Dronabinol Reduced PTSD Nightmares in 10-Week Trial

Key Takeaways

• In patients with post-traumatic stress disorder (PTSD) and frequent, intense nightmares, bedtime dronabinol reduced nightmare burden more than placebo in a placebo-controlled trial.
• More than one-third of dronabinol-treated patients reported complete disappearance of nightmares after treatment.
• No severe side effects or withdrawal symptoms after discontinuation were reported, although mild to moderate adverse effects were more frequent with dronabinol.

Trauma-related nightmares in post-traumatic stress disorder (PTSD) can drive repeated nocturnal re-experiencing, fragmented sleep, and fear of going to bed, while existing pharmacologic options often provide only partial relief. Investigators at Charité–Universitätsmedizin Berlin evaluated whether a bedtime cannabinoid regimen could reduce nightmare burden without major safety concerns.

In the Nature Medicine trial, Charité investigators enrolled more than 170 patients with PTSD and frequent, intense nightmares in a double-blind, placebo-controlled comparison. Participants received plant-derived tetrahydrocannabinol (THC) drops in the form of dronabinol or an identical-looking, cannabis-flavored placebo every evening before bedtime for 10 weeks.

Nightmare burden fell by an average of 3.7 points with dronabinol versus 2.2 points with placebo on a 0-8 scale. Another 21% of dronabinol-treated patients reported at least a halving of nightmare burden, and a sizable subset no longer reported nightmares by the end of treatment.

No severe side effects or withdrawal symptoms after discontinuation were reported, although mild to moderate adverse effects such as dizziness, headache, and increased appetite were more frequent with dronabinol.

Clinician Questions

Which PTSD symptoms appeared to improve with dronabinol in this trial?

The reported signal was specific to nightmares and sleep-related burden rather than a broad improvement across PTSD symptom domains. Overall PTSD severity and accompanying depression did not change conclusively, so the findings support a symptom-targeted interpretation of benefit.

What unresolved questions remained after the 10-week dronabinol trial for PTSD-related nightmares?

The investigators identified longer-term effectiveness, long-term safety, and the possibility of tolerance over time as the main unanswered questions after the study period.

How was dronabinol given in the placebo-controlled PTSD nightmare trial?

Dronabinol was given as a prescription drop formulation containing plant-derived THC every evening before bedtime and was compared with an identical-looking, cannabis-flavored placebo.