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A wide range of factors can suppress melatonin production, particularly night-time exposure to light but also aging and some diseases. Since low melatonin levels can cause sleep disturbances, many people take supplemental melatonin in pill form. It is the fourth most popular natural supplement Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. See Full Reference among American adults.
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Clinical studies of cannabis and cannabis-based products for therapeutic purposes are limited to studies carried out with dried cannabis that was smoked or vapourized and with synthetic or natural cannabis-based products that have received market authorization (i.e. dronabinol, nabilone, and nabiximols). With the possible exception of trials conducted with Epidiolex (CBD-enriched oil) for epilepsyReference 576Reference 577 and one open-label pilot clinical trial of oral THC oil for symptoms associated with post-traumatic stress disorder (PTSD)Reference 571 there are no other clinical studies of fresh cannabis or cannabis oils for therapeutic purposes. As such, providing precise dosing guidelines for such products is not possible although existing sources of information can be used as a reference point (see below).
PTSD is a psychiatric disorder of significant prevalence and morbidityReference 1039. In the overall population, more than two thirds of individuals may experience a serious traumatic event at some point in their lifetimeReference 1039. PTSD refers to the development of a cluster of characteristic symptoms that follow exposure to an extreme traumatic stressor and which appears to involve aberrant memory processing and impaired adaptation to changed environmental conditionsReference 1040. Characteristic symptoms include persistent, intrusive recollections, or a re-experiencing of the original traumatic event (through dreams, nightmares, and dissociative flashbacks), numbing and avoidance, and increased arousalReference 578. Sleep disturbance also occurs in up to 90% of casesReference 1038. Patients with PTSD are also at risk for other psychological disorders, including but not limited to generalized anxiety disorder, major depressive disorder, and substance use disorder as well as physical problems including chronic pain, hypertension, and asthmaReference 1041. There appears to be a link between exposure to a traumatic event and cannabis use, especially in military veterans, and research suggests that individuals with PTSD may be particularly likely to use cannabis specifically to alleviate symptoms of PTSD and associated distressReference 1039Reference 1041Reference 1042. There is also evidence to suggest that particular symptoms and correlates of PTSD including anxiety, stress, insomnia and depression are among the most frequently cited reasons for cannabis useReference 1042. Despite much anecdotal evidence suggesting the benefits of cannabis use to treat PTSD, there is a lack of standardized large-scale controlled trials to make any firm conclusions regarding the efficacy or safety of cannabis for the treatment of PTSDReference 1043.
There is evidence to suggest that the endocannabinoids, anandamide and 2-AG play important roles in the development and function of the PTSD neurocircuit, especially in stress responsesReference 1048. Impaired CB1 receptor function has been suggested as a potentially important etiological mechanism of PTSDReference 1048. Indeed, a number of pre-clinical studies demonstrate that deletion of the CB1 receptor or its inhibition by pharmacological antagonists prevent the extinction of aversive memories (i.e. learned inhibition of fear), a naturally adaptive processReference 1049-Reference 1052. Conversely, in some cases, CB1 receptor agonism or increased endocannabinoid-mediated neurotransmission (e.g. via inhibition of FAAH) appear to enhance extinction to some degreeReference 1049Reference 1052, but further research is required to clarify and substantiate this effect. Studies in animals also show that reduction of endocannabinoid levels (mainly 2-AG but also anandamide) via Dagla gene knockout is associated with increased anxiety, stress and fear responsesReference 1053. Taken together, the evidence from pre-clinical studies suggests a role for the ECS in the extinction of aversive memories and impairment of memory retrieval. Furthermore, the available evidence raises the possibility that manipulation of the ECS (via inhibition of FAAH, upregulation of DAGL, increased anandamide or 2-AG tone, or even perhaps via administration of CBD) can facilitate disruption of contextual fear memories as well as have anti-anxiogenic effectsReference 1039Reference 1054. These may represent potential therapeutic options for the treatment of diseases associated with inappropriate retention of aversive memories or inadequate responses to aversive situations, such as PTSD or phobiasReference 1050, although much additional research is needed.
A preliminary, randomized, double-blind, placebo-controlled cross-over clinical study of 10 Canadian male military personnel with PTSD who were not responsive to conventional treatment and who continued to experience trauma-related nightmares, received 0.5 mg nabilone or placebo and titrated to the effective dose (i.e. nightmare suppression) or to a maximum daily dose of 3 mg nabiloneReference 1038. Average daily dose achieved for nabilone was 2.0 mg/day. Treatment arms lasted for seven weeks each, with a two-week washout period in between. Score on the Global Impression of Severity of PTSD was 3.3 at screening (4 = extreme). The mean reduction in nightmares measured by the Clinician-Administered PTSD Scale (CAPS) for Recurring and Distressing Dream scores were -3.6 and -1.0 in the nabilone and placebo groups respectively (p = 0.03). Mean global improvement measured by the Clinical Global Impression of Change scale was statistically significant between the nabilone and placebo groups. Half (50%) of the subjects reported a significant improvement in nightmare suppression on nabilone, while only 11% of subjects reported improvement with placebo. Mean scores for the General Well-Being Questionnaire showed a difference from baseline of 20.8 and -0.4 for the nabilone and placebo groups respectively. Incidence rates of adverse events in the nabilone and placebo groups were approximately the same (50% vs. 60%, respectively). The most common adverse effects associated with nabilone treatment were dry mouth and headache. There were no serious adverse events or subject dropout. While the study findings are promising, the sample size was very small.
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Opioid dependence, particularly intravenous heroin dependence, is associated with a number of medical conditions. For this reason, a complete physical examination, review of systems, and laboratory evaluation (when indicated) should be conducted. The patient should be screened for tuberculosis as well as for commonly encountered medical complications. These include HIV/AIDS, viral hepatitis (especially B and C), other sexually transmitted diseases, and opportunistic infections. Injection sites should be examined for infection or abscess and patients should be queried about night sweats, chills, nutritional intake, diarrhea and gastrointestinal distress, fever, and cough. History or evidence of trauma also should be elicited as part of a comprehensive assessment upon which a full treatment plan will be based. In general, patients should be ambulatory and able to participate in rehabilitative activities during detoxification. However, during the first 24 hours they may require bed rest or reduced activity.
The use of herbs and supplements for chronic insomnia that is not medically supervised should be discouraged because an underlying, treatable cause of insomnia may otherwise be masked. The pharmacist should first address sleep hygiene and other nonmedical or psychiatric causes of insomnia before recommending these supplements. The pharmacist should remind patients that dietary supplements such as valerian, chamomile, and melatonin are not supported by large, prospective, placebo-controlled studies. Patients should be advised to take the same dosage and frequency that have been studied in clinical trials and not to exceed labeled amounts. The purchase and use of natural products that do not list the exact amount contained in each dosage unit should be discouraged. The pharmacist should elicit a careful history from the patient regarding any allergies, especially to ragweed and daisies, keeping in mind that many patients with allergic rhinitis may not know which allergens trigger their attacks. Patients who are allergic to ragweed and flowers in the daisy family (asters, chrysanthemums) may have allergic reactions to products containing chamomile.
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But before we get to the solutions, it's important to recognize that anxiety is real. With a multitude of guises, it can present itself in your life as insomnia, depressions, fatigue, addiction self-medication, job or relationship paralysis, and more. In many cases, it can be fleeting; natural even, to feel anxious before, say, your wedding, or the birth of your child, or in the midst of a major life change. However, chronic anxiety is not meant to be a daily part of the human experience and can lead to stress which leads to cortisol dysregulation that can eventually impact not just your emotional well-being but your physical health as well.