Subjects were 46 participants who comprised a subset of a population based sample (n=109) evaluated at the Mount Sinai School of Medicine (MSSM) four to six years following the 9/11 attacks (Yehuda et al., 2009). The subjects studied at the MSSM were those who responded positively to a mailing asking participants to have an in-person diagnostic evaluation, complete self-report questionnaires and permit an 8 am blood draw. The study was approved by the Institutional Review Board (IRB) at the Mount Sinai School of Medicine; all subjects provided written informed consent and were subsequently screened to establish eligibility. Subjects were excluded if they met criteria for primary psychotic disorder, bipolar illness, alcohol or substance dependence, or major endocrine, neurological, or other medical illness, including diabetes. Although subjects with PTSD showed greater number of lifetime psychiatric diagnoses than those without PTSD (Table 1), as has been previously described (Breslau et al. 2000), none were receiving psychiatric treatment or taking psychotropic medications at the time of participation. The 46 subjects included in this report were those with remaining frozen samples available for endocannabinoid assay who had previously provided consent for analyses of compounds unrelated to the goals of the initial investigation, i.e., associations with genotype. Selection was based purely on availability of biological sample in conjunction with appropriate consent, and not on any other inclusion or exclusion criteria, clinical or otherwise. Subjects with endocannabinoid determinations (n=46) were similar in age, gender distribution, and lifetime trauma exposure histories to the remaining members of the original cohort (n=63). Of 46 subjects, 22 were deemed to have suffered direct, high magnitude exposure to the events of 9/11 (direct exposure to the events of 9/11), whereas 24 reported indirect exposure. ‘Direct exposure’ was assigned to participants who were in the vicinity of the World Trade Towers at the time of the attacks with immediate threat to their safety or survival, or had suffered the loss of family members or intimate friends on 9/11. ‘Indirect exposure’ was attributed to those who witnessed collapse of the Towers from a safe distance, were informed of the attacks while out of town, or observed the events on TV, without enduring direct threat to self or family members.
A ten-year-old girl presented in January 2015 for a reevaluation of behaviors related to her diagnosis of posttraumatic stress disorder (PTSD) secondary to sexual abuse. Her chief issues included anxiety, insomnia, outbursts at school, suicidal ideation, and self-destructive behaviors. Her grandmother, who has permanent custody of the patient and her younger brother, accompanied her.
In March 2015, CBD oil was recommended as a potential additional treatment to help her insomnia and anxiety, and her grandmother provided full informed consent. Our patient was administered the Sleep Disturbance Scale for Children18 and the Screen for Anxiety Related Disorders (SCARED)19 before taking the CBD oil and each month afterward for the next 5 months. Test scores on the Sleep Disturbance Scale for Children and Screen for Anxiety Related Disorders demonstrated an improvement.
A trial of CBD supplements (25 mg) was then initiated at bedtime, and 6 mg to 12 mg of CBD sublingual spray was administered during the day as needed for anxiety. A gradual increase in sleep quality and quantity and a decrease in her anxiety were noted. After 5 months, the patient was sleeping in her own room most nights and handling the new school year with no difficulties. No side effects were observed from taking the CBD oil. She now sleeps in her own room most of the time, which has never happened before.”
Further study will need to be conducted to determine the permanency of our patient’s positive behaviors and how long she will need to continue taking the CBD oil. We do not have a reasonable foundation to recommend dosing from the scientific literature. However, in our experience, this supplement given 12 mg to 25 mg once daily appears to provide relief of key symptoms with minimal side effects. Our patient did not voice any complaints or discomfort from the use of CBD. We routinely asked about headache, fatigue, and change in appetite or agitation in addition to conducting a routine psychiatric evaluation. Although CBD is considered generally safe,17 the long-term effects are yet to be studied.