Dear Friends of everything I have read this was the easiest and most informative. If you are considering alternative medicine, please read this amazingly informative article on how medical cannabis can help many neurology and mental health problems. We owe it to ourselves to do this research!
• Winter/Spring 2008By Tod Mikuriya, MD
William Woodward, MD, of theAmerican Medical Association, testify-ing before Congress in 1937 against theProhibition of cannabis, paraphrased aFrench author (F. Pascal, 1934) to theeffect that “Indian hemp has remarkableproperties in revealing the subcon-scious.”A Congressman asked, “Are there anysubstitutes for that latter psychologicaluse?”Woodward replied, “I know of none.That use, by the way, was recognized byJohn Stuart Mill in his work on psychol-ogy, where he referred to the ability of Cannabis or Indian hemp to revive oldmemories —and psychoanalysis de-pends on revivivification of hiddenmemories.”For including that reference to Mill(1867) in the list I have been compilingof conditions amenable to treatment bycannabis, I was ridiculed by Drug CzarBarry McCaffrey in 1996. I stand by itsinclusion, of course, and in the 10 yearssince California physicians have beenapproving cannabis use by patients, Ihave found myself appreciating and con-firming Mill’s insight with every reportthat cannabis has eased symptoms of post-traumatic stress disorder.Approximately eight percent of the>9,000 Californians whose cannabis useI have monitored presented with PTSD(309.81) as a primary diagnosis. Manyof them are Vietnam veterans whosechronic depression, insomnia, and ac-companying irritability cannot be re-lieved by conventional psychotherapeu-tics and is worsened by alcohol. Formany of these veterans, chronic painfrom old physical injury compoundsproblems with narcotic dependence andside effects of opioids.Cannabis relieves pain, enables sleep,normalizes gastrointestinal function andrestores peristalsis. Fortified by im-proved digestion and adequate rest, thepatient can resist being overwhelmed bytriggering stimuli. There is no other psy-chotherapeutic drug with these synergis-tic and complementary effects.
Practical Treatment Goals
In treating PTSD, psychotherapyshould focus on improving how the pa-tient deals with resurgent symptomsrather than revisitation of the events.Decreasing vulnerability to symptomsand restoring control to the individualtake priority over insight as treatmentgoals. Revisiting the traumatic eventswithout closure and support is not use-ful but prolongs and exacerbates painand fear of loss of control. To repeat:cathartic revisiting of the traumaticexperience(s) without support and clo-sure is anti-therapeutic and can exacer-bate symptoms.Physical pain, fatigue, and sleep defi-cit are symptoms that can be ameliorated.Restorative exercise and diet are requi-site components of treatment of PTSDand depression. Cannabis does not leavethe patient too immobile to exercise, asdo some analgesics, sedativesbiodiazapenes, etc. Regular aerobic ex-ercise (where injury does not interfere)relieves tension and restores controlthrough kinesthetic involvement. Exer-cise also internalizes the locus of con-trol and diminishes drug-seeking to man-age emotional response.
The importance of sound sleep
PTSD often involves irritability andinability to concentrate, which is aggra-vated by sleep deficit. Cannabis use en-hances the quality of sleep throughmodulation of emotional reactivity. Iteases the triggered flashbacks and ac-companying emotional reactions, includ-ing nightmares.The importance of restoring circadianrhythm of sleep cannot be overestimatedin the management of PTSD. Avoidanceof alcohol is important in large part be-swings, and insomnia.While decreasing the intensity of affectual response, cannabis increasesintrospection as evidenced by the slow-ing of the EEG after initial stimulation.Unique anti-depressive effects are expe-rienced immediately with an alterationin cognition. Obsessive and pressuredthinking give way to introspective freeassociations (given relaxed circum-stances). Emotional reactivity is calmed,worries become less pressing.Used on a continuing basis, cannabiscan hold depressive symptoms at bay.Agitated depression appears to respondto the anxiolytic component of the drug.Social withdrawal and emotional shut-ting down are reversed.The short-term memory loss inducedby cannabis that may be undesirable inother contexts is therapeutic in control-ling obsessive ideation, amplified anxi-ety and fear of loss of control ignited bythe triggering stimuli.
Easement Effects of Cannabis
In treating PTSD, cannabis providescontrol and amelioration of chronic stres-sors without adverse side effects. Main-stream medicine treats PTSD symptomssuch as hyperalertness, insomnia, andnightmares with an array of SSRI andtricyclic anti-depressants, sedatives, an-algesics, muscle relaxants, etc., all of which provide inadequate relief and haveside effects that soon become problem-atic. Sedatives, both prescribed and over-the-counter, when used chronically, com-monly cause hangovers, dullness, seda-tion, constipation, weight gain, and de-pression. See list below.Cannabis is a unique psychotropicimmunomodulator which can best becategorized as an “easement.” Modu-lating the overwhelming flood of nega-tive affect in PTSD is analogous to therelease of specific tension, a process of “unclenching” or release. As when aphysical spasm is relieved, there is aperception of “wholeness” or integrationof the afflicted system with the self. Forsome, this perceptual perspective ischanged in other ways such as distanc-ing (separating the reaction from thestimulus, which can involve either less-ening the reaction, as with modulation,or repressing/suppressing the memory;walling it off; forgetting).The modulation of emotional re-sponse relieves the flooding of negative
The Toxic Alternatives
Commonly prescribed medications for PTSD as listed in
“Postraumatic Stress Disorder Among Military Returnees From Afghanistan and Iraq,”
by Matthew J. Friedman, MD,PhD, in the April 2006
American Journal of Psychiatry:
Paroxetine, Sertraline, Fluoxetine, Citalopram, FluvoxamineMay produce insomnia, restlessness, nausea, decreased appetite, daytime sedation, ner-vousness, and anxiety, sexual dysfunction, decreased libido, delayed orgasm or anorgasmia.Clincically significant interactions for people prescribed monoamine oxidase inhibitors(MAOIs). Significant interactions with hepatic enzymes produce other drug interactions.Concern about increased suicide risk in children and adolescents.
Other second-generation antidepressants:
Trazadone may be too sedating, may produce rare priapism. Velafaxine may exacerbatehypertension. Buproprion may exacerbate seizure disoder. Mirtrazepine may cause seda-tion.
PhenetzineRisk of hypertensive crisis; patients required to follow a strict dietary regime. Contrain-dicated in combination with most other antidepressants, CNS stimulants, and deconges-tants. Contraindicated in patients with alcohol/substance abuse/dependence. May produceinsomnia, hypotension, anticholinergic side effects, and liver toxicity.
Imipramine, Amitriptyline, DesipramineAnticholinergic side effects (dry mouth, rapid pulse, blurred vision, constipation). Mayproduce ventricular arrhythmias. May produce orthostatic hypotension, sedation, or arousal.
Prazosin, Propranolol, Clonidine, GuanfacineMay produce hypotension, brachycardia (slow heartbeat), depressive symptoms, psy-chomotor slowing or bronchospasm.
Carbamazepine may cause neurological symptoms, ataxia, drowsiness, low sodium level,leukopenia. Valproate may cause gastrointestinal problems, sedation, tremor and thromb-ocytopenia (low platelet levels in blood). It is teratogenic (induces mutations, should not beused during pregnancy). Gabapentin may cause sedation and ataxia (difficulty forming sen-tences). Lamotrigine may cause Stevens-Johnson syndrome, rash, fatigue. Topirimate maycause glaucoma, sedation, dizziness, and ataxia.
Risperidone, Olanzapine, QuetiapineMay cause weight gain. Risk of type 2 diabetes with olanzapine
Cannabis for Post Traumatic Stress
affect. The skeletal and smooth musclerelaxation decreases the sympatheticnervous reactivity and kindling compo-nent of agitation. Fight/flight responsesand anger symptoms are significantlyameliorated. The fear of loss of controldiminishes as episodes of agitation andfeeling overwhelmed are lessened. Ex-periences of control then come to pre-vail. Thinking is freed from attachmentto the past and permitted to fix on thepresent and future. Instead of beingtransfixed by nightmares, the sufferer isfreed to realize dreams.Based on both safety and efficacy,cannabis should be considered first in thetreatment of post-traumatic stress disor-der. As part of a restorative program withexercise, diet, and psychotherapy, itshould be substituted for “mainstream”anti-depressants, sedatives, muscle re-laxants, tricyclics, etc.
Cannabis is a unique psychotropic immunomodulatorthat can best be categorized as an “easement.
cause of the adverse effects on sleep. Theshort-lived relaxation and relief providedby alcohol are replaced by withdrawalsymptoms at night, causing anxiety andthe worsening of musculoskeletal pain.Evening oral cannabis may be a use-ful substitute for alcohol. With properdosage, the quality and length of sleepcan be improved without morning dull-ness or hangover. For naïve patients, useof oral cannabis should be gradually ti-trated upward in a supportive setting; thisis the key to avoiding unwanted mentalside effects.I recommend the protocol J. RussellReynolds M.D., commended to QueenVictoria: “The dose should be given inminimum quantity, repeated in not lessthan four to six hours, and gradually in-creased by one drop every third or fourthday, until either relief is obtained, or thedrug is proved, in such case to be use-less. With these precautions I have nevermet with any toxic effects, and haverarely failed to find, after a compara-tively short time, either the value or theuselessness of the drug.”The advantage of oral over inhaledcannabis for sleep is duration of effect;a disadvantage is time of onset (45-60minutes). When there is severe recurrentinsomnia with frequent awakening it ispossible to medicate with inhaled can-nabis and return to sleep. An unfortunateresult of cannabis prohibition is that re-searchers and plant breeders have notbeen able to develop strains in whichsedative components of the plant pre-dominate.
Modulation, Not Extinction
Although it is now widely acceptedthat cannabinoids help extinguish pain-ful memories, my clinical experiencesuggests that “extinguish” is a misnomer.Cannabis modulates emotional reactiv-ity, enabling people to integrate painfulmemories —to look at them and beginto deal with them, instead of suppress-ing them until a stimulus calls them forthwith overwhelming force.The modulation of emotional re-sponse relieves the flooding of negativeaffect. The skeletal and smooth musclerelaxation decreases the release of cor-ticosteroids and escalating “fight-or-flight” agitation. The modulation of mood prevents or significantly decreasesthe symptoms of anxiety attacks, mood