Epidemic of Post-traumatic Stress Disorders (PTSD)
No one wants to talk about it, but a posttraumatic stress disorder (PTSD) epidemic has now reached crisis levels among our nation’s service members and veterans.
According to a 2014 report by Institute of Medicine (IOM), data from the U.S. Department of Defense (DoD) showed that the proportion of service members with PTSD increased dramatically since the wars in Afghanistan and Iraq began, from less than 1% in 2004 to more than 5% in 2012. In 2012, 13.5% of soldiers had a diagnosis of PTSD, as did 10% of marines, 4.5% of Navy personnel, and 4% of Air Force personnel.
Those are staggering figures when you consider the U.S. armed forces have about 1.4 million active duty personnel and an additional 354,000 reservists and National Guard members. Total DoD costs for PTSD care of eligible service members ballooned from $29.6 million in 2004 to $294.1 million in 2012.
Then there are our veterans. As of September 2013, the U.S. had a veteran population of about 22 million people. In 2012, more than 502,000 veterans made at least two visits to the U.S. Department of Veterans Affairs (VA) for PTSD outpatient care. Those veterans made up 9.2% of all users of VA health care, up from 4.1% in 2002.
Data on veterans from the Afghanistan and Iraq wars was even more dramatic. At the time of the report, a staggering 24% of all Afghanistan and Iraq war vets had a diagnosis of PTSD.
The report found that nearly 1 in 4 vets who fought in those wars were diagnosed with PTSD. Yet the authors acknowledged that the figures should’ve probably been higher as the numbers likely underestimated the incidence and prevalence of PTSD in the veteran population. Not a lot of financial data is available, but for the 3 years from 2010 to 2012, PTSD costs for veterans spiked from $2.56 billion in 2010 to a whopping $3.04 billion in 2012.
Sadly, with our current healthcare system, the DoD and VA are woefully ill-equipped to provide adequate care for our service members and veterans. Although there are programs and services meant for the prevention, diagnosis, and treatment for PTSD, many of the current so-called “evidence-based” treatments remain ineffective and have a high failure rate. In fact, according to the VA’s latest figures, veterans committed suicide at a rate of 20 per day in 2014.
This isn’t a problem that the nation can just sweep under the rug and ignore. We need to do more – a lot more. And that includes looking at different treatment options that may be beneficial for PTSD patients. Increasingly, veterans are turning to CBD as an alternative to the treatments being offered by the DoD and VA programs.
CBD and PTSD
Treatment for PTSD currently consists of psychotherapy, medication, or a combination of the two. Cognitive behavior therapy (CBT) includes cognitive processing therapy (CPT), prolonged exposure (PE), eye movement desensitization and reprocessing (EMDR), and stress inoculation training (SIT). Medications commonly used to treat PTSD are selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). These are antidepressants that work by increasing levels of serotonin in the brain.
Unfortunately, PTSD treatments today “appear to be local, ad hoc, incremental, and crisis-driven, with little planning devoted to the development of a long-range approach to obtaining desired outcomes,” the IOM report says. Furthermore, evidence suggests that SSRIs and SNRIs have had little to no beneficial effect for combat veterans and may even cause worsening of suicidal ideas in vulnerable patients – a likely explanation for the 20 a day suicide rate amongst veterans.
This is why there have been increasing efforts to unravel the neurobiological mechanisms that underlie PTSD symptoms. Because PTSD is associated with the persistence of a heightened prominence of traumatic memories and a failure of the extinction process to diminish the impact of traumatic memories, researchers have turned their focus to finding a drug that can somehow block the pathological over consolidation and continuous retrieval of the traumatic event, while enhancing its extinction and reducing the anxiety symptoms.
While no such drug currently exists, studies point to the endocannabinoid system (ECS) as a possible therapeutic target to treat both the emotional and cognitive dysfunctions characterizing PTSD. In fact, CBD has been shown to affect the ECS to induce anxiolytic and antipsychotic effects. And not surprisingly, veterans fed up with the ineffective treatments for PTSD from the VA have turned to CBD as a last resort. But can this non-psychoactive cannabinoid from the cannabis sativa plant be the answer to the PTSD epidemic?
To test potential theories, many researchers use animal PTSD models involving rats and mice. The most-used physical stressor models are single-prolonged stress, restraint stress, foot shock, stress-enhanced fear learning, and underwater trauma. Common social stressors are housing instability, social instability, early-life stress, and social defeat. Psychological models rely on controlled exposure to the test animal’s natural predator.
In a study published in 2012 in the Journal of Psychiatric Research, Brazilian researchers investigated the anti-anxiety actions of CBD administration in rats with PTSD. Because predator exposure promotes long-lasting anxiogenic effect in rodents, an effect related to symptoms found in PTSD patients, the researchers were interested in seeing if CBD could treat these symptoms and whether the serotonin receptor subtype 5HT1A was responsible.
Male Wistar rats exposed to a predator (cat) were given CBD and seven days after, the stress animals were submitted to the elevated plus maze. The elevated plus maze is a test measuring anxiety in lab animals and is based on the test animal’s aversion to open spaces. To investigate the involvement of 5HT1A receptors with CBD, some rats were pre-treated with a 5HT1A receptor antagonist or blocker.
The researchers found that repeated administration of CBD prevented long-lasting anxiogenic effects (anxiety) promoted by a single predator exposure. Pretreatment with a 5HT1A antagonist (WAY100635) attenuated (lowered) CBD’s effects. Seven days after predator exposure 5HT1A mRNA expression was upregulated in the frontal cortex and hippocampus regions of the brain.
In conclusion, they found that predator exposure promotes long-lasting upregulation of 5HT1A receptor gene expression in the brain. However, CBD hemp oil treatments prevent the long-lasting anxiety that rats get when they’re exposed to a predator – probably by facilitating 5HT1A receptors neurotransmission. Their results suggest that CBD has beneficial potential for PTSD treatment and that 5HT1A receptors could be a therapeutic target in the disorder.
Another form of extreme stress linked to PTSD is acute restraint which is an uncontrollable stress situation that produces endocrine and autonomic responses characterized by increases in glucocorticoids levels, blood pressure and heart rate, and the activation of several brain structures.
In addition to physiological responses, animals submitted to restraint also develop behavioral changes. After the exposure to stress, rats will explore less in an open field, they will have increased immobility in a forced swimming test, and they also explore less in the elevated plus maze. These behavior changes can be lowered by anxiolytic and antidepressant drugs.
However, in another study published in 2008 in the British Journal of Pharmacology, Brazilian researchers investigated the possible effect of CBD on the behavioral changes of rats with PTSD. They found that CBD attenuated the acute physiological changes and the behavioral consequences of restraint stress through the 5-HT1A receptors. Again, the implications mean that CBD has potential for treating PTSD and that 5-HT1A receptors may be a target.
Finally, in another study published in 2008 in the journal of the European College of Neuropsychopharmacology, researchers from Brazil investigated CBD’s effects on the extinction of contextual fear memories in conditioned rats. The rats were first exposed to a stressor and then 24-hours later were subjected to 3 consecutive exposures to the conditioning context. They found that rats that were pre-injected with CBD responded differently. In fact, CBD facilitated extinction of contextual fear memory and induced anti-anxiogenic effects in the fear-potentiated plus-maze test. The authors concluded that CBD could be an interesting pharmacological approach to reducing the anxiogenic effects of stress and promote the extinction of fear memories.
The Final Word
These studies show promise for CBD as a potential treatment option for patients who suffer from PTSD. As mentioned, the current PTSD epidemic in the U.S. is in danger of exploding into a full-blown crisis.
If we truly want to help our nation’s service members and veterans, perhaps we should be more open to novel therapeutic approaches. Now more than ever, we need to act. Let’s shine a light on this epidemic before it gets worse and let’s not leave our nation’s warriors and heroes to suffer in darkness.
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