Oregon Medical 
Marijuana Program
OR
Post Traumatic Stress Disorder
Marijuana Eases Traumatic Memories
Scientists have known for years that the brain makes substances almost identical to the active ingredient in marijuana, but the function of these "cannabinoids" remained mysterious. Researchers now say they help to extinguish traumatic memories.
"In certain situations, being able to forget is very important for emotional survival," said George Kunos, a neurobiologist at the National Institutes of Health.
The research, published today in the journal Nature, is not an endorsement for pot smoking, scientists said. Instead, the findings may help scientists develop new drugs to treat anxiety, post-traumatic-stress disorder and phobias.
"This paper is not saying you should go ahead and smoke marijuana," said Pankaj Sah, a neuroscientist at the Australian National University in Canberra who wrote an accompanying editorial in the journal. "It's saying that it's worth thinking about these specific actions of these compounds."
In the 1980s, scientists were surprised to find the brain has special receptors for the psychoactive elements in cannabis, Kunos said. An Israeli scientist named Rafael Mechoulam then found that the brain made its own versions of these cannabinoids.
To figure out why, authors of this latest study, from the Max Planck Institute of Psychiatry in Munich, Germany, decided to examine mice that had been engineered genetically so that they lacked cannabinoid receptors.
Neuroscientist Beat Lutz said he and his colleagues conditioned the mice to associate a mild shock with the sound of a bell. Normal mice eventually lost the association between the bell and the shock. "They figure out that the tone is not dangerous anymore and say, 'I don't have to freeze,' " Lutz said.
But the mice lacking the cannabinoid system never readjust, always freezing in terror at the sound.
Researchers also found that normal mice produce the natural cannabinoids when they are extinguishing their traumatic association with the bell.
It's not clear whether the cannabinoid system helps the mice to forget the traumatic association of the bell and the shock, or just gives them enough mental flexibility to adjust to a new situation, Lutz said. It's possible that the cannabinoids are important for the ability to relearn and readjust in a number of situations.
Kunos, from the National Institutes of Health, said that the cannabinoids probably play other roles. Using similar methods to Lutz, he found that they help regulate appetite.
Sah, of the Australian National University, said the latest findings may explain why some people with psychiatric problems try to find relief with marijuana. Although experts often have labeled marijuana use as a contributor to these people's mental illness, he suggested that people with certain psychiatric problems perhaps are self-medicating in an attempt to help their brains extinguish some painful or traumatic memory or thought.
Lester Grinspoon, a pro-marijuana psychiatrist at Harvard University and author of the 1971 book "Marijuana Reconsidered," said he would like to see cannabis made into pills that could be prescribed, but said the drug is not patentable and therefore would be unattractive for drug companies to manufacture and market.
Lutz suggested that, instead of supplying extra cannabinoids, a drug might enhance the effects of natural ones.
He also suggested such a drug might need to be taken in conjunction with psychotherapy, during which patients would work on getting rid of fearful associations.
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Newshawk: Alun at LCA & www.ccguide.org.uk
Pubdate: Thu, 05 Aug 2004
Source: Jerusalem Post (Israel)
Copyright: 2004 The Jerusalem Post
Contact: http://info.jpost.com/C002/Services/Feedback/editors.html
Website: http://www.jpost.com/
Details: http://www.mapinc.org/media/516
Author: Associated Press
Bookmark: http://www.mapinc.org/mmj.htm (Cannabis - Medicinal)
Return Back To Main Medical Page
IDF TO TREAT SHELL SHOCK WITH CANNABIS
The IDF will soon begin using cannabis to treat soldiers suffering from combat stress, the military said Wednesday.
An army statement said the military medical corps and the Hebrew University of Jerusalem would begin treating victims of post-traumatic stress -commonly known as shell shock - with THC, the active ingredient in the cannabis plant. It said the treatment would begin on an experimental basis. "The use of THC as part of the treatment for post-traumatic stress disorder
was approved by military and civilian committees relevant to the subject, the statement said.
An IDF spokesman said treatment would be given to both conscript soldiers and reservists.
Since September 2000, the Israeli military has been conducting day to day operations against the Palestinian terror infrastructure in the West Bank and the Gaza Strip.
During that time many soldiers have been treated for combat stress following service at military checkpoints and in military operations. The IDF continues to ban the use of all drugs on a leisure basis, including cannabis derivatives marijuana and hashish.
source: http://www.onlinepot.org/medical/idftreatsshellshock.htm
PTSD and Cannabis: A Clinician Ponders Mechanism of Action
By David Bearman, MD
One often intractable problem for which cannabis provides relief is post-traumatic stress disorder (PTSD). I have more than 100 patients with PTSD.
Among those reporting that cannabis alleviates their PTSD symptoms are veterans of the war in Vietnam, the first Gulf War, and the current occupation of Iraq. Similar benefit is reported by victims of family violence, rape and other traumatic events, and children raised in dysfunctional families.
Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder —once referred to as “shell shock” or “battle fatigue” — is a debilitating condition that follows exposure to ongoing emotional trauma or in some instances a single terrifying event. Many of those exposed to such experiences suffer from PTSD. The symptoms of PTSD include persistent frightening thoughts with memories of the ordeal. PTSD patients have frightening nightmares and often feel anger and an emotional isolation.
Sadly, PTSD is a common problem. Each year millions of people around the world are affected by serious emotional trauma. In more than 100 countries there is recurring violence based on ethnicity, culture, religion or political orientation.
Men, women and children suffer from hidden sexual and physical abuse. The trauma of molestation can cause PTSD. So can rape, kidnapping, serious accidents such as car or train wrecks, natural disasters such as floods or earthquakes, violent attacks such as mugging, torture, or being held captive.
The event that triggers PTSD may be something that threatened the person’s life or jeopardized someone close to him or her. Or it could simply be witnessing acts of violence, such as a mass destruction or massacre. PTSD can affect survivors, witnesses and relief workers.
Symptoms
Whatever the source of the problem, PTSD patients continually relive the traumatic experience in the form of nightmares and disturbing recollections. They are hyper-alert. They may experience sleep problems, depression, feelings of emotional detachment or numbness, and may be be easily aroused or startled. They may lose interest in things they used to enjoy and have trouble feeling affectionate. They may feel irritable, be violent, or be more aggressive than before the traumatic exposure.
Triggers
Seeing things that remind them of the incident(s) may be very distressing, which could lead them to avoid certain places or situations that bring back those memories. Anniversaries of a traumatic event are often difficult.
Ordinary events can serve as reminders of the trauma and trigger flashbacks or intrusive images. Movies about war or TV footage of the Iraqi war can be triggers. People with PTSD may respond disproportionately to more or less normal stimuli —a car backfiring, a person walking behind them. A flashback may make the person lose touch with reality and re-enact the event for a period of seconds, hours or, very rarely, days. A person having a flashback in the form of images, sounds, smells, or feelings experiences the emotions of the traumatic event. They relive it, in a sense.
Symptoms may be mild or severe — people may become easily irritated or have violent outbursts. In severe cases victims may have trouble working or socializing. Symptoms can include:
• Problems in affect regulation —for instance persistent depressive symptoms, explosion of suppressed anger and aggression alternating with blockade and loss of sexual potency;
• Disturbance of conscious experience, such as amnesia, dissociation of experience, emotions, and feelings;
• Depersonalization (feeling strange about oneself), rumination;
• Distorted self-perception —for instance, feeling of helplessness, shame, guilt, blaming oneself, self-punishment, stigmatization, and loneliness;
• Alterations in perception of the perpetrator —for instance, adopting distorted beliefs, paradoxical thankfulness, idealization of perpetrator and adoption of his system of values and beliefs;
• Distorted relationship to others, for instance, isolation, retreat, inability to trust, destruction of relations with family members, inability to protect oneself against becoming a victim again;
• Alterations in systems of meaning, for instance, loss of hope, trust and previously sustaining beliefs, feelings of hopelessness;
• Despair, suicidal thoughts and preoccupation;
• Somatization —for instance persistent problems in the digestive system, chronic pain, cardiopulmonary symptoms (shortness of breath, chest pain, dizziness, palpitations).
• Cannabis
Ample anecdotal evidence suggests that cannabis enhances ability to cope with PTSD. Many combat veterans suffering from PTSD rely on cannabis to control their anger, nightmares and even violent rage. Recent research sheds light on how cannabis may work in this regard.
Neuronal and molecular mechanisms underlying fearful memories are often studied in animals by using “fear conditioning.” A neutral or conditioned stimulus, which is typically a tone or a light, is paired with an aversive (unconditioned) stimulus, typically a small electric shock to the foot. After the two stimuli are paired a few times, the conditioned stimulus alone evokes the stereotypical features of the fearful response to the unconditioned stimulus, including changes in heart rate and blood pressure and freezing of ongoing movements. Repeated presentation of the conditioned stimulus alone leads to extinction of the fearful response as the animal learns that it need no longer fear a shock from the tone or light.
• Fear Extinction
Emotions and memory formation are regulated by the limbic system, which includes the hypothalamus, the hippocampus, the amygdala, and several other structures in the brain that are particularly rich in CB1 receptors.
The amygdala, a small, almond-shaped region lying below the cerebrum, is crucial in acquiring and, possibly, storing the memory of conditioned fear. It is thought that at the cellular and molecular level, learned behavior —including fear— involves neurons in the baso-lateral part of the amygdala, and changes in the strength of their connection with other neurons (“synaptic plasticity”).
CB1 receptors are among the most abundant neuroreceptors in the central nervous system. They are found in high levels in the cerebellum and basal ganglia, as well as the limbic system. The classical behavioral effects of exogenous cannabinoids such as sedation and memory changes have been correlated with the presence of CB1 receptors in the limbic system and striatum.
In 2003 Giovanni Marsicano of the Max Planck Institute of Psychiatry in Munich and his co-workers showed that mice lacking normal CB1 readily learn to fear the shock-related sound, but in contrast to animals with intact CB1, they fail to lose their fear of the sound when it stops being coupled with the shock.
The results indicate that endocan-nabinoids are important in extinguishing the bad feelings and pain triggered by reminders of past experiences. The discoveries raise the possibility that abnormally low levels of cannabinoid receptors or the faulty release of endogenous cannabinoids are involved in post-traumatic stress syndrome, phobias, and certain forms of chronic pain.
This suggestion is supported by our observation that many people smoke marijuana to decrease their anxiety and many veterans use marijuana to decrease their PTSD symptoms. It is also conceivable, though far from proved, that chemical mimics of these natural substances could allow us to put the past behind us when signals that we have learned to associate with certain dangers no longer have meaning in the real world.
What is the Mechanism of Action?
Many medical marijuana users are aware of a signaling system within the body that their doctors learned nothing about in medical school: the endocan-nabinoid system. As Nicoll and Alger wrote in “The Brain’s Own Marijuana” (Scientific American, December 2004):
“ Researchers have exposed an entirely new signaling system in the brain: a way that nerve cells communicate that no one anticipated even 15 years ago. Fully understanding this signaling system could have far-reaching implications. The details appear to hold a key to devising treatments for anxiety, pain, nausea, obesity, brain injury and many other medical problems.”
As a clinician, I find the concept of retrograde signaling extremely useful. It helps me explain to myself and my patients why so many people with PTSD get relief from cannabis.
We are taught in medical school that 70% of the brain is there to turn off the other 30%. Basically our brain is designed to modulate and limit both internal and external sensory input.
The neurotransmitter dopamine is one of the brain’s off switches.The endocannabinoid system is known to play a role in increasing the availability of dopamine. I hypothesize that it does this by freeing up dopamine that has been bound to a transporter, thus leaving dopamine free to act by retrograde inhibition.
By release of dopamine from dopamine transporter, cannabis can decrease the sensory input stimulation to the limbic system and it can decrease the impact of over-stimulation of the amygdala.
I postulate that exposure to the PTSD-inducing trauma causes an increase in production of dopamine transporter. The dopamine transporter ties up much of the free dopamine. With the brain having lower-than-normal free dopamine levels, there are too many neural channels open, the mid-brain is overwhelmed with stimuli and so too is the cerebral cortex. Hard-pressed to react to this stimuli overload in a rational manner, a person responds with anger, rage, sadness and/or fear.
With the use of cannabis or an increase in the natural cannabinoids (anandamide and 2-AG), there is competition with dopamine for binding with the dopamine transporter and the cannabinoids win, making a more normal level of free dopamine available to act as a retrograde inhibitor.
This leads to increased inhibition of neural input and decreased negative stimuli to the midbrain and the cerebral cortex. Since the cerebral cortex is no longer overrun with stimuli from the midbrain, the cerebral cortex can assign a more rational meaning and context to the fearful memories.
I have numerous patients with PTSD who say “marijuana saved my life,” or “marijuana allows me to interact with people,” or “it controls my anger,” or “when I smoke cannabis I almost never have nightmares.” Some say that without marijuana they would kill or maim themselves or others. I have no doubt that cannabis is a uniquely useful treatment. What remains is for the chemists to determine the precise mechanism of action.
Oregon in Denial Over Cannabis as an Antidepressant
By Ed Glick
I’ve been working as a nurse for 25 years, about half of that in acute care mental health nursing at Good Samaritan Regional Medical Center in Corvallis, Oregon. Eight years ago the Oregon Medical Marijuana Act pass-ed by the initiative process and a state program began registering patients.
It wasn’t long before I started meeting patients coming into the regional mental health unit who reported that they were using cannabis to self-medicate for a variety of mental-health symptoms. It wasn’t long after that that I started volunteering at the Compassion Center, a volunteer medical facility that helps assist patients with education, support and registration into the medical marijuana program.
Pretty soon I started seeing the same patients who were having psychiatric emergencies coming to the Compassion Center to see me for cannabis recommendations, which I can’t provide and which, actually, they couldn’t get because there is no allowance in Oregon for psychiatric treatments. All the “debilitating conditions” are physical with the exception of Alzheimer’s agitation.
In Corvallis, a very progressive community, there is virtually no doctor who will recommend cannabis for cancer pain or for severe nausea or AIDS. The whole medical system of Corvallis said “No, you’re locked out.” So then I go down to the Compassion Center and all these people from the medical system that I’m employed in say, “My doctor won’t do it, he’s afraid he’ll lose his license.”
So we assist these people by trying to find a physical correlation to their psychiatric symptom. For example, if they’re having PTSD symptoms they might be sick and have physical symptoms.
How high a percentage of these people were treating psychiatric symptoms? I put together a very simple survey to find out. I reviewed 172 charts. The average patient age was 43. All the patients were registered in OMMA; 95% were registered for pain. A very large percentage of Oregon registrants are pain patients.
Some 40% had multiple qualifying conditions (not including psychiatric) —physical pain and nausea, for example. Pain and with spasticity —they often go together.
The results: 64% of the patients in the survey showed some kind of significant psychiatric benefit; 39% reported insomnia relief; 5% reported PTSD symptom relief, many of them veterans who go to the VA hospital in Roseburg and are denied. The VA doctors tell them “No, I can’t. I’ll lose my DEA license.” They just don’t want to stand up to it —although they’re beginning to refer patients to us, which is kind of interesting.
Anxiety, 11%; depressive symptoms, 11%; 15% of the cohort reported that they were using cannabis to decrease the side effects of medications; 56% reported reduced use of medications.
What these patients report to me is that they’re sick and tired of Vioxx and they’re sick and tired of Flexeril, Vicodin —people are literally sick of these drugs. They can’t sleep, they can’t function, they’re drugged up, they don’t have any enjoyment of life.
When they start using cannabis they leave off the Vioxx and they leave off the Vicodin. Vicodin has a place, but for long-term pain management it is really poor.
Appetite stimulation —tremendously important for people who are in pain all the time— was 20%.
I put the survey together as a request to the Oregon Department of Human Services to reconvene the Debilitating Conditions Advisory Panel, which I was a member of in 2000. At that time nine patients had submitted requests to include psychiatric conditions to the list.
The state health officer did a fairly good job of bringing together the panel, but the whole thing was skewed from the outset by political manipulation by the governor’s office and by the head of the Department of Health Services. The information that they would allow us to consider had to be filtered through rules stating that if it’s not a double-blind, peer-reviewed clinical trial, it doesn’t get a lot of evidentiary weight.
We were not allowed to give much weight to patients’ reports. And of course there was no relevant double-blind, peer-reviewed clinical trial. So the panel was set up to fail.
A few patients came in and gave very compelling testimonials. And then out of nowhere came a whole bunch of medical experts —psychiatrists from Oregon Health Sciences University and the National Alliance for the Mentally Ill— and they just had fits. “This is quackery,” they said.
The only person who even differentiated between affective depressive-type disorders and schizophrenic thought disorders was one of the patients. None of the doctors even made any differentiation between these two completely different sets of medical problems.
After a long, protacted time we all wrote our comments out, and there was a vote, and we voted to add affective disorders —severe agitation and depressive symptoms. Didn’t happen. They finally did add Alzheimer’s agitation.
So, five years later I brought in the study I’d done with OMMP registrants and asked them to reconvene the Debilitating Conditions Panel based on this new evidence showing that indeed there is some psychiatric effect that people are getting from their cannabis use. And they rejected the request with a “summary denial.”
Then Lee Berger, an attorney in Portland, asked if I’d be willing to sue the Department of Human Services’ OMMP and I said yes. We filed our petition for judicial review in February —a formal request “to Add Clinical Depression, Depressive Symptoms, Post-Traumatic Stress Disorder (PTSD), Severe Anxiety, Agitation and Insomnia, to Those Diseases and Conditions Which Qualify as ‘Debilitating Medical Conditions’ under the Oregon Medical Marijuana Act.” And it worked! I can’t believe it!
We got word last week that, because the OMMP doesn’t really want to go to court, they’ve decided to kind of sue for peace. All we’re asking is that they reconvene a panel to evaluate these conditions. So, we’re in the process of negotiatng with them to get this thing back on track.
We want to close some of the loopholes that allow them to skew the evidence base. It’s pretty clear that there are a lot of patients who are using cannabis for insomnia, for mood stabilizing, and for peace. Just for a a very simple, elemental peace, especially with chronic diseases like severe chronic pain. Cannabis is actually a miracle drug for pain, in my opinion.
There’s no question the last thing the pharmacy industry wants is millions and millions of Americans growing and using their own medicine that covers such a wide array of diseases.
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Rodney Dangerfield's Lifelong Romance With Marijuana
By Joan Dangerfield
The comedian’s widow gave this talk at the Patients Out of Time conference on cannabis therapeutics in Santa Barbara April 7.
If Rodney were here today he would say something brilliant. He would probably open with a marijuana joke. He’d say, “I tell ya, that marijuana really has an effect on you. The other day I smoked a half a joint and I got so hungry, I ate the other half.”
Rodney had a fantastically unique mind. Few people knew he was a mathematical genius, but everyone knew he was hilarious. His humor was a razor thrust into social hypocrisy and the little injustices of life. He wrote “killers” and made the world laugh.
Another thing that was not widely known about Rodney is that he endured quite a bit of personal suffering in his life. He was heartbreakingly neglected as a child. We’ve all heard the expression “the tears of a clown,” and in many ways Rodney embodied that experience. Like most geniuses, the special chemistry that created his remarkable mind also created certain psychological challenges. Acute anxiety and manic depression were congenital issues that plagued Rodney’s life.
To give you an idea of how his anxiety would manifest itself, Rodney couldn’t sit still. In Caddyshack, his character, Al Cervic, is constantly fidgeting like he’s about to burst out of his skin. The truth is, this was no act. Rodney was under duress. He felt Chevy Chase was talking too slowly and it got on his nerves. Rodney’s impatience would come out through his body. The pace of the whole world was too slow for him until he found marijuana.
Rodney first lit up back in 1942 when he was 21. He was hanging out with a comic named Bobby Byron and his friend Joe E. Ross —some of you might remember Joe E. Ross from Car 54. They went to the Belvedere Hotel in New York where Bobby lived. The night would prove to have such an impact on Rodney’s life that he even remembered the room number they were in —1411.
Although he was supposed to be enjoying himself with friends, Rodney was characteristically agitated and anxiety ridden. It’s how he felt every day of his life to that point. But when Rodney got high, he couldn’t believe it.
For the first time in his life, he left relaxed and peaceful, and had a sense of well-being. That night marijuana became a new friend that would be in Rodney’s life for the next 62 years.
I met Rodney in 1983, and after a 10-year courtship, Rodney and I enjoyed 11 years of marriage. I must admit that when I became a part of Rodney’s life, I did not approve of his marijuana use. My Mormon background hadn’t given me experience with any illegal substances and I was always afraid Rodney would get arrested.
Rodney was concerned about my feelings and agreed to look for legal alternatives to treat his ailments. Over the years we consulted the best experts we could find in search of legal anti-anxiety and pain medications and even tried Marinol. But nothing worked for him the way real marijuana did.
A couple of years ago Rodney was in the process of writing his autobiography, in which he wanted to be very candid about everything in his life. He even wanted to title the book “My Lifelong Romance with Marijuana.”
I was sure then that Rodney would be arrested. So I looked for, and found, Dr. David Bearman here in Santa Barbara.
Dr. Bearman examined Rodney and obtained records from Rodney’s other doctors for review. In addition to his anxiety and depression, at the time Rodney’s medical conditions included constant pain from the congenital fusion of his spine, an inoperable dislocated shoulder and rotator-cuff tear and arthritis. Rodney wasn’t able to take traditional pain medications because of their interactions with his blood-thinning medication, Coumadin.
We were elated a few days after that initial visit with Dr. Bearman when Rodney’s medicinal use was approved. Rodney showed the approval letter to everyone and carried miniature versions in his pockets. Ever the worried wife, I included a copy of the letter in the memory box of his casket in case the feds were waiting for him at the Pearly Gates.
Even though Rodney endured numerous health challenges over the years, including aneurysms, heart surgeries and a brain bypass, he remained active and vital during his last incredible year. He swam regularly, went on a multi-city press tour to promote his best-selling book (the publisher made him change the title to “It’s Not Easy Bein’ Me”), recorded an album of love songs called “Romeo Rodney,” and wrote countless new jokes.
After all those years of pot smoking, his memory and his joke-writing ability did not suffer and his lungs were okay. He was as sharp as ever.
Even moments after brain surgery Rodney didn’t miss a beat. Rodney’s doctor came to his bedside after he was taken off the respirator. He said, “Rodney, are you coughing up much?” And Rodney said, “Last week, five-hundred for a hooker.”
Some of you may be aware that 4:20 is a symbolic time of day for many marijuana enthusiasts. About a year after Rodney’s brain surgery, he had heart surgery and due to complications his life ended... Coincidentally, or perhaps meaningfully, at 4:20 p.m. EST.
source: http://ccrmg.org/journal/06spr/perspective2.html
By Tod Mikuriya, MD
William Woodward, MD, of the American Medical Association, testifying before Congress in 1937 against the Prohibition of cannabis, paraphrased a French author (F. Pascal, 1934) to the effect that “Indian hemp has remarkable properties in revealing the subconscious.” A Congressman asked, “Are there any substitutes for that latter psychological use?” Woodward replied, “I know of none. That use, by the way, was recognized by John Stuart Mill in his work on psychology, where he referred to the ability of Cannabis or Indian hemp to revive old memories —and psychoanalysis depends on revivivification of hidden memories.”
For including that reference to Mill (1867) in the list I have been compiling of conditions amenable to treatment by cannabis, I was ridiculed by Drug Czar Barry McCaffrey in 1996. I stand by its inclusion, of course, and in the 10 years since California physicians have been approving cannabis use by patients, I have found myself appreciating and confirming Mill’s insight with every report that cannabis has eased symptoms of post-traumatic stress disorder.
PTSD As a Dissociative Disorder
PTSD—a chronic condition involving horrific memories that cannot be erased—is a dissociative identity disorder. The victims’s psyche is fragmented in response to contradictory inputs that cannot be resolved.
Dissociative identity disorders are expressed in bizarre or inappropriate behaviors with intense sadness, fear, and anger. Repression or “forgetting” of the experiences may develop as a coping mechanism.
When traumatic or abusive experiences cannot be integrated into normal consciousness —as in the case of the Jekyl-Hyde behaviors of abusive parents or caregivers— creation of separate personalities or identities may occur.
For example, the woman who was molested by a family member may have both superfically-compliant and repressed-raging identities. The persona that’s presented to the world can be swept away when a stimulus calls forth the overwhelming rage.
Such fragmenting of the individual personality causes tremendous stress. The psyche is incomplete because of repression and denial. The person tries to appear normal and logical but in fact is in turmoil, angry and depressed. The inability to deal directly with emotional issues results in ongoing splitting and compartmentalization of the personality —and in extreme cases, multiple personalities, hysterical fugue (a separate state of consciousness that the individual may not recall), blindness, paralysis, and other functional disruptions.
In 1994 the term “Multiple Personality Disorder” was replaced with the more widely applicable “Dissociative Identity Disorder.” As an article (by Foote et al) and editorial (Spiegel) in the April 2006 American Journal of Psychiatry attest, it is only relatively recently that PTSD has been characterized as a dissociative disorder. [continued below]
Case Report:
A 52-year-old retired executive secretary brought her 20-year-old daughter along to her follow-up interview two years after starting cannabis therapy. During her initial visit she had not disclosed fully the causality of her chronic depression with symptoms of PTSD (nightmares, chronic insomnia, dissociative episodes, rage).
She was experiencing loss of emotional control with crisis psychiatric interventions. Hypervigilance characterized her presentation; she described herself as being “all clenched up.”
On follow-up she reported being able to recover and process repressed memories of sexual abuse from age five to 15 by her father (a preacher) and having been beaten by her enraged mother. She reported the diminution and cessation of dissociative reactions to the painful memories. This permitted her to process and resolve —or come to an accord with— these unthinkable memories. Her continuing psychotherapy focused on these issues. She no longer experienced episodes of loss of control. She was able to relax her hypervigilance. Her self-esteem was significantly improved and she seemed happy and optimistic
Her daughter confirmed that her mother was less irritable and more emotionally available since starting cannabis therapy. Both described improvement in their relationship.
Case Report:
A 55-year-old disabled male veteran had been a naval air crewman on patrol during the Vietnam war. A P2V turbo-prop engine failed to reverse properly on landing. A propeller broke loose, pierced the fuselage, and instantly killed his crew mate who was two feet away. He brought a large binder of documentation of the incident.
His PTSD was expressed primarily through a haunting, recurrent flashback nightmares that replayed the traumatic event. Attendant were the feelings of being emotionally overwhelmed. Sleep deficit was a salient aggravating factor for increasing vulnerability. Cannabis restored sleep and controlled nightmares. Depression and irritability had been eased.
Easement by Cannabis
Approximately eight percent of the >9,000 Californians whose cannabis use I have monitored presented with PTSD (309.81) as a primary diagnosis. Many of them are Vietnam veterans whose chronic depression, insomnia, and accompanying irritability cannot be relieved by conventional psychotherapeutics and is worsened by alcohol. For many of these veterans, chronic pain from old physical injury compounds problems with narcotic dependence and side effects of opioids.
Survivors of childhood abuse and other traumatic experiences form a second group manifesting the same symptoms —loss of control and recurrent episodes of anxiety, depression, panic attacks and mood swings, chronic sleep deficit and nightmares.
The brief case reports in the box at the right of this page, unique though the subjects may be, typify two different forms that PTSD takes, both of which are eased by cannabis. The recurrent nightmares from the vet’s traumatic episode took on a life of their own, causing nocturnal turmoil and dread. The repressed memories of the sexually abused and beaten woman were symptoms of a fragmented, dissociative response to the disorder.
Easement by cannabis helped both —the vet by toning down his reaction to the nightmares and restoration of his sleep, the woman by modulating her emotional reactivity and permitting her to process and integrate the experience and give up the fragmented, dissociative defense mechanisms, which in due course she no longer needed.
Repression and suppression are defense mechanisms that break down when the victim is fatigued and/or hurting and subjected to triggering stimuli. With cannabis, vegetative functions necessary for recovery, growth and repair are normalized.
Cannabis relieves pain, enables sleep, normalizes gastrointestinal function and restores peristalsis. Fortified by improved digestion and adequate rest, the patient can resist being overwhelmed by triggering stimuli. There is no other psychotherapeutic drug with these synergistic and complementary effects.
Practical Treatment Goals
In treating PTSD, psychotherapy should focus on improving how the patient deals with resurgent symptoms rather than revisitation of the events. Decreasing vulnerability to symptoms and restoring control to the individual take priority over insight as treatment goals. Revisiting the traumatic events without closure and support is not useful but prolongs and exacerbates pain and fear of loss of control. To repeat: cathartic revisiting of the traumatic experience(s) without support and closure is anti-therapeutic and can exacerbate symptoms.
Physical pain, fatigue, and sleep deficit are symptoms that can be ameliorated. Restorative exercise and diet are requisite components of treatment of PTSD and depression. Cannabis does not leave the patient too immobile to exercise, as do some analgesics, sedatives biodi-azapenes, etc. Regular aerobic exercise (where injury does not interfere) relieves tension and restores control through kinesthetic involvement. Exercise also internalizes the locus of control and diminishes drug-seeking to manage emotional response.
The importance of sound sleep
PTSD often involves irritability and inability to concentrate, which is aggravated by sleep deficit. Cannabis use enhances the quality of sleep through modulation of emotional reactivity. It eases the triggered flashbacks and accompanying emotional reactions, including nightmares.
The importance of restoring circadian rhythm of sleep cannot be overestimated in the management of PTSD. Avoidance of alcohol is important in large part because of the adverse effects on sleep. The short-lived relaxation and relief provided by alcohol are replaced by withdrawal symptoms at night, causing anxiety and the worsening of musculoskeletal pain.
Evening oral cannabis may be a useful substitute for alcohol. With proper dosage, the quality and length of sleep can be improved without morning dullness or hangover. For naïve patients, use of oral cannabis should be gradually titrated upward in a supportive setting; this is the key to avoiding unwanted mental side effects.
I recommend the protocol J. Russell Reynolds M.D., commended to Queen Victoria: “The dose should be given in minimum quantity, repeated in not less than four to six hours, and gradually increased by one drop every third or fourth day, until either relief is obtained, or the drug is proved, in such case to be useless. With these precautions I have never met with any toxic effects, and have rarely failed to find, after a comparatively short time, either the value or the uselessness of the drug.”
The advantage of oral over inhaled cannabis for sleep is duration of effect; a disadvantage is the time of onset (45-60 minutes). When there is severe recurrent insomnia with frequent awakening it is possible to medicate with inhaled cannabis and return to sleep. An unfortunate result of cannabis prohibition is that researchers and plant breeders have not been able to develop strains in which sedative components of the plant predominate.
Modulation, Not Extinction
Although it is now widely accepted that cannabinoids help extinguish painful memories, my clinical experience suggests that “extinguish” is a misnomer.
Cannabis modulates emotional reactivity, enabling people to integrate painful memories —to look at them and begin to deal with them, instead of suppressing them until a stimulus calls them forth with overwhelming force.
The modulation of emotional response relieves the flooding of negative affect. The skeletal and smooth muscle relaxation decreases the release of corticosteroids and escalating “fight-or-flight” agitation. The modulation of mood prevents or significantly decreases the symptoms of anxiety attacks, mood swings, and insomnia.
While decreasing the intensity of affectual response, cannabis increases introspection as evidenced by the slowing of the EEG after initial stimulation. Unique anti-depressive effects are experienced immediately with an alteration in cognition. Obsessive and pressured thinking give way to introspective free associations (given relaxed circumstances). Emotional reactivity is calmed, worries become less pressing.
Used on a continuing basis, cannabis can hold depressive symptoms at bay. Agitated depression appears to respond to the anxiolytic component of the drug. Social withdrawal and emotional shutting down are reversed.
The short-term memory loss induced by cannabis that may be undesirable in other contexts is therapeutic in controlling obsessive ideation, amplified anxiety and fear of loss of control ignited by the triggering stimuli.
Easement Effects of Cannabis
In treating PTSD, cannabis provides control and amelioration of chronic stressors without adverse side effects. Mainstream medicine treats PTSD symptoms such as hyperalertness, insomnia, and nightmares with an array of SSRI and tricyclic anti-depressants, sedatives, analgesics, muscle relaxants, etc., all of which provide inadequate relief and have side effects that soon become problematic. Sedatives, both prescribed and over-the-counter, when used chronically, commonly cause hangovers, dullness, sedation, constipation, weight gain, and depression. See chart at right.
Cannabis is a unique psychotropic immunomodulator which can best be categorized as an “easement.” Modulating the overwhelming flood of negative affect in PTSD is analogous to the release of specific tension, a process of “unclenching” or release. As when a physical spasm is relieved, there is a perception of “wholeness” or integration of the afflicted system with the self. For some, this perceptual perspective is changed in other ways such as distancing (separating the reaction from the stimulus, which can involve either lessening the reaction, as with modulation, or repressing/suppressing the memory; walling it off; forgetting).
The modulation of emotional response relieves the flooding of negative affect. The skeletal and smooth muscle relaxation decreases the sympathetic nervous reactivity and kindling component of agitation. Fight/flight responses and anger symptoms are significantly ameliorated. The fear of loss of control diminishes as episodes of agitation and feeling overwhelmed are lessened. Experiences of control then come to prevail. Thinking is freed from attachment to the past and permitted to fix on the present and future. Instead of being transfixed by nightmares, the sufferer is freed to realize dreams.
Based on both safety and efficacy, cannabis should be considered first in the treatment of post-traumatic stress disorder. As part of a restorative program with exercise, diet, and psychotherapy, it should be substituted for “mainstream” anti-depressants, sedatives, muscle relaxants, tricyclics, etc.
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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:
SSRIs
Paroxetine, Sertraline, Pluoxetine, Citalopram, Fluvoxamine
May produce insomnia, restlessness, nausea, decreased appetite, daytime sedation, nervousness, 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 exacerbate hypertension. Buproprion may exacerbate seizure disoder. Mirtrazepine may cause sedation.
MAOIs
Phenetzine
Risk of hypertensive crisis; patients required to follow a strict dietary regime. Contraindicated in combination with most other antidepressants, CNS stimulants, and decongestants. Contraindicated in patients with alcohol/substance abuse/dependence. May produce insomnia, hypotension, anticholinergic side effects, and liver toxicity.
Tricyclic Antidepressants
Imipramine, Amitriptyline, Desipramine
Anticholinergic side effects (dry mouth, rapid pulse, blurred vision, constipation). May produce ventricular arrhythmias. May produce orthostatic hypotension, sedation, or arousal.
Antiadrenergic Agents
Prazosin, Propranolol, Conidine, Guanfacine
May produce hypotension, brachycardia (slow heartbeat), depressive symptoms, psychotomor slowing or bronchospasm.
Anticonvulsants
Carbamazepine may cause neurological symptoms, ataxia, drowsiness, low sodium level, leukopenia. Valproate may cause gastrointestinal problems, sedation, tremor and thrombocytopenia (low platelet levels in blood). It is teratogenic (induces mutations, should not be used during pregnancy). Gabapentin may cause sedation and ataxia (difficulty forming sentences). Lamotrigine may cause Stevens-Johnson syndrome, rash, fatigue. Toprimate may cause glaucoma, sedation, dizziness, and ataxia.
Atypical Antipsychotics
Risperidone, Olanzapine, Quetiapine
May cause weight gain. Risk of type 2 diabetes with olanzapine
Cannabis as a treatment for PTSD provides effective control and relief of chronic stressors. Its side-effect profile seems especially benign when contrasted with those of the prevailing mainstream treatments.--T.H.M.
source: http://ccrmg.org/journal/06spr/ptsd.html
19:00 31 July 2002
Special Report from New Scientist Print Edition. Subscribe and get 4 free issues.
Alison Motluk
Marijuana has been used medicinally for thousands of years, and people with certain psychiatric conditions such as schizophrenia are more likely to smoke pot than healthy people.
The active chemical in marijuana, tetrahydrocannabinol or THC, binds to the brain's cannabinoid receptors, which are known to be linked to pain sensations, emotion and movement. And in the past decade, researchers have identified chemicals made within the brain that are similar to THC.
Now Beat Lutz at the Max Planck Institute of Psychiatry in Munich and his team have found that these cannabinoids play an important role in getting rid of unwanted memories in mice. The finding could lead to new treatments for people who have related mental conditions. "We could understand the problem of phobia or post-traumatic stress disorder by investigation of this cannabinoid system," says Lutz.
Neuroscientist Daniele Piomelli at the University of California, Irvine, says: "It's an important paper. It's going to have a big impact in the field."
Freezing with fear
The researchers genetically engineered mice so that they lacked a particular type of cannabinoid receptor called CB1. These are normally found in the amygdala, a brain region associated with fear.
They then conditioned the mice, as well as their normal litter mates, to associate a particular musical tone with an electric shock. Both groups of mice quickly learned the association, freezing with fear whenever they heard the tone. A week later, the mice were repeatedly exposed to tones but without the associated electric shock. The normal mice soon shed their fear response, but the modified mice still showed fear 11 days later.
The researchers found that the modified mice eventually suppressed the bad memories, but it took them about six times longer than the normal mice. Lutz's group also showed that blocking CB1 receptors in the normal mice meant they were unable to stamp out the negative association.
New treatments
The team later studied the mice's amygdalae, and confirmed that animals who were now unlearning the unpleasant association had significantly higher levels of two major cannabinoids - anandamide and 2-arachidonoylglycerol - than those who'd never been trained.
This suggests that these chemicals help wipe out bad memories by binding to CB1 receptors.
The findings give a new lead for research into treatments for conditions such as phobia and post-traumatic stress disorder. But Lutz points out that marijuana itself is too blunt an instrument to be a potential treatment, because it activates all the brain's cannabinoid receptors at once.
Journal reference: Nature (vol 418, p 530)
source: http://www.newscientist.com/article/dn2616...d-memories.html
Science: Endocannabinoids extinguish bad memories in the brain
Researchers at the Max Planck Institute of Psychiatry in Munich (Germany) have shown that the endogenous cannabinoid system plays a central role in the extinction of aversive memories.
Transgenic mice without the brain cannabinoid receptor (CB1) and mice treated with a CB1 receptor antagonist showed strongly impaired extinction of fear in experiments. The animals that were conditioned to associate a musical tone with an electric shock, produced a fear reaction, and continued to react even when the tone was not followed by a shock. Normal mice quickly stopped reacting to the tone once it was not associated with a shock, but the treated mice needed much more time to forget their fear.
Dr. Beat Lutz and his team found out that the amygdala, an area of the brain central to storing memory and fear, was flooded with endocannabinoids, when the mice were gradually forgetting the learned response to the shock. The use of cannabis would not produce the same effect in humans, Lutz said, because it overflows the whole brain and is not specific enough.
Dr. Pankaj Sah, a neuroscientist at the Australian National University in Canberra said in a comment the latest findings may explain why some people with psychiatric problems try to find relief with marijuana. He suggested that people with certain psychiatric problems perhaps are self-medicating in an attempt to help their brains extinguish some painful or traumatic memory or thought.
(Sources: Marsicano G, et al. The endogenous cannabinoid system controls extinction of aversive memories. Nature 2002 Aug 1;418(6897):530-4; Sah P. Neurobiology: Never fear, cannabinoids are here. Nature 2002 Aug 1;418(6897):488-9; Reuters of 31 July 2002; Seattle Times of 1 August 2002; Abstract of Giovanni Marsicano et al. at the 2002 ICRS Meeting)
source: http://www.cannabis-med.org/english/bullet...el.php?id=123#1
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PTSD: Cannabis Vs. Virtual Reality Therapy (VRT) Pizzen Conflict 2008
Dr. Phil Leveque Salem-News.com
Phillip Leveque has spent his life as a Combat Infantryman, Physician Pharmacologist and Toxicologist.
(MOLALLA, Ore.) - As a Combat Infantryman with PTSD and an observer of PTSD breakdown on the "Front Lines" and as a physician who took care of about 400 Vietnam PTSD victims who requested cannabis medication, I take a dim view that subjecting battle PTSD victims to intense battle sounds – bombs and heavy machine gun fire – would "snap them out" of their PTSD. Most such battle Veterans will hit the dirt if they hear a truck backfire.
To even think or suggest that Virtual Reality battle sounds would "help" battle caused PTSD stretches my understanding and my memories of artillery barrages.
I read of recent VRT with clinical but quizzical interest. I was in Europe for 18 months with 5 months in the battle zones. I endured heavy artillery barrages, mortar barrages, 40mm anti-aircraft cannon fire and more than my share of rifle and machine gun fire as a scout, point man and forward observer.
On my best day, a buddy and I captured 26 German officers – we were on the POINT. My worst day we lost 150 men crossing the Rhine River. I've been there, seen that and done that and believe me it requires frontline battle experience to understand what it is and what it does to self and close buddies. The six younger guys (18 & 19) in my section never could talk of their experiences the rest of their lives.
My wife was a holocaust survivor who also was under bombing in England during WWII. We shared a lot of misery in common. For me to let her understand what it was like to be a frontline Dogface we went to see the movie Battleground which was the first movie about the Battle of the Bulge. It was tough on me as it was so realistic and re-witnessing experiences like my own was really stressful.
I couldn't even read WWII books for 25 years after the war. My first book was about the North African War. It was much different from my own experience in the snow, ice and mud.
I had recurring nightmares of being caught in artillery barrages for years and still do occasionally 65 years later. My therapy was hard physical work and harder mental work getting two Doctors degrees (medicine and internship are a lot similar with battle).
When my sons got to be about 15 they asked their mother "does dad ever talk of his war experiences?". She got me in a corner, "I know you can't talk about it but you've got to write it down". Because I had spent most of my time in "no-mans-land" I was forbidden to keep a diary.
Remembering battle experiences was a terror and anyone who says it's cathartic is full of crap. The book took me ten years to write. I still get the shakes when I read it.
I was in a War History writing class, mostly Vietnam Vets, for three years. I couldn't even read many of my stories to the class.
I got reacquainted with the Army and Marine Vets in the writing class and again as a physician for at least 400 battle Vets with PTSD.
My classmates told me most of their friends could not or would not talk of their experiences and most of my classmates couldn't talk with their wives or children.
Only about one of ten World War Two Vets were in actual battle. The Infantry (my branch) suffered 70 percent of the killed (about 300 thousand) and 70 percent of the wounded (about 600 thousand). Damned few Infantrymen could even go deer hunting when they got home.
Virtual Reality Therapy subjects PTSD patients to genuine battle sounds. I rate myself with PTSD at about 6 out of 10. I know damned well I can barely tolerate real battle noise and I can't imagine any PTSD Vet with PTSD about a scale of 4 tolerating VRT or benefiting from it.
My Vietnam Vets told me that cannabis was the best medicine they had used. For a VRT Psychologist to call them "basement hiding pot smokers" is disdainful and disgusting. They need all the help and understanding we can give them.
Got a question or comment for Dr. Leveque?
Email him: Newsroom@Salem-News.com
source: http://www.salem-news.com/articles/novembe...is_11-10-08.php
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PTSD Virtual Reality Therapy:
Fraudulent High-Priced Boondoggle: Part One
Dr. Phil Leveque Salem-News.com
Phillip Leveque has spent his life as a Combat Infantryman, Physician Pharmacologist and Toxicologist.
(MOLALLA, Ore.) - I was abjectly stunned and stupefied when I first read of Virtual Reality Therapy for PTSD Veteran victims. What it first suggested to me was that the VA Psychologists (and Social Workers) didn’t have the slightest comprehension of who and what they were presumed to be treating.
In the first place, the terms surrounding the definition of PTSD are ambiguities and arcane with battle fatigue, shellshock, homesickness, “miss their mothers”, war neurosis, psychoneurosis, sexual repression, battle anxiety, eight balls and malingerer terms. There are probably a few other terms but most require explanation.
Battle fatigue is inexact.
By definition, Infantry soldiers are always exhausted. They work our butts off with little sleep to make us TOUGH. "Terror fatigue" or "horror fatigue" is more appropriate. If your buddy at your side is blown apart you may feel horror and terror that the next shot is for you.
"Shellshock" is concussion from mortar or artillery. Traumatic Brain Injury (TBI) is probably the current term. Psychoneurosis was invented in World War Two and is a general inclusive term. Dr. Freud said all neurosis were from sexual repression. (He never was in a barrage).
"Battle anxiety" – hell yes – who wants to get wounded or killed? Eight balls and malingerers? Some people just didn’t want to be in the service, especially most of the Army Infantry – 8 million of us draftees.
The Draft Boards rejected about 15 percent. Basic training rejected about 7 percent. Good, I wouldn’t want those guys near me in battle.
Ok, lets get to PTSD.
These Shrinkologists seem to think this is a specific entity. IT IS NOT. PTSD is on a Bell Curve like IQ’s – Intelligence Quotients – with a standard deviation of about 3. Some guys pee their pants in basic training. These are the most sensitive or grade ONE.
At the far end, TEN, are the “War Lovers”. General George Patton, my boss, was one. He was crazy but presumably a good tactician. We called him “Old Blood & Guts” – our blood – his guts. Most of us hated him. He was definitely a grade TEN.
Most PTSD victims are between grade four and six. Anyone three or less will probably have little need of PTSD Therapy. Those grade four to six might be able to tolerate Virtual Reality bomb bursts and machinegun fire but they probably wouldn’t like it. For grades seven and eight I doubt if many could tolerate it.
When I saw Ken Burns' World War Two, it was all I could do to avoid diving under the furniture. I’ve been there, seen that and done that. For the unfortunate PTSD victims of grades eight, nine or ten, I’ll be astonished if they can tolerate realistic battle sounds at all.
I have written several articles about PTSD Vets and therapy, Salem-News.com. I have had dozens of email responses. Almost all agree with me and their stories are blood curdling. I have not had even one comment which indicates the VA treatment, medical or virtual reality, has helped them.
As far as I am concerned with my 400 or so PTSD Veterans who have rejected VA therapy, whatever the VA Shrinkologists are doing is a gigantic financial windfall for a whole bunch of guys who don’t know what they are doing.
By the way, punch up "PTSD Virtual Reality Therapy" on Google. You will find 43+ pages telling you how wonderful this is (FOR THE PSYCHOLOGISTS).
My own Alma Mater, The Oregon Medical School, has just started a Virtual Reality program. Very few veterans have volunteered.
HOORAH FOR MY COMBAT INFANTRYMEN BUDDIES
Got a question or comment for Dr. Leveque?
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source: http://www.salem-news.com/articles/novembe...eque_110208.php
PTSD: Virtual Reality Therapy Part Two: Condemnation
Dr. Phil Leveque Salem-News.com
Phillip Leveque has spent his life as a Combat Infantryman, Physician Pharmacologist and Toxicologist.
Nov-06-2008
(MOLALLA, Ore.) - I previously posted in Part One that as a PTSD victim, an observer in battle, and a physician taking care of over 400 PTSD Vet victims, that I felt Virtual Reality Therapy (VRT) would not work for the most seriously affected PTSD Vet victims, although it might for minimally or moderately affected victims.
As a physician taking care of these patients after they have given up and absolutely rejected VA treatment, I have accepted what these VA "rejects" have said. These Vets have told me of the excessive variety and amount of medications tried on them as human "guinea pigs" which usually made them worse from the adverse side effects. Even newspapers and TV news have indicated about one thousand Vet suicides per month from VA medical malpractice.
The concept that Virtual Reality Therapy for PTSD probably has some value for minimally affected victims but for severe "rubber room" victims it certainly has no place. These are the most needful patients. It appears that the success with minimally-affected Vets has given the psychology therapists the psychological chutzpah to assume that VRT would work for the most seriously affected PTSD victims.
Whether these psychologists have been able to back and forth "talk" with extremely serious PTSD victims in the 7-8-9-10 category, I doubt it. They are so bad they can't even endure seeing the word PTSD.
I was astonished to see on my computer 43 pages of stories indicating the great promise of VRT (did they have good Public Relations personnel?). Ok, I'll accept that for the minimally affected Vets.
I also looked up Vets comments on VA pharmaceutical therapy which rarely had an even slightly warm comment. Some of the comments about the psychoneurotic wards in Walter Reed Hospital made me cringe in disbelief. The rest appear not much better.
I know from my own experience as a Combat Infantryman in World War II that alcoholic or nicotine use for temporary escapes from battle were what helped keep us going. I have known about cannabis/marijuana as similar medicine for about 60 years.
When my 400 or so Vietnam Vets told me that cannabis gave better relief than Army medications or beer or booze, I paid attention. Some will say to use Marinol which is pure THC and legal medicine. However, it's not the same as the natural substance and produces a large amount of "panic attacks" and paranoia in the 10mg dose. It is used orally and once it is absorbed, panic attacks can continue for several hours. Unlike this, inhaled vapors (NOT SMOKE) can be easily adjusted to effective dosage.
Now, Nov 5th, 2008, Michigan has become the 13th state approving/allowing medical cannabis/marijuana. We are approaching one million legal medical cannabis users. With the U.S. Govt saying some 70 million use it illegally (for medical purposes).
It is time for the U.S. Govt. employees to get over their REEFER MADNESS and regard cannabis/marijuana as the very useful/successful medicine that it is.
In the meantime, millions of Vets and their families are suffering. PTSD is the worst sequel of battle and the VA is "supposed" to be taking care of us. WHAT A DISGRACE.
Got a question or comment for Dr. Leveque?
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source: http://www.salem-news.com/articles/novembe...que_11-6-08.php
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Depression - Cannabis - Euphoria
Dr. Phil Leveque Salem-News.com
Phillip Leveque has spent his life as a Combat Infantryman, Physician Pharmacologist and Toxicologist.
Oct-27-2008
Image courtesy: c-ville.com
(MOLALLA, Ore.) - The Merck Manual indicates 20 percent of women and 12 percent of men will suffer clinical depression. This is a rather depressing world we’re living in.
Antidepressant drugs are among the most prescribed medications but their adverse side effects can often be paradoxically lethal with suicide being prominent.
Todays TV news presents a new electromagnetic machine for depression which stimulates the brain which probably causes cannabinoid secretions which makes patient subjects feel better. It had better, a treatment series costs 6 thousand dollars.
Well, I have a surprise for some people. The U.S. Govt says cannabis as an alleged drug causes euphoria which (surprise surprise) causes euphoria which is addicting. Imagine, a very safe replacement for amphetamine, once the most prescribed and addicting mood stimulants being replaced with cannabis.
The U.S. Govt estimates about 70 million cannabis users. I have medically interviewed at least 4000 of them. Almost all were long time users. None complained of adverse euphoria.
If such a high percentage of the population have clinical depression certainly many of my 4000 patients had depression which unfortunately is not an acceptable condition for an Oregon medical marijuana permit. The Oregon “egg heads” in charge of the program will not accept ANY psychological problem – it must be physical!
This is really strange. One of my largest patient groups are PTSD Veterans (about 400 of them). Most found out in Vietnam that cannabis gives best relief for battle stress. Whether battle stress produces/causes depression may be arguable. For a Combat Infantryman his only real relief is a “million dollar wound” which will get him away from certain death. If that doesn’t cause depression nothing will. Anxiety and blood curdling fear are certainly part of this PTSD syndrome. The worst factor is that once a person has PTSD, there is usually no escape…most people know that severe battle Veterans cannot talk about their experiences it hurts too much.
When these PTSD Veterans get/got home with nightmares etc., the VA doctors and non-doctors prescribed every kind of drug available. The Vets usually found out most of their drugs made them worse. They rediscovered cannabis but the VA non-doctors said you can’t use illegal drugs (even if they work best) and have VA treatment. How absurd. Believe it or not the VA system is supposed to HELP Vets.
In the meantime, with 70 million cannabis users many vets are using. Alternately many are alcoholics or tobacco addicts. Both of these cause hundreds of thousands of deaths. Cannabis has never killed anybody.
YES CANNABIS WILL ALLEVIATE DEPRESSION.
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source: http://www.salem-news.com/articles/october...eque_102308.php
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Oregon Doctor Answers Reader's Questions on Medical Marijuana and PTSD (VIDEO)
Bonnie King and Dr. Phil Leveque Salem-News.com
This is a special question and answer segment featuring Salem-News.com's Bonnie King and Dr. Phillip Leveque.
Dr. Phil Leveque and Bonnie King from Salem-News.com
(SALEM, Ore.) - Dr. Phillip Leveque has treated over 4,000 patients throughout his career as a Physician, Pharmacologist and Toxicologist. Prior to that, he served in General Patton's Army in WWII as an infantry soldier fighting The Nazi's in Europe.
This intimate connection with the soldier's combat experience in war, led to Phil Leveque treating hundreds of veterans as an Osteopathic Doctor during his practice, many of whom suffer from Post Traumatic Stress Disorder. Consequently, he became one of the world's most experienced physicians in dealing with this complex disorder.
He has known many veterans who use cannabis as a therapy for PTSD and he writes frequently about their high rate of success, and ability to stay off hard drugs and alcohol, both of which are killers. Marijuana has never led to a single death.
As the years passed, Dr. Leveque has become one of the most outspoken advocates for medical marijuana and he was instrumental in helping Oregon achieve its status as a legal medical cannabis state.
Medical Marijuana Victory
This week, the U.S. Supreme Court stated once and for all, that police and sheriff agencies in states where medical marijuana is legal, have no right attempting to enforce an out of date federal law that prohibits marijuana altogether.
Dr. Leveque has advocated for this for years, and it is a victory week for people who use cannabis as a safe and sane medicine to treat a variety of illnesses and diseases.
In this Salem-News.com video segment, Bonnie King shares a number of reader-generated questions with Dr. Leveque. One person asked if medical marijuana is helpful for people who suffer from epilepsy. Leveque says it is, and he also explains why medical marijuana is helpful for epileptics.
Another Salem-News.com viewer asked if cannabis can help skin conditions like scleroderma.
A former Marine who served in Lebanon during the Beirut crisis asks how medical marijuana might help him deal with PTSD and ongoing headaches.
Watch the video segment by taking link below and don't hesitate to send your own questions to Dr. Phil Leveque. We will either send you a written reply, or answer the question during one of our upcoming video segments. You can also leave your question as a comment at the bottom of the story, and the doctor will post a reply in following comment.
Got a question or comment for Dr. Leveque?
Email him: Newsroom@Salem-News.com
source: http://www.salem-news.com/articles/decembe...vid_12-3-08.php
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By Phil Newton on November 24, 2008 - 4:09pm in From Mouse to Man
"....because I can't forget no matter how hard I try.........."
Corporal Cloy Richards, PTSD sufferer.
Cannabis has often been proposed to treat posttraumatic stress disorder (PTSD) and rates of marijuana use are significantly higher in PTSD sufferers. However like all medical marijuana issues it's controversial and complicated. I will try and explain some of the science behind the issue.
The basic rationale is this; a defining feature of PTSD is that sufferers cannot "forget" a traumatic event such as combat or rape. It is well established that cannabis use impairs certain types of memory and may help sufferers "forget". Additionally cannabis often reduces anxiety and promotes sleep, both of which are beneficial for PTSD where elevated general anxiety and sleep disturbances are very common.
Cannabis acts upon receptors in the brain called, appropriately enough, cannabinoid receptors. The first and best described of these is called CB1, or cannabinoid receptor-1. CB1 is found throughout the brain. These receptors don't exist to get people high! What this means is that there are substances produced naturally by the brain, called endocannabinoids, that act at cannabinoid receptors.
The best described endocannabinoids are called anandamide and 2-arachidonyl glycerol (2-AG). These endocannabinoids are flighty molecules, they are rapidly synthesized only when required and don't stick around for long, being swiftly broken down by an enzyme by the name of "fatty acid aminohydrolase", less tongue-twistingly known as FAAH. Endocannabinoids are involved in many biological processes including appetite regulation, pain, anxiety, mood, nausea and blood pressure. All of which are also affected by marijuana.
One of the most interesting things these endocannabinoids appear to do, according to research in rats and mice, is stimulate the ability to forget about bad things. The basic research paradigm used is called "fear conditioning" and works on the same principle as Pavlov's dogs; rodents are played a sound, usually a beep, just before a very slight electric shock. This shock, much like a threat in the wild, causes the animals to freeze in their tracks. Although the shock is mild and brief, the animals obviously don't like it and learn very quickly that the beep means a shock is coming. After a short time, just the beep (without the shock) causes the animals to freeze and, crucially, causes the production of endocannabinoids in the brain. The relevance of this model to the human condition is obvious. PTSD symptoms are often triggered by exposure to something in the environment that reminds the sufferer of trauma.
After a while, rodents, like most people, will learn that the beep no longer means that a shock is coming and will no longer freeze when the beep is played. If animals are treated with a drug that blocks CB1 receptors then they show a profound inability to forget. The same result is found in mice genetically engineered to not have CB1, playing the beep causes them to freeze long after normal animals have learned to forget. Again, the relevance to PTSD is obvious; only some people who experience an extreme trauma will develop PTSD. Could genetic differences in their endocannabinoid system help explain why this is?
Perhaps most interestingly, animals given an extra booster of endocannabinoids find it easier to forget. Drugs which inhibit the breakdown of endocannabinoids by blocking FAAH have the same effect, suggesting that medications which stimulate the endocannabinoid system may be beneficial in the treatment of PTSD.
Exposure therapy is a commonly used treatment for PTSD; patients are repeatedly re-exposed to those triggers which precipitate their symptoms, much like the rodents and the beep. This tactic is completely at odds with the intuitive response of PTSD sufferers, who will actively avoid these triggers. As I mentioned above, basic research findings indicate that exposure to these triggers causes the brain to produce it's own cannabinoids, which then help the brain to forget. Perhaps the brains of PTSD sufferers have impaired cannabinoid synthesis, or maybe they break it down more quickly. Thus maybe cannabis treatment would be the most effective when given during exposure therapy?
That's the basic science. Sounds simple right? In fact it should be a no-brainer that cannabis use will be beneficial for PTSD sufferers?
Well, as so often occurs in science, it's not that simple. A major problem is that the cannabinoid system is found in almost all part of the brain and as such is involved in many different biological processes. A sobering example of this is the weight loss drug Acomplia TM from Sanofi-Aventis. The rationale behind this drug is reasonable enough; smoking pot gives people "the munchies", suggesting endocannabinoids promote eating. Blocking the CB1 receptor (with AcompliaTM) should therefore reduce food intake. Sure enough, it does. But it also makes people depressed and has other psychiatric side effects. These side effects are so severe that AcompliaTM has been withdrawn.
Cannabis also has a lot of potential side effects, many of them undesirable; apathy, psychosis, respiratory problems associated with smoking, prenatal toxicity, addiction (although this is controversial). One of the most troubling side effects of cannabis is that high doses can, in some people, trigger bouts of extreme anxiety. Not something any PTSD sufferer would want.
Another problem is that THC, the major active ingredient of cannabis, is not the same as the endocannabinoids found normally in the brain (otherwise we'd all be high all the time). It's not entirely clear that THC has the same "memory-erasing" effects as the brains natural endocannabinoids. In fact some researchers even think that treatment with pure THC may have the opposite effects, delaying an animal's ability to forget.
Nevertheless, a holy grail of "medical marijuana" programs for cancer and pain is the design of drugs which have the beneficial effects of marijuana without these undesirable side effects. Drug design programs based upon this reasoning may themselves eventually have a very beneficial side effect; drugs which can help PTSD patients forget.
source: http://blogs.psychologytoday.com/blog/from...-potted-history
Cannabis Memory PTSD (Post Traumatic Stress Disorder)
http://www.youtube.com/watch?v=AmHiYtt2kEg
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