"Combat fatigue": how cannabis helps veterans suffering the consequences of war

March 27, 2019

The symptoms associated with emotions, mental and moods of a person have initiated many studies throughout the history of medicine and psychology. However, even today there is always a level of culpability that society shares with those who suffer these conditions. We are victims of these emotionally affected thoughts and feelings being it a strong condition or trauma that makes us vulnerable. Stigmas like these affect self-esteem and willpower. Psychological and psychiatric medication helps but still leaves many patients unstable.

 

Mental health is essential for the human being and must be treated responsibly. It does not mean that there is no cure or there is no way to mitigate the effects. Without professional help, many consequences have been generated that can even be fatal for those who need support.

 

Most affected by this situation are war veterans. They not only sacrifice their youth but also acquire mental health issues from battles and face high levels of emotional pressure, stress and others. In turn they are subjected to circumstances that are out of their hands, such as seeing their brothers die, family separation and the constant dangers of combat. Post-traumatic stress syndrome is linked in particular to emotional devastation caused by wars and severe traumatic events such as natural disasters, 911, hurricanes, etc.

 

It is noteworthy that scientific studies have only been conducted during the last decades about the psychiatric symptoms related to exposure to combat and other experiences of war. Surprisingly, it was not until 1980 that post-traumatic stress disorder was formally included as an autonomous clinical entity. This was the concept that was given in the manual of diagnosis of mental disorders of the American Psychiatric Association and the theoretical basis of this were based on studies with veterans of the Vietnam War (1965-1975).

 

It is quite remarkable that the problem that causes this disorder is associated with serious anxiety problems. In recent years, epidemiological findings have been examined, with prevalence figures between 12 and 30%. Between 15 to 25% evolve into chronicity and an equally high number of veterans who become victims of serious social disorders.

 

The symptoms of this type of disorder can vary from very mild to critical depending on the subject and the severity of the mental state. Some of the symptoms associated with post-traumatic stress can be dissociation, social and occupational deterioration, major depression, survivor's fault syndrome, among many others and can even lead to suicide.

 

 

Also during the trauma, there is a surge of cortisol, which causes adrenal exhaustion and produces dysfunction in the hypothalamic-pituitary axis. This leads to a decrease in the level of cortisol in the baseline, which in turn results in an increase in the negative feedback system, leading to hyperactivity and hypervigilance. Deregulation of neurotransmitters is also present, causing a failure in the stress response system to react, adapt and recover from a situation. An increase in norepinephrine, a decrease in serotonin and an increase in glutamate may contribute to the physical, mental and emotional symptoms of post-traumatic stress disorder.

 

 

To detect this type of anxiety disorder, structured diagnostic interviews are conducted taking as standard the scale of PTSD applied by the clinician (CAPS) developed by Blake that, based on specific criteria, assesses the severity and frequency of symptoms. In turn, the psychophysiological assessment and symptoms bring on warning signs such as agitation, sweating, flushing, tremors, feeling of nervousness, feeling of imminent danger, panic or catastrophe, increased heart rate, hyperventilation, insomnia and avoiding situations that generate anxiety. In addition, there are currently different and multiple scales and measurement instruments and self-report of post-traumatic stress with psychometric properties, some of them are:

 

  • Symptom scale of TEPT Autorreporte Falsetti, Resnick, Resick Y Kilpatrik 1993

  • Purdue Scale of PTSD-Revised (Lauterbach and Vrana 1996)

  • Checklist for PTSD (PCL; Weathers Litz, Herman, Huska and Keane, 1993)

  • The Distressing Events Questionnaire (DEQ: Kubany, Leisen, Kaplan and Kelly 2000)

  • Mississippi Scale for Fight-Related PTSD (Mississippi Scale, Keane Caddell and Taylor 1988)

  • Posttraumatic Stress Diagnostic Scale (PDS, Foa, 1995)

  • Minnesota Multiphasic Personality Inventory (MMPI and MMPI-2)

 

Taking the above into account, different types of treatments can be performed depending on the severity of the case. Generally, these focus on coping skills, exposure-based treatments, cognitive therapy and combination of treatments, desensitization and reprocessing of eye movements. The current treatment with drugs is limited mainly to antidepressants. These medications have been shown to produce low remission rates with only one out of nine 9 patients responding positively. Apart from the Veterans Affairs / Department of Defense guidelines, other guidelines do not recommend pharmacotherapy as a first option, particularly in the veteran population.

 

What is the healthiest and most natural option for PTSD?

 

Cannabis has been evaluated as an alternative and novel treatment option that has become an area of interest in states that legalize its use for post-traumatic stress disorder. Cannabis is capable of attacking the imbalance of neurotransmitters, thus calming the system of stress and attenuates the structural and physiological anomalies that cause the increase of activity in the amygdala.

 

Medical cannabis has been used to treat anxiety and panic disorders such as agoraphobia, social anxiety, generalized anxiety, panic disorder, specific phobias and substance-induced anxiety. The disorders can have intense, excessive and persistent symptoms, interfering with everyday life as they are difficult to control and involve disproportionate responses compared to real danger.

 

According to a study conducted in March 2018 by Ilona Shishko and Rosana Oliveira, this plant contains cannabinoids and 18 other classes of chemical compounds, including cannabidiol or CBD. CBD is a cannabinoid that does not produce psychoactive effects, has antipsychotic properties and works to minimize side effects caused by THC. CBD comes in a variety of forms, including capsules, tinctures or vape. This component is the object of study because it exerts several reactions in the body that can make it a potential option for the treatment of post-traumatic stress disorder.

 

Cannabidiol has demonstrated neuroprotective, analgesic, sedative, antiemetic, antispasmodic, anti-inflammatory and anxiolytic properties. It has been shown that the stimulation of cannabinoid receptors increases stress coping behaviors, as well as the activation of serotonin and norepinephrine in the midbrain. Researchers have even explained that cannabinoid CB-1 presynaptic receptors work in concert with the adrenergic, cholinergic, and dopaminergic systems by helping regulate the release of neurotransmitters from the axon terminals. An important role has also been given to 5-HT1A, a subtype of the serotonin receptor, which is very important in this type of case since anxiety and depression can sometimes be treated with drugs directed to the serotonin system.

 

 

 

 

In this way, cannabis can play a fundamental role in the treatment of post-traumatic stress disorder by activating the CB-1 receptors in the amygdala to reduce anxiety. The stimulation of these receptors in the prefrontal cortex can increase serotonin, a neurotransmitter of potential importance for antidepressant properties.

 

 

The cannabis plant demonstrates that it generates behaviors or reactions in the human body increasing neurogenesis, mood and memory, as well as a decrease in hypervigilance, hyperactive and intrusive memories and a normalization of cortisol in response to agonists in the hippocampus (the area that performs functions in memory and cognition). By stimulating the limbic and paralimbic area, there may be a decrease in the activity of the amygdala and the hypothalamus. This could help regulate the hypothalamic-pituitary axis and cortisol and, therefore, decrease hypervigilance.

 

Although studies and research have continued to be carried out, it cannot be denied that CBD has demonstrated its relationship in the effects that counteract the symptoms of anxiety, depression, and post-traumatic stress, making it a paradigmatic alternative and solving the limitations of treatments for post-traumatic stress disorder.

 

If you suffer from "combat fatigue" or know a veteran who is suffering from this condition, share this information and provide hope for those who struggle with this disease every day. If you want to learn more about this and other uses of cannabis, we invite you to read our next blog. We also invite you to participate in our seminars where you can expand your knowledge in this field. For more information visit our website www.pharmacologyunvieristy.com or write to us at info@pharmacologyuniversity.com.