We all experience fearful events in our lives. But what scientists are trying to learn is why some people can process these events with relative ease while others continue to face significant difficulty with the memories years, or even decades later. Data shows that only about 20 percent of people who experience a traumatic event actually develop PTSD. But the prevalence of PTSD rose significantly during the pandemic, making it harder to quantify how many of us might be living with it. About 8 million people receive a PTSD diagnosis each year, but countless more go without an official diagnosis.
Scientists have learned that PTSD significantly impacts three areas of the brain: the amygdala, the hippocampus, and the prefrontal cortex.
The amygdala is a section of nervous tissue in the brain that is responsible for emotions, survival instincts, and memory. It’s how we detect fear. By using our senses, such as sight and sound, the amygdala responds to perceived threats by releasing hormones. This all happens unconsciously, deep in our brains.
When affected by PTSD, the amygdala becomes hyperactive. This can make it harder to calm down or get to sleep at night. How the amygdala processes trauma can lead to chronic stress, heightened fear, and increased irritation.
The hippocampus is the part of the brain that’s responsible for storing and retrieving memories, while also importantly differentiating between past and present experiences. In a 2014 study, Researchers observed that, as opposed to a control group, subjects with PTSD had significantly decreased gray matter volume in their hippocampus in addition to a decrease in volume between the hippocampus and amygdala. Researchers believe this decrease may be associated with the dysfunctional emotional memory processing in PTSD patients that leads to symptoms like hyper-arousal or avoidance.
The prefrontal cortex of the brain is central to fear processing. It regulates how fears are acquired and the strategies to regulate or diminish fear responses. Although the amygdala and other subcortical regions of the brain are perhaps best understood with relationship to threat processing, burgeoning evidence supports the role of different regions of the prefrontal cortex (PFC) in regulating the encoding of threat-related behaviors. The PFC also appears to have a critical role in threat inhibition and extinction, as well as in processes such as emotion regulation and avoidance.
Doctors can treat PTSD with pharmaceutical medications such as Zoloft or Paxil. These medicines are in a class called Selective Serotonin Reuptake Inhibitors (SSRIs) and have received approval by the FDA to treat depression for PTSD. While these medications work for some, they don’t work for others and they aren’t right for every PTSD patient.
New treatment options discovered in recent years might better assist doctors and patients in finding new ways to combat the symptoms of PTSD. Here’s a few that have gained interest in the medical community:
The first FDA-regulated study on the benefits of smoked cannabis for PTSD yielded favorable results in 2021.The placebo-controlled, double-blind study specified levels of improvement among participants using smoked cannabis blends with a 9 percent THC concentration. Multidisciplinary Association for Psychedelic Studies (MAPS) conducted the study. In it, the research showed improvements in samples containing 11 percent CBD, as well as mixed samples containing 8 percent of both THC and CBD.
Another randomized, double-blind 2020 study from Wayne State University in Michigan looked at how cannabis use impacts the amygdala response in those dealing with PTSD. This study looked at amygdala responses in three groups of participants – healthy controls who had not been exposed to trauma, trauma exposed adults without PTSD, and trauma-exposed adults with PTSD. The 71 participants were either given a low dose of THC or a placebo. They were then exposed to threatening stimuli and their amygdala responses were recorded. Those treated with THC had lowered threat-related amygdala reactivity.
From this study, scientists observed that those who took low doses of THC showed measurable signs of reduced fear and anxiety in situations designed to trigger fear. Since these results were found in all three groups, it suggests that even those with PTSD were able to experience less fear with THC in their system.
While most of the studies have focused on THC, other cannabinoids in the cannabis plant are being studied for their potential to treat PTSD, too. A 2019 study showed that CBD also appeared to offer relief in a subset of patients who reported frequent nightmares as a symptom of their PTSD.
Some patients prescribed antidepressants for their PTSD experience side effects such as upset stomach and insomnia. One of the reasons that psychedelic therapies are appealing is that they’re thought to work with only a few doses—limiting the risk of side effects.
Psychedelics are a class of psychoactive substances that can alter perception and mood and affect numerous cognitive processes. These include lysergic acid diethylamide (LSD), methylene dioxin methamphetamine (MDMA), dimethyltryptamine (DMT), psilocybin (psychedelic mushrooms), ketamine, and ayahuasca.
Over the past few years, studies have suggested that psychedelics combined with therapy may help patients with PTSD and other mental illnesses. The FDA has designated both treatments as breakthrough therapies, a priority status given to promising drugs designed for an unmet need. MDMA has received breakthrough status for treating PTSD and psilocybin has received the designation for treating treatment resistant depression.
Cognitive Behavior Therapy (CBT) has consistently been found to be the most effective treatment of PTSD both in the short term and the long term. CBT usually involves meeting with a therapist weekly for up to four months and involves confronting the reminders of the trauma in a therapeutic manner so that the feelings decrease. Additional types of therapy that psychiatric doctors use to treat PTSD are exposure therapy and eye movement desensitization and reprocessing (EMDR). Exposure therapy has more evidence of efficacy for PTSD than other interventions.
Psychotherapy can help by teaching new approaches to addressing symptoms, identifying ways to cope if any symptoms arise again, and improving the way you view yourself, others and the world.
All of these treatment options are tools to help PTSD patients gain control over long term fear or other debilitating symptoms after a traumatic event. You and your mental health professional can discuss what type of therapy or combination of therapies may best meet your needs.
Author: Gabrielle Dion Visca
Gabrielle has been writing and editing professionally for the medical and wellness industries for more than 20 years. She’s held positions with The Journal of Pediatrics, Livestrong, The Cincinnati Enquirer, and Patient Pop. She currently writes articles about medical marijuana for Duber Medical, and is the founder of the Ohio cannabis journalism non-profit, MedicateOH.