New options for treating post-traumatic stress disorder are greatly needed to improve patient wellbeing

PTSD (post-traumatic stress disorder) awareness day takes place today, June 27th.

Here Dr James Rucker, Consultant Psychiatrist at Sapphire Medical Clinics explains how medical cannabis treatments can help some patients with PTSD.

“Post-traumatic stress disorder (PTSD) is a cruel condition that can wreck and even end lives, through suicide, and for which many current treatments have proved inadequate.

Some people assume PTSD only affects soldiers – and it does to a dreadful degree. But current members and ex-members of the armed forces are not the only sufferers.

Anyone who has witnessed or lived through a terrible event can suffer from PTSD. Car crashes, fires, industrial accidents, assault, robbery, domestic violence, and a host of other violent or frightening incidents can trigger PTSD.

Studies suggest that between 5% and 10% of adults may experience PTSD over a lifetime.

People experience PTSD differently, but common symptoms are flashbacks, nightmaresintrusive thoughts, and anxiety.

It is the re-experiencing of the memories and emotions of trauma ‘back then’ as though it is in the ‘here and now’. This becomes associated with behaviours like avoidance, social withdrawal, depression, and irritability which can widely impact on relationships, work prospects, and physical health.

Current treatments include trauma-focussed psychotherapy, eye movement desensitisation and reprocessing therapy, and SSRI antidepressants. The first two are hard to get on the NHS, particularly longer-term forms. Antidepressants can help some, but many don’t respond, or have unacceptable side-effects.

Alcohol is commonly used by patients in an attempt to self-medicate. Whilst it may bring short term relief from anxiety, in the long run it generally lowers mood and increases anxiety.

Illegal drugs come with various problems, including black market supply lines, tainted supplies, the risk of criminalisation, and a general lack of clinical trial evidence about whether they help. All of these psychosocial factors can serve to increase anxiety further.

We are now trying a different approach – medical cannabis – and have completed an observational study looking at 162 patients with PTSD, treated for up to six months at our clinic. The average age of the patients was 37 and 40% were women. Half the patients were unemployed.

The patients were given a series of quality of life tests, including a specific one for PTSD called the Impact of Events Scale which measures 22 areas of thoughts and feelings covering intrusion, avoidance, and hyperarousal. Patients rate the elements on a scale of one to five.

There was a statistically significant reduction in the severity of scores in the Impact of Events Scale after treatment, and also improvement in other areas such as sleep quality and anxiety.

Apart from our work, we know there is plenty of anecdotal evidence that medical cannabis helps. The problem is that there is very little clinical trial evidence.

The gold standard of medical proof is a randomised controlled trial where the therapy is tested against a placebo. We have such trials planned – but they are very expensive. We are hoping that an independent body, such as the National Institute for Health Research, may fund these – but there is intense competition for such funding.

In the meantime, we will continue with our observational studies, in the hope that the benefits of treatment will be maintained over time.

Such data does not in itself provide gold-standard proof. Only randomised controlled trials can do this. However, we hope it may help inform future clinical studies and practice. We all know that better treatments for PTSD are greatly needed.