Marijuana for PTSD Symptoms: First Placebo RCT Questions Benefits

What’s happening – PTSD can be challenging to manage with the pharmacological options currently available. With an increasing number of Veterans who suffer from PTSD turning to cannabis to self-medicate, more information is needed on its safety and effectiveness. A new study reports on the first randomized placebo-controlled trial of smoked cannabis that attempts to answer this question.

Researchers compared the results of three different cannabis concentrations with placebo in Veterans diagnosed with PTSD. The findings reveal that all three concentrations, as well as the placebo, were well tolerated by participants, and all of them provided similar levels of relief for PTSD symptoms during the 3-week study period. Importantly, none of the cannabis forms were found to be more effective than placebo for relieving PTSD symptoms.

The details – Read the full study by Bonn-Miller et al in PLOS ONE. See also, how to counsel patients with PTSD about recreational marijuana use in our Psy-Q below.

Why it’s noteworthy – A March 2021 literature review published in Clinical Psychology Review exploring cannabis use among military Veterans demonstrated that many Veterans have conditions that qualify them for medical marijuana use, despite the fact that cannabis has been consistently associated with the use of other drugs in this patient population. Marijuana use overall was linked to negative health and mental health outcomes in Veterans, including increased risk of self-harm and suicide. In addition, the review authors pointed out that most studies exploring the risks and benefits of cannabis use among Veterans are of poor quality and therefore do not paint an accurate picture of its safety and effectiveness. The new Bonn-Miller paper may provide more accurate, real-world data on cannabis’ effects on PTSD symptoms.

The perspectives –

  • Military Times reported on the Bonn-Miller study, highlighting that while benefits were achieved in both the cannabis and placebo groups, in Stage 2 of the study period, there were slightly stronger improvements in those taking cannabis containing higher levels of THC, which may be worth studying further to see if longer use truly brings more benefits over placebo.
  • A study reported in Cannabis and Cannabinoid Research followed 150 people with PTSD and determined that recreational and medical forms of cannabis do show promise to treat PTSD, but the authors stress that more research is needed to understand the safety profile and the effects from different types of cannabis.
  • The Battle Brothers Foundation recently received IRB approval to conduct an observational study in conjunction with medical data company NiaMedic to better understand the effectiveness of medical cannabis use in Veterans with PTSD who may be refractory to other treatments.

 The conversation –

  • @AmirEnglund (a cannabis scientist at the Institute of Psychiatry, King’s College London) tweets: “New placebo-controlled clinical trial of CBD for cocaine addiction finds no improvement in craving or relapse compared to placebo.”
  • @hoch_ava (Ludwig-Maximilians-University of Munich, Dept. of Psychology) says: “Is cannabis medicine not effective for PTSD? We need more studies #cannabis.”
  • @ZhangMona (state cannabis policy reporter) shares: “At long last, the first clinical trial on cannabis and PTSD has been published in @PLOSONE.”

In practice –  This patient guide provides an overview of different types of medical marijuana typically used to manage PTSD symptoms.

Psy-Q: This Week's Challenge

What is the best way to counsel patients with PTSD who are self-medicating with marijuana? Aaron Weiner PhD, ABPP, answers.

Get the Answer

Post-COVID-19 Psychosis: New Data and Risks

What’s happening – Viral infections, particularly those with respiratory symptoms, have long been associated with changes to the CNS and related cognitive, affective, behavioral, and perceptual changes, including psychosis and hallucinations. With COVID-19, there has been particular concern about people demonstrating psychoneurological effects after infection. To better understand this risk, researchers conducted a literature review that captured 42 cases of psychosis reported in COVID-19 patients.

While they discovered neurobiological evidence of an association between COVID-19 and psychoses, they could not define the specific mechanisms through which psychoses occur in patients. This prevented them from being able to establish clear causality. Therefore, more research is needed to fully understand the relationship and what it means.

The details – Read the full study by de Sousa Moreira et al in Neuroscience Letters.

Why it’s complicated – de Sousa Moreira’s team also noted concerns about in utero COVID-19 infection and the impact it could have on future neurodevelopment and psychiatric complications. Since the COVID-19 virus – and its variants – are still not fully understood, any effects will take time to uncover.

The conversation –

  • Schizophrenia Research reports on a review of 14 studies in which the incident cases of psychosis in people infected by COVID-19 were between 0.9% to 4%. The scientists conclude that viral exposure is related to several factors, including COVID-19 exposure, treatments, and related psychosocial stress. They also concluded that managing the patients posed real challenges during the pandemic.
  • Another literature review, published in Progress in Neuro-psychopharmacology and Biology Psychiatry, looked at a variety of search terms including “psychosis,” that can occur with COVID-19. They determined that psychosis is one of the psychiatric and neurosocial symptoms that can occur during or after the infectious stage of COVID-19. Risk factors include being female, working as a healthcare professional, having avascular necrosis, and experiencing pain.
  • An article in the Baltimore Sun shares one patient’s story with psychosis symptoms including hallucinations and paranoia following COVID-19 infection and calls attention to the trend of people recovered from COVID developing symptoms of psychosis.

The conversation –

  • @DrEscotet (professor emeritus at the University of Texas UTRGV) linked to a Scientific American article noting: “COVID Can Cause Forgetfulness, Psychosis, Mania or a Stuffer. The virus induces neurological symptoms that persist long after the pandemic ends…”
  • @Dra_TeraisaMesa (Psychiatry International Scientific Committee) tweets about the Schizophrenia Research paper: “The potential impact of #COVID-19 on #psychosis: A rapid review of contemporary epidemic and #pandemic research…”
  • @NYTHealth (New York Times Health and Science desk) tweets about a patient story: “Single-handedly the most terrifying thing I’ve ever experienced in my life,” said a man who developed psychosis after having Covid-19. Twice admitted to a psych ward, he believed people were after him. “It’s not real, but it feels so real.”

In practice – See also how the COVID pandemic has affected the mental health of long-term care residents.

Schizophrenia and Blood Pressure Medications: New Links Found

What’s happening – While observational studies have identified a link between people taking high blood pressure medications and developing schizophrenia, the relationship is not fully understood. This gap prompted scientists in Australia and the UK to more fully explore the specifics of schizophrenia etiology, genetics, and different classes of hypertension drugs.

Using a two-sample Mendelian randomization analysis, the team discovered that people taking ACE inhibitor treatments, which are commonly used to lower blood pressure by lowering angiotensin-converting enzyme (ACE) messenger RNA and protein expression, had an increased risk of developing schizophrenia.

A deeper analysis revealed that the association between ACE and schizophrenia does not seem to be related to blood pressure. Rather, they believe the association is linked to a genetic variant responsible for lower ACE gene levels and protein. This finding suggests that ACE inhibitors, particularly those that are centrally acting, may also be related to an increased risk of schizophrenia.

The details – Read the full study by Chauquet S et al in JAMA Psychiatry.

Why it’s complicated – The majority of people with schizophrenia (about 80%) are diagnosed in their teen or young adult years, which is usually before they would require treatment for high blood pressure, according to the Chauquet paper. However, as these patients get older and require ACE inhibitors, researchers worry the medication may trigger new schizophrenia symptoms or worsen existing ones.

 The conversation – 

  • Medscape Medical News interviewed one of the study’s co-authors, Sonia Shah, PhD, who stressed that the findings are not enough to warrant changing current prescription medication guidelines. However, the results could prompt clinicians to adopt greater pharmacovigilance.
  • Psychiatry and Behavioral Health Learning Network shared a Q&A with an author of a related study by Hagi et al in JAMA Psychiatry, on cardiovascular risk factors and cognitive impairment in people with schizophrenia. A surprising finding there was how being overweight or obese did not have a strong association with cognitive dysfunction.
  • Medical Dialogues reported on Chauquet’s paper, noting that, with such high rates of hypertension among psychiatric patients, the findings can help clinicians make educated decisions on the best pharmacological options for patients with comorbidities.

The perspectives

  • @SIRSGlobal (Schizophrenia International Research Society) tweets about the Hagi paper: “Metabolic disorders linked to greater cognitive deficits in people with [#schizophreniaa.”
  • @zenbrainest (scientist) tweets: “NIMHDirector @NIMHgov Metabolic disorders linked to cognitive deficits in schizophrenia…perhaps drugs with lower metabolic side-effects could improve cognition?”
  • @DrDarpanKaur (psychiatrist) tweets: “#MentalHealthAwareness Chronic medical conditions affect mental health. Diabetes, Hypertension @ Coronary Artery Disease are chronic medical disease which impact mental health. Psychiatric Disorders are highly co-morbid. Awareness is needed….”

In practice – Inside the American Psychiatric Association’s latest guidelines on treating schizophrenia.

Last Updated: Apr 20, 2021