May 22, 2010

Smoking Some Weed to Deal with PTSD? – Ecstasy May Be the Better Choice

I used to smoke weed – a lot of weed. Back in my teen years. From the time I woke up until the minute I went to sleep, I was high. I even went to jail briefly for trying to grow my own personal supply (the judge didn’t quite see the “can do” spirit in my endeavor).

One thing I noticed from spending several years of my life in a literal cloud of smoke was that all development stopped. My emotional life was stunted, my physical skills were stunted (possibly costing me a career as a soccer player), and my relationships were stunted.

That was 25 years ago – haven’t smoked since then. [Update: I should have mentioned this before – I was suffering PTSD from the sudden death of my father when I was 13 – and using weed to self-medicate the grief and the other symptoms of PTSD.]

Since I last used, the potency of marijuana has increased substantially (from 10-15% THC in what we grew back in the 80s to as much as 25-30% THC now – The highest concentration of THC found in a single sample was 37.2%). The imbalance brought about by increasing THC without increasing the other cannibnoids, some of which are actually good for the brain has resulted in a substantial increase of psychosis in users. At particular risk are teens who smoke, becoming more likely to suffer psychosis later in life (typical age of psychotic onset is 18-35).

John McGrath, MD, PhD, FRANZCP; Joy Welham, MAPs; James Scott, MBBS, FRANZCP; Daniel Varghese, MBBS, FRANZCP; Louisa Degenhardt, PhD; et al. (2010). Association Between Cannabis Use and Psychosis-Related Outcomes Using Sibling Pair Analysis in a Cohort of Young Adults. Arch Gen Psychiatry. 2010;67(5):440-447.

We know that there are many psychological effects of marijuana use (and possible mental health issues, as already noted), such as the following:

  • distorted sense of time
  • paranoia
  • magical or “random” thinking
  • short-term memory loss
  • anxiety and depression

As a further example, people with social anxiety disorder, such as myself, are much more likely than an average person to smoke weed. We do not expect that getting high makes the SAD better, however, we actually expect to make it worse, which it does. People with anxiety issues should not smoke weed – and yet they do so much more than other people, knowing that it actually makes cognitive and behavioral issues worse.

In addition to decreased testosterone in men and short-term memory damage, there are other issues with chronic use according to the Gale Encyclopedia of Psychology (2nd ed., Gale Group, 2001):

THC has been found to destroy cells in the hippocampus, a part of the brain that is important in the formation of new memories. Psychologically, chronic use of marijuana has been associated with a loss of ambition known as amotivational syndrome.

Considering all we know, it’s amazing that anyone would consider using weed for Post-Traumatic Stress Disorder (PTSD), which is an anxiety disorder. But that is exactly the topic of a recent NPR story on Morning Edition. Here is some of the story:

Can Marijuana Ease PTSD? A Debate Brews

The Department of Veterans Affairs finds itself in a difficult position because some vets want to use marijuana to treat symptoms of post-traumatic stress disorder. Pot possession remains illegal under federal law. The VA says that as a federal agency its doctors can’t recommend using it.

The problem is especially acute in New Mexico, where one-fourth of the state’s more than 1,600 medical marijuana patients are PTSD sufferers.

‘Medical Cannabis Saved Our Marriage’

Paul Culkin of Rio Rancho, N.M., traces his PTSD back to 2004 when he was in Kosovo and part of an Army bomb squad. A car crashed into a business. The manager was inside trying to put out a fire. Culkin went in once to try to get him to leave, but he wouldn’t go.

“The second time when I went in to get him out of there — that’s when the car bomb exploded and the glass hit me,” Culkin says.

He recovered from the physical wounds, but years later the trauma of that moment can come back without warning.

“Sometimes you’ll see a car that’s just not in the right place and it’ll send me back to that thinking that it could, possibly, be a car bomb,” Culkin says.

Culkin started avoiding social situations and was quick to anger. He says the treatment he’s received from the VA — mostly counseling and antidepressant medication — has helped. But, he says, marijuana also works well to relieve his anxiety.

To be legal in New Mexico, he had to go outside the VA system and pay for another doctor and a psychiatrist to recommend him for the state’s medical marijuana program. Then he spent more than $1,500 to set up a small growing operation in his garage.

Enlarge Jeff Brady/NPR Victoria Culkin says that her husband Paul’s marijuana use saved their marriage.

Culkin says he doesn’t usually smoke the marijuana, instead choosing to dissolve an extract in hot chocolate or tea so he can control the dose better.

His wife, Victoria, says the marijuana has made a big difference.

“He’s a different person. He’s a better person. He’s more open. He’s more communicative,” she says. “At one point, we almost got a divorce, and I can honestly say that I think medical cannabis saved our marriage and our family.”

Sounds great, doesn’t it? Weed saved his marriage. But then there is the medical point of view:

“There is no solid evidence that cannabinoids — that marijuana — is, in itself, an effective treatment for post-traumatic stress disorder,” says Dr. David Spiegel, director of the Stanford Center on Stress and Health. “Before anyone can claim that, there needs to be some more solid research on that topic.”

Spiegel says recovery from trauma begins with the victims regaining control, over both their bodies and their mental reactions to the traumatic event. Smoking marijuana could make that more difficult, he says.

“The last thing you want is to be losing control at a time when you’re remembering an event in which you lost control,” Spiegel says.

According the National Institute of Mental Health, the following are the three main groupings of symptoms for those with PTSD:

1. Re-experiencing symptoms:

  • Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
  • Bad dreams
  • Frightening thoughts.

Re-experiencing symptoms may cause problems in a person’s everyday routine. They can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing.

2. Avoidance symptoms:

  • Staying away from places, events, or objects that are reminders of the experience
  • Feeling emotionally numb
  • Feeling strong guilt, depression, or worry
  • Losing interest in activities that were enjoyable in the past
  • Having trouble remembering the dangerous event.

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

3. Hyperarousal symptoms:

  • Being easily startled
  • Feeling tense or “on edge”
  • Having difficulty sleeping, and/or having angry outbursts.

Hyperarousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic event. They can make the person feel stressed and angry. These symptoms may make it hard to do daily tasks, such as sleeping, eating, or concentrating.

A major element of the symptoms is the hyperarousal, which the weed might help (since it makes users sleepy), but there is also the emotional blunting (made worse by weed), the feeling of being on edge/anxious (made worse by weed, over time), trouble remembering the trauma, which might seem great, but slows the healing (made worse by weed), and bad dreams or flashbacks of the event (made worse by weed, just as negative LSD flashbacks are more likely when high).

Antidepressants and talk therapy (and more recently EMDR) are the common treatments. The effectiveness is not the best – and it takes years when it is effective, which is why the military is looking at other approaches.

One new approach getting a lot of attention in the last few years (though not from the military) is treating PTSD with MDMA, more commonly known as ecstasy, E, X, and so on.

Psychiatrists that have administered MDMA to anxiety patients have noted that it promotes emotional engagement; strengthens the bond between the patient and doctor, known as the therapeutic alliance; decreases emotional avoidance; and improves tolerance for recall and processing of painful memories.

According to Johansen and Krebs, “MDMA [Ecstasy] has a combination of pharmacological effects that…could provide a balance of activating emotions while feeling safe and in control.”

They suggest three possible biological reasons why ecstasy could help individuals with PSTD. First, Ecstasy is known to increase the release of the hormone oxytocin, which is involved in trust, empathy, and social closeness.

Because people with PTSD often report feeling emotionally disconnected and unable to benefit from the supportive presence of family and friends or therapists – a situation that is likely to contribute to the development and maintenance of the disorder – use of ecstasy might also help ameliorate these symptoms, suggest the authors.

“By increasing oxytocin levels, MDMA may strengthen engagement in the therapeutic alliance and facilitate beneficial exposure to interpersonal closeness and mutual trust,” they write.

There are literally dozens of papers on this – none of which reporting any negative side effects of note.

However, one risk factor is that MDMA can deplete serotonin levels in the brain (neurotoxicity), leading to depression, but the administration of alpha lipoic acid and other antioxidants can completely eliminate this issue (by the way, apparently THC is also neuroprotective in MDMA use, but the two would mostly cancel each other out in treating PTSD).

Supervised MDMA therapy is where we should be looking for treatment – not to smoking weed, which simply makes the issue worse in the long term and only serves to mask the symptoms. MDMA, on the other hand, treats the underlying issues and need not be used long term to be useful. Seems like the better choice all around.

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