Endocannabinoid System as Therapeutic Target of PTSD: A Systematic Review

Abstract

Post-Traumatic Stress Disorder (PTSD) is a complex disorder involving dysregulation of stress-related hormones and neurotransmitter systems. Research focused on the endocannabinoid system (eCBS) for anxiety and stress regulation, cognitive and emotional responses modulation and aversive memories extinction, leading to the hypothesis that it could represent a possible alternative treatment target for PTSD. In this systematic review, we summarize evidence about the efficacy and safety of medicinal cannabidiol (CBD), Δ9-tetrahydrocannabinol (Δ9-THC), and nabilone in PTSD treatment. The PRISMA statement guidelines were followed. A systematic literature search was conducted in MEDLINE/PubMed, Scopus and Web of Science by two independent researchers, who also performed data extraction and quality assessment. Among the initial 495 papers, 234 were screened for eligibility and 10 were included. Studies suggested that different medicinal cannabinoids at distinct doses and formulations could represent promising treatment strategies for the improvement of overall PTSD symptomatology as well as specific symptom domains (e.g., sleep disorders, arousal disturbances, suicidal thoughts), also influencing quality of life, pain and social impact. Although there is a robust rationale for treatment with drugs that target the eCBS and the results are promising, further studies are needed to investigate the safety and efficacy profile of their prolonged use.

Nabilone for the Treatment of Post-Traumatic Stress Disorder: A 2021 Update

“…These comprised 2 systematic reviews. 10,11 The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 12 flow chart of the study selection is presented in Appendix 1. Additional references of potential interest are provided in Appendix 5.…”

“…Two systematic reviews 10,11 (that included a total of 1 relevant non-randomized study) were identified for inclusion in this review. No relevant health technology assessments, 11 was from 1974 to July 2020.…”

“…The systematic review by Steardo et al (2021) 10 was authored by researchers in Italy. The relevant trial included in this systematic review was conducted in Canada.…”

“…The intervention in the relevant study in the systematic review by Steardo et al (2021) 10 was nabilone taken before bedtime at a starting dose of 0.5 mg and then titrated. Doses were kept below 6 mg/day.…”

“…Patients received flexible duration of treatment with nabilone depending on clinical response. 10 The relevant non-randomized study was a single-arm trial that did not include a control group.…”