Dr. Matthew Hill

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614 appearances 1 recordings 1 series first heard Jul 2024 last heard Jul 2024

Dr. Matthew Hill’s voice in public audio — every appearance, attributed to the second.

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Huberman Lab · How Cannabis Impacts Health & the Potential Risks | Dr. Matthew Hill · 8 Jul 2024 podcast

It gets a little bit more complicated because obviously PTSD has an anxiety component to it, but there's a lot more to it as well. And again, there's very little research in this space. There was one really, really small study study done by the Canadian military. First, they did one version of it that was an open label.

Open label trials for people who don't know, it's just basically everyone knows what they're getting. It's not blinded in any way. But because of the self-reported data from the veteran population about cannabis helping, especially with sleep. And the big thing that they reported was that it suppressed their nightmares. And so...

Post-traumatic stress disorder is a very complex disease for many reasons, and one component of it is the re-experiencing events that happen during sleep where there's a lot of nightmares and individuals will kind of re-experience the trauma that led to the development of the PTSD.

And there does seem to be some suggestion that because they're remembering it and maybe changing the details because they're in a dreamscape space that they reconsolidate it a little bit more. And there's often a high degree of sympathetic activation and arousal that goes on with these nightmares.

And some of the belief is that this is part of the sensitization process that can happen in PTSD where the disease can worsen over time because the re-experiencing and the reconsolidation and the sensitization of the disease that happens over time in this kind of sleep state can make it worse.

The majority of veterans who have used cannabis and report benefit if you actually talk to them about it, as I've done in a few different situations and also just look at the anecdotal data, almost all of it talks explicitly about sleep. And they say, oh, we use cannabis or THC before bed. We find we don't have the nightmares and just the simple trickle-down effect of that.

is hugely beneficial for them. And so the Canadian military did an open label trial on this, again, not blinded. It was small numbers, but they basically found as soon as they put people on nabilone, this synthetic version of THC, it very, in like a large proportion, I think like 85% of them almost stopped having these nightmares.

And this was like a treatment resistant population that was pretty severe. So this was a big benefit. So they then took open label and did what you should and moved forward to do a double-blind placebo-controlled. Now, it was a very small sampled studies. And that is obviously always a problem with human work is if this was like 15 or 17 people.

So not powered enough to really make any kind of firm conclusions, but interesting in the sense that at least it was done in a proper crossover design where they got placebo at one point, they got Nablon at one point, it was switched, they didn't know which one they were on. Um, because they're taking it right before bed, maybe that will remove some of the subjective bias.

Again, you can't totally remove it, but like if someone's taking it within, you know, an hour or so of going to sleep, they may not feel behind the same way. But, uh, even under the double-blinded conditions, they found a very effective suppression of the, of the nightmares and the re-experiencing.

And then they also, at the same time, found this increase in kind of quality of life measures, which tracked with the fact that they were probably sleeping better. Um, I don't think they actually reported any change or even looked at maybe the overall PTSD score. They only reported or really focused on the nightmare component of it because that was the primary outcome of the study.

So I thought that was interesting because that's – if you look at the anecdotal data in PTSD, that's where a lot of it is focused on is using it as kind of – I wouldn't – maybe call it a sleep aid because it's really more of a modulator of the dream state.

I mean, depression and PTSD are both two disorders that are characterized by changes in REM. Like they have earlier onset to REM, so they go into REM faster. They tend to have some altered architecture of the REM component of their sleep. So in those states, maybe suppressing REM isn't actually a bad thing.

At least certainly for PTSD, I would imagine in terms of the context of the nightmares, that's providing some benefit. Whether or not it globally is changing the disease severity or improving the disease, I don't think we really have any evidence to say. But again, I can understand the...

the desire for people to kind of self-medicate, let's say, by using this as an approach to try and reduce that component of their sleep so that they sleep better, they feel better. Maybe down the road, it would help the prognosis of the disease long-term if it's not sensitized in the same way. But I don't think we have any strong data that we can leverage in that capacity to be able to say it.

But to me, it's one of the more interesting areas. I think anxiety disorders in general, there's definitely some potential. So as I had mentioned earlier,

the the pha inhibitor that elevates anandamide levels so johnson and johnson did do a trial in social anxiety disorder it's published i think from a few years ago at 21 or something i can pull up the reference for that where they did find some benefit it wasn't huge and some of this had to do with the design of the study because they kind of underdosed the patients a bit and so

Not everyone actually showed the elevation in anandamide when they went back and looked, but when they actually isolated the group of people that had higher anandamide, in that proportion of the patients, they did see some symptom improvement. So it did support it. And this is, I mean, very similar.

Like for us, this is a big thing because all of the work that we focused on is looking at how stress and stress hormones regulate anandamide. largely anandamide signaling. And one of the main things that we've demonstrated that's been replicated relatively well over the years is that stress exposure can actually cause a rapid loss of anandamide signaling.

And it's that loss of anandamide signaling that seems to facilitate some synaptic strengthening in the amygdala and promote activity in areas that are involved in these anxiety circuits. And so... The thought has always been, well, if anandamide, you know, it's that job as its kind of tonic housekeeper at keeping things in that homeostatic range.

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