Condition · ICD-11 6B40
Post-traumatic stress disorder
Reviewed by Dr. Placeholder C (HPCSA MP0XXXXX · Psychiatry) · Last updated · Published
Post-traumatic stress disorder (PTSD) is characterised by re-experiencing, avoidance, hyperarousal, and negative mood changes following exposure to a traumatic event. First-line treatment is trauma-focused psychotherapy — EMDR or trauma-focused CBT — with SSRIs or venlafaxine for symptomatic support. Cannabinoid-based therapy is a developing area with mixed evidence and significant safety considerations; it is considered in South Africa only as an adjunct to ongoing psychological care, never as a replacement.
What the evidence says
Evidence for cannabinoids in PTSD remains limited and contested. Observational studies show symptom improvement in some veteran cohorts, but randomised controlled trial data is sparse. Nabilone (a synthetic cannabinoid) has limited evidence for PTSD-related nightmares. CBD-dominant formulations have a better safety profile but less direct efficacy data. Cannabinoids do not replace trauma-focused psychotherapy or first-line pharmacotherapy; they are considered where those have been trialled and symptom burden remains high.
How the doctor will evaluate you
Expect a detailed clinical history, current psychological treatment plan (therapist name and contact preferred), SSRI / SNRI trial history with dose and duration, substance-use screening, and screening for psychosis or bipolar-I risk — which are generally contraindications to THC-dominant therapy. The doctor will often reach out to your treating psychologist or psychiatrist before submitting a Section 21 application.
When to see a doctor urgently
- Personal or family history of psychosis or bipolar-I disorder
- Active substance-use disorder
- Current suicidal ideation requiring acute mental-health review
- Trauma-focused psychotherapy never trialled
If any of the above apply, seek in-person medical care — do not wait for a remote Section 21 consultation.
The South African Section 21 pathway
PTSD is evaluated on a case-by-case basis in the Section 21 pathway. Applications are stronger when supported by a treating mental-health clinician’s letter documenting first-line treatment history and rationale for considering cannabinoid augmentation.
Frequently asked
- Will cannabinoids replace my SSRI?
- Not as a first step. Most doctors add, not substitute. Any change to an existing SSRI is done in coordination with your prescribing psychiatrist and takes weeks to months.
- Is THC safe for someone with PTSD?
- It depends on individual risk factors. THC can worsen anxiety or intrusive thoughts in some patients. The doctor will discuss whether a CBD-dominant formulation is more appropriate, particularly if you have a history of psychosis or panic.
- Do I need my psychologist’s involvement?
- Yes, in most cases. Medical cannabis is considered an adjunct to, not a replacement for, evidence-based psychological care.
Related conditions
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