Childhood Trauma and Stress: Is There a Role for Cannabidiol (CBD)?

Children who are victims of trauma and stress may suffer from anxiety, sleep problems, mood disorders, emotional responses, and post-traumatic stress disorder (PTSD). Adults who had adverse childhood experiences (ACEs) may suffer from the same symptoms. Substance use is higher in individuals with a history of childhood trauma and chronic stress, with many choosing cannabis to cope with symptoms.¹ Cannabidiol (CBD), a cannabis constituent, is currently being studied for its potential effects on symptoms associated with trauma.

Endocannabinoid System (ECS) and the Stress Response

The endocannabinoid system (ECS) comprises endogenous cannabinoid ligands and receptors, and plays an essential role in the stress response. The ECS constrains the sympathetic nervous system and hypothalamic-pituitary-adrenal (HPA) axis response to stress. Trauma causes ECS downregulation, blunting the ability to restore homeostasis from stress. This increases the likelihood of experiencing stress-related symptoms and an inability to cope with stress as time goes on.^2,3

Researchers have suggested that trauma experienced during childhood, as opposed to in adulthood, might affect how the body's ECS responds. Specifically, a trend towards increased cannabinoid ligands and decreased receptors is observed in adults and children if trauma happens in early childhood. If the trauma happens in adulthood, the opposite is observed: decreased ligands and increased receptors. These trends are seen in both preclinical and clinical studies, although more human studies are needed to confirm this effect.^2,3

PTSD involves the formation of a fear memory after a traumatic event, which cannot be extinguished. The ECS plays a role in fear extinction and reducing aversive memories. An improperly functioning ECS perpetuates PTSD and its associated symptoms.^2,4

CBD and PTSD

Among trauma-exposed individuals, cannabis is often used to cope with anxiety, distress, and inattention. Given the fact that the ECS is dysregulated in individuals with a trauma history, cannabis use may be an attempt to compensate for the dysregulation. However, regular cannabis use was shown to suppress the ECS, which may promote the development of cannabis use disorder.¹

Cannabidiol (CBD) is a non-psychoactive constituent of cannabis that is of interest to researchers for its potential mechanisms that may alleviate PTSD symptoms. A survey on CBD users showed that they self-medicated to help with anxiety, stress, sleep, and other symptoms.⁵

Preclinical studies in animal models are investigating CBD’s potential impact on PTSD-related behaviors. A small case series examined CBD use in adult PTSD patients and observed reported improvements, though larger trials are needed to confirm any effect. Patients were followed for 8 weeks, and a range of doses were given from 25–100 mg/day.⁶ A randomized, double-blinded, placebo-controlled trial on 48 healthy adult participants used a Pavlovian fear-conditioning model to assess the effects of CBD on fear extinction and memory consolidation. Findings showed enhanced consolidation of extinction learning with CBD.⁷

Since ECS dysregulation differs depending on when the trauma was experienced—childhood or adulthood—studies are needed to determine CBD's effect in both situations.⁴

Has CBD Been Tested in Children?

Most of the research on CBD in children uses Epidiolex. This CBD medication is FDA-approved for pediatric and adult patients having seizures associated with rare conditions like Lennox-Gastaut syndrome, Dravet syndrome, and tuberous sclerosis complex. While Epidiolex is FDA-approved for specific seizure disorders, anecdotal reports have mentioned other observed effects, which have not been formally evaluated or approved by the FDA. These include improved emotional functioning, cognitive and executive function, and language and communication.

Epidiolex has been rigorously evaluated in controlled trials, and safety data is available for doses up to 50 mg/kg/day. The most common adverse effects include somnolence, diarrhea, and elevated liver function enzymes in conjunction with other medication use.^8,9

In general, CBD is considered safe and non-habit forming; however, its effects on the developing brain have not been rigorously studied. There are reports that CBD can cause seizures in toddlers.¹⁰ A study on CBD use in pregnant mice showed a tendency towards anxiety behaviors and genomic changes in brain DNA methylation in adult mouse offspring.¹¹

CBD was studied for treatment-resistant anxiety in young people aged 12–25 years. Doses were titrated up to 800 mg/day over 12 weeks. Overall Anxiety Severity and Impairment Scale (OASIS) scores decreased by 42.6% and depressive symptoms improved significantly. Adverse events included fatigue, low mood, hot flashes, or cold chills.¹²

In a single case report, a ten-year-old girl with PTSD and a sexual abuse history reportedly showed improved sleep and anxiety after CBD use. The patient only experienced partial relief with pharmaceutical medications.¹³

Several studies on children with autism spectrum disorder have explored the effects of CBD and tetrahydrocannabinol (THC); however, study results are mixed. Some show promising improvement in behavior, sleep, social function, and communication. However, there is concern about the use of THC—the psychoactive chemical in cannabis—on the developing brain.¹⁴

CBD and Childhood Trauma

Childhood trauma may impact the endocannabinoid system, which plays a role in regulating stress responses. Some early research is exploring whether CBD might influence stress-related processes, particularly in adults. However, evidence regarding the use of CBD in children remains limited. Professional organizations advise caution when considering CBD for pediatric use, emphasizing the need for more rigorous studies to understand its safety and potential effects.¹⁴

References

1. Bassir Nia A, Weleff J, Fogelman N, Nourbakhsh S, Sinha R. Regular cannabis use is associated with history of childhood and lifetime trauma in a non-clinical community sample. J Psychiatr Res. 2023;159:159-164.
2. Bassir Nia A, Bender R, Harpaz-Rotem I. Endocannabinoid System Alterations in Posttraumatic Stress Disorder: A Review of Developmental and Accumulative Effects of Trauma. Chronic Stress. 2019;3.
3. Goldstein Ferber S, Trezza V, Weller A. Early life stress and development of the endocannabinoid system: A bidirectional process in programming future coping. Dev Psychobiol. 2021;63(2):143-152.
4. Lookfong NA, Raup-Konsavage WM, Silberman Y. Potential Utility of Cannabidiol in Stress-Related Disorders. Cannabis Cannabinoid Res. 2023;8(2):230-240.
5. Moltke J, Hindocha C. Reasons for cannabidiol use: a cross-sectional study of CBD users, focusing on self-perceived stress, anxiety, and sleep problems. J Cannabis Res. 2021;3(1):5.
6. Elms L, Shannon S, Hughes S, Lewis N. Cannabidiol in the Treatment of Post-Traumatic Stress Disorder: A Case Series. J Altern Complement Med. 2019;25(4):392-397.
7. Das RK, Kamboj SK, Ramadas M, et al. Cannabidiol enhances consolidation of explicit fear extinction in humans. Psychopharmacology. 2013;226:781-792.
8. Wechsler RT, Burdette DE, Gidal BE, et al. Consensus panel recommendations for the optimization of EPIDIOLEX® treatment for seizures associated with Lennox-Gastaut syndrome, Dravet syndrome, and tuberous sclerosis complex. Epilepsia Open. 2024;9(5):1632-1642.
9. Szaflarski JP, Bebin EM, Comi AM, et al. Long-term safety and treatment effects of cannabidiol in children and adults with treatment-resistant epilepsies: Expanded access program results. Epilepsia. 2018;59(8):1540-1548.
10. Kachru R, Perry-Lunardo C, Thompson LA. CBD Use in Children—Miracle, Myth, or Mystery? JAMA Pediatr. 2021;175(6):652.
11. Wanner NM, Colwell M, Drown C, Faulk C. Developmental cannabidiol exposure increases anxiety and modifies genome-wide brain DNA methylation in adult female mice. Clin Epigenetics. 2021;13(1):4.
12. Berger M, Li E, Rice S, et al. Cannabidiol for Treatment-Resistant Anxiety Disorders in Young People: An Open-Label Trial. J Clin Psychiatry. 2022;83(5).
13. Shannon S, Opila-Lehman J. Effectiveness of Cannabidiol Oil for Pediatric Anxiety and Insomnia as Part of Posttraumatic Stress Disorder: A Case Report. Permanente J. 2016;20(4):16-005.
14. Efron D, Taylor K. Medicinal Cannabis for Paediatric Developmental, Behavioural and Mental Health Disorders. Int J Environ Res Public Health. 2023;20(8).