
 for Treating Post-Traumatic Stress Disorder   


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Around 15-35% of those who experience serious trauma are likely to develop post-traumatic stress disorder (PTSD), and among those who have experienced abuse, neglect, or other adversity in childhood, the number tends toward the high end. Of those who develop PTSD , more than a third will fail to recover even after many years of therapy and medications (Darves-Bornoz et al., 2008). These people demonstrate considerable impairments in their overall quality of life, including physical health and psycho-social functioning (Schelling et al., 1998).

Obviously, the current treatment approaches (SSRI antidepressants, cognitive-behavioral therapy, and exposure therapy) are not working for a significant number of people.

One of the innovations in recent years has been the use of beta-blockers (high blood pressure medication) to reduce anxiety, hypervigilance, flashbacks, and nightmares. The one I see most often is Prazosin, which seems to work, in part, by reducing adrenaline levels, thereby decreasing anxiety.

Prazosin is an alpha-adrenergic blocker originally used to treat hypertension. "The reason we think it works in the setting of nightmares is that prazosin crosses the blood–brain barrier, so it gets into the brain and kind of dampens the norepinephrine effects, which we think contribute to nightmares," Dr. King said.

In my experience, the side-effects of this medication are far less intrusive and long-lasting than those of the SSRI and SNRI medications. The benefits, even if it is only improved sleep can be considerable for those who are good responders.

In this new article from Frontiers in Behavioral Neuroscience, the authors propose that a potential target for treating the anxiety and hypervigilance symptoms, as well as many of the other symptoms (avoidance, arousal, and re-experiencing), is the endocannabinoid system. A quick Google Scholar search turned up a lot of research in this area, including these articles:

  • Fraser, GA. (2009). The Use of a Synthetic Cannabinoid in the Management of Treatment-Resistant Nightmares in Posttraumatic Stress Disorder (PTSD). CNS Neuroscience & Therapeutics, 15; 84–88. doi: 10.1111/j.1755-5949.2008.00071.x
  • Hill, MN and Gorzalka, BB. (2009). The Endocannabinoid System and the Treatment of Mood and Anxiety Disorders. CNS & Neurological Disorders – Drug Targets, 8, 451-458.  

My issue with this Frontiers article is that the authors don’t even mention possible treatments for PTSD that do not involve a pill. While I have many clients who need medication, at least in the short term, in order to get benefit from therapy, I have many who do not need medications, or who have enough affect regulation to manage the difficult symptoms when they come up.

No matter how many cool drugs are developed, we should always try to treat people without drugs first and foremost. Even with the medications that seem to have few side effects, such as the concepts proposed below, there are ALWAYS side effects.

The endocannabinoid system regulates memory, appetite, energy balance/metabolism, stress response, immune functions, pain perception, body temperature, and even neurogenesis. There is no way we can manipulate this system for one outcome and not impact its functions in other areas of the body.

Full Citation: 

Trezza V and Campolongo P. (2013, Aug 9). The endocannabinoid system as a possible target to treat both the cognitive and emotional features of post-traumatic stress disorder (PTSD). Frontiers in Behavioral Neuroscience, 7:100. doi: 10.3389/fnbeh.2013.00100

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