The Harmony Treatment Algorithm for Psychiatric Wellness
Step 1: Consider Referral to a Medical Cannabis Program:
Dysfunction of endocannabinoid signaling has been implicated in most psychiatric disorders.
Cannabis has unique therapeutic effects for treating PTSD which can’t be replicated by any other class of medications.
Cannabis is the only medication that has proven effective in treating every symptom cluster of PTSD.
Different strains of Cannabis can have a very different effect, everybody is different.
Keep track of the strains you try and where you get them from.
Most of my PTSD patients find that “Indicas” are better for anxiety and for sleep.
“Kush” strains are often well liked among PTSD patients.
“Sativas” tend to be more energizing and some patients prefer these during the day.
Some patients like high CBD strains or “CBD only” products for pain, sleep, depression and/or seizures but these oftentimes don’t seem to be very effective for hyper-arousal type anxiety or for suicidality.
Most of my patients prefer a higher THC content to help reduce their hyper-arousal symptoms and to allow them to remain in the present rather than dwelling on the past or stressing about the future.
Use caution with “Sativas”- they seem much more likely to cause anxiety/paranoia.
Many chronic pain patients report that mixing a high CBD strain with a high THC strain works better than any individual strain.
This is likely due to differences not only in cannabinoid profiles, but also because of the interplay of various terpenoids and flavonoids found in these strains.
Start slow- the inhaled route of administration offers the most rapid onset of effects- try 1-2 puffs every 10-15 minutes if no previous use until symptoms reduced (consider a vaporizer to reduce pulmonary risks).
Use caution with edibles, it can be 2-6 hours to reach peak plasma levels and inconsistent absorption in GI tract.
Tinctures and candies that can be absorbed through the oral mucosa allow more rapid onset of effects than by swallowing.
The oral route coverts THC into a more sedating form which can provide better sleep and reduction of nightmares.
Use caution with any product extracted with a solvent due to the potential for contamination if not done properly.
Use caution with “legal CBD only” preparations, there may be a risk of heavy metal contamination and solvent contamination from CBD sourced from industrial hemp in Eastern Europe and China.
Use only organically grown Cannabis to reduce risk of heavy metal contamination and insecticide.
The rectal route of administration offers consistent absorption and offers an alternative if unable to tolerate other routes.
Use caution when driving and don’t drive until you know how Cannabis effects you.
Step 2: Eat a Healthy Diet
Get plenty of vegetables. Eat only organic soy, wheat and corn. Consider eliminating gluten from your diet.
Step 3: Move
Get some exercise- regular exercise helps support endocannabinoid function.
Step 4: Begin Fish Oil
2000-4000 mg daily- high EPA and DHA (if vegan you can use an algae based omega 3 supplement).
Omega 3’s have been shown to help with depression, mood stabilization and PTSD.
They are the building blocks for the endocannabinoids and help stabilize function of the ECS.
Step 5: Begin Vitamin E 400 IU daily
Vitamin E is depleted by Omega 3’s and adding Vitamin E gives a boost to the efficacy of Omega 3’s
Vitamin E helps modulate endocannabinoid function.
Step 6: Begin Probiotic
Do you have stomach or intestinal problems or chronic inflammatory conditions? Have you taken antibiotics? Have you had your appendix removed? Yes- start a good probiotic (at least 50 billion cultures).
Probiotics help reduce inflammatory processes and modulate CB1 receptor expression
Step 7: Learn Mindful Awareness
Check the internet or the public library- type in “mindfulness”.
Learn to breathe.
Mindful awareness can help to reduce stress responses.
I recommend a book called “A New Earth” by Eckhart Tolle.
Reducing stress in general helps give the endocannabinoid system a rest.
Mindfulness balances activation in areas of the brain involved in PTSD responses and which have high concentrations of cannabinoid receptors.
Step 8: Consider Vitamin D3
5000 IU daily.
Do you have inadequate time in Sun or have dark colored skin? Yes- Vitamin D deficiency has been linked to a number of autoimmune disorders and Vitamin D supplementation can help to support CB2 receptor function.
Step 9: Consider Magnesium Citrate
Do you drink bottled water and/or suffer from ongoing anxiety/insomnia RT stress, and/or have seizures or autism? Yes- add a good magnesium supplement 250-500 mg daily (Recommend “Natural Calm”)- watch for loose stools/diarrhea.
Low magnesium levels can contribute to stress, seizures, diabetes, obesity, heart problems, depression, Parkinson’s, inflammatory processes, cerebral palsy, loss of bone mass, vascular calcification, asthma and decreased kidney function.
Step 10: Consider Turmeric
500 mg twice a day with black pepper.
Do you have inflammatory pain? Turmeric has been used for centuries to treat pain and inflammation.
Black pepper augments the effects of turmeric.
Both turmeric and black pepper act at cannabinoid receptors to reduce pain and inflammation.
Step 11: Consider Tart Cherry Juice
Tart cherry juice contains anthocyanins that interact at cannabinoid receptors to reduce pain and inflammation.
Tart cherry juice may be especially helpful for gout and arthritic pain.
Step 12: Consider 5HTP
Do you have ongoing depression / irritability / insomnia / or anxiety? Add 5HTP 100 mg QHS (with B6).
5HTP is a precursor to both serotonin and melatonin.
Crosses blood brain barrier and then decarboxylated by Vitamin B-6.
Unlike pharmaceutical antidepressants, 5HTP increases brain levels of serotonin.
If no benefit after 2 months increase dose to 200 mg qhs, can increase dose to 300 mg qhs after 2 additional months if inadequate response
* If symptoms worsen stop immediately.
Step 13: Consider Folic Acid
Do you have fair skin and spend a lot of time in the Sun and eat a diet lacking in green vegetables? Yes- take a folic acid 1 mg.
Folic acid is depleted by UV radiation in sunlight.
Low levels of folic acid can contribute chronic inflammatory processes and to a number of neuropsychiatric disorders.
Step 14: Know When Seek Professional Help if Needed
Not everybody will experience an adequate response to these interventions.
Recognize when you need to seek professional help.
I highly recommend EMDR or CBT type therapies.
You might want to consider pharmaceuticals at this point- they still have their place in psychiatric medicine and have proven beneficial to many patients.
Pharmaceuticals should be considered as a second line of treatment if safer, more effective treatments fail to provide adequate relief.
If you are having suicidal or homicidal thoughts that do not rapidly resolve with Cannabis use and if you feels like you might act on those thoughts call 911 of go to the nearest emergency room.