PTSD
Study register · detail RCT · PTSD · 2020

Cannabinoid modulation of corticolimbic activation to threat in trauma-exposed adults: a preliminary study.

Clear benefit GRADE Moderate 55 citations
Samplen = 71 Pat.
Durationunclear
ControlPlacebo
EndpointfMRI amygdala reactivity
Blindingdoppelblind
DesignRCT
Cannabinoidthc
Routeoral
Key finding

THC reduced threat-related amygdala reactivity, increased mPFC activation and enhanced mPFC-amygdala coupling in adults with PTSD.

Summary

n=71 (19 PTSD patients, 27 trauma-exposed controls without PTSD, 25 healthy controls); randomized, double-blind, placebo-controlled. Acute low dose of THC in PTSD patients: reduced threat-associated amygdala reactivity, increased mPFC activation during threat, enhanced mPFC-amygdala coupling (fMRI). THC modulates threat-associated processing in PTSD.

P
PopulationTrauma-exposed adults with and without PTSD as well as healthy controls: HC (n=25), TEC without PTSD (n=27), PTSD group (n=19); total n=71
I
InterventionAcute low-dose oral THC administration (single dose), between-groups design
C
ControlPlacebo (oral)
O
OutcomeIn PTSD patients: THC reduced threat-related amygdala reactivity, increased mPFC activation and enhanced mPFC-amygdala coupling during threat processing
Confidence in the evidence
Moderate

The third of four GRADE levels, the effect estimate is probably reliable.

Downgraded for
Imprecision
Quality profile
Sample size
Blinding Double-blind
Effect size Clear benefit
Citations / year
Authors
Rabinak CA, Blanchette A, Zabik NL, Peters C, Marusak HA, Iadipaolo A, Elrahal F
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Abstract
Rationale: Excessive fear and anxiety, coupled with corticolimbic dysfunction, are core features of stress- and trauma-related psychopathology, such as posttraumatic stress disorder (PTSD). Interestingly, low doses of ∆(9)-tetrahydrocannabinol (THC) can produce anxiolytic effects, reduce threat-related amygdala activation, and enhance functional coupling between the amygdala and medial prefrontal cortex and adjacent rostral cingulate cortex (mPFC/rACC) during threat processing in healthy adults. Together, these findings suggest the cannabinoid system as a potential pharmacological target in the treatment of excess fear and anxiety. However, the effects of THC on corticolimbic functioning in response to threat have not be investigated in adults with trauma-related psychopathology. Objective: To address this gap, the present study tests the effects of an acute low dose of THC on corticolimbic responses to threat in three groups of adults: (1) non-trauma-exposed healthy controls (HC; n = 25), (2) trauma-exposed adults without PTSD (TEC; n = 27), and (3) trauma-exposed adults with PTSD (n = 19). Methods: Using a randomized, double-blind, placebo-controlled, between-subjects design, 71 participants were randomly assigned to receive either THC or placebo (PBO) and subsequently completed a well-established threat processing paradigm during functional magnetic resonance imaging. Results: In adults with PTSD, THC lowered threat-related amygdala reactivity, increased mPFC activation during threat, and increased mPFC-amygdala functional coupling. Conclusions: These preliminary data suggest that THC modulates threat-related processing in trauma-exposed individuals with PTSD, which may prove advantageous as a pharmacological approach to treating stress- and trauma-related psychopathology.

The impediment to action advances action. — Marcus Aurelius