Friends are double dosing: Marijuana and Prozac
I have two friends who were recently diagnosed with depression. They were both prescribed Prozac by their respective doctors. Both of them are heavy marijuana users and both failed to mention that to their doctors. One has been on Prozac for two months and the other for six weeks. I have noticed that their behavior has become strange: mood swings, paranoia, oversleeping, fatigue. They continue taking their Prozac (20 mg a day) and continue smoking pot. I am afraid that there might be some negative interaction between the substances, one being an antidepressant and the other a depressant. Can you provide some insight?
Dear Concerned Friend,
The mere fact that you’ve asked such a thoughtful question shows that you genuinely care about the well-being of your friends. Regardless of why your friends may be using marijuana, it’s possible that mixing it and Prozac (generic name: fluoxetine) may be having negative effects on their health. To date, there have been a few studies which have revealed that marijuana may inhibit fluoxetine’s efficacy, and the two combined could produce unpleasant and unsafe side effects such as paranoia, fatigue, and mood swings. However, for the most part, there hasn’t been extensive research investigating the interactions between the two substances. As such, it’s strongly recommended that your friends speak with their respective medical providers about their individual experiences, so they can learn about any risks they may face.
Although not much is known about how the two substances may influence one another, much is known about the effects of each substance on its own. Known for being one of the most common antidepressants on the market, fluoxetine is a selective serotonin reuptake inhibitor (SSRI). As an SSRI, it treats depression by altering the brain’s ability to absorb serotonin, a neurotransmitter that’s involved in the regulation of emotions and mood. As with any antidepressant, it comes with its fair share of side effects, including nervousness, drowsiness, anxiety, restlessness, sleepiness, or insomnia. Fortunately, these side effects usually improve within one to two weeks of use when used as indicated by a health care provider. It may also be helpful to know that it can take between four and five weeks before people start to feel the full effects of the medication. That being said, the side effects of fluoxetine may resemble some of the side effects of marijuana use.
As a psychoactive drug, marijuana can have varying effects on a person depending on their mood, surroundings, and frequency of use; based on these factors, it can act as a sedative, hallucinogenic, or a stimulant. Though majority of users smoke or eat it because of its associated “high” feeling, it can result in a lousy time for others. On its own, it can cause mood swings, fatigue, paranoia, worsened symptoms of schizophrenia, and anxiety. With an increased dosage comes an increased likelihood that marijuana will have a hallucinogenic effect, and the worse the side effects may be. And sometimes, these symptoms can be even worse when marijuana has been laced with other drugs, such as phencyclidine (PCP), where feelings of paranoia are more likely to occur. So, on its own, marijuana might result in uncomfortable side effects and experiences.
With your friends’ current mental health in mind, it’s worthy to note that marijuana use has been shown to cause some depressive symptoms in people, particularly heavy users. While some people with major depressive disorder (MDD) report using marijuana to reduce their symptoms, some studies found that it can create more depressive-like behaviors in those experiencing MDD. Also, compared to non-marijuana users, frequent marijuana users report poorer mental health outcomes and lower life satisfaction. As such, it’s possible that your friends’ marijuana use, prior to fluoxetine, may have influenced or heightened their depressive states, and their decision to currently mix it with fluoxetine might be exacerbating their symptoms. However, this is just speculation and can only be confirmed by a medical provider.
In addition to altering your friends emotional and physical states, fluoxetine and marijuana can alter their cognitive abilities — especially when combined. On its own, marijuana is known to lessen a person’s ability to concentrate, and alter their general perceptions of space and time. Much like marijuana, fluoxetine has been found to affect motor skills, decision-making skills, and perception. Thus, certain activities including schoolwork, job responsibilities, and driving may become particularly difficult or unsafe when double-dosing.
Now, you might be skeptical about the idea of your friends speaking with their medical providers, depending on the legality of marijuana where they live. While this is an understandable and common concern, rest assured that if they’re in the United States, your friends are typically protected by laws that protect confidentiality between health care providers and patients. Regardless of where your friends live, medical providers need to know about their patients’ potential illicit, prescription, and over-the-counter drug use; by being informed, they’re able to make safe and appropriate recommendations, as it can help prevent various undesirable drug interactions. With this in mind, if your friends are also concerned, it could be beneficial for them to monitor their drug usage — whether it be prescription, over-the-counter, controlled, or illicit— and record any noticeable changes in their moods, behaviors, or physical and cognitive abilities. After taking these notes, they could meet with their medical providers who can potentially shed light on why they are experiencing unpleasant symptoms and seek to mitigate them.
As a friend, you may choose to talk to your friends about what you’ve noticed with their behavior and can provide them with this information and express your concern for their well-being. It might be helpful for your friends to consider how their cognitive abilities are being impacted. If they’re concerned about these changes in behavior, you can also recommend that they speak with a health care provider or mental health professional. They’re lucky to have someone as observant and caring as you are looking out for them. For additional information on talking with your friends, consider checking out I’m worried about my friend’s escalating drug use in the Go Ask Alice! archives.
Dear Alice, I have two friends who were recently diagnosed with depression. They were both prescribed Prozac by their respective doctors. Both of them are heavy marijuana users and both failed to mention that to their doctors. One has been on Prozac for two months and the other for six weeks. I have noticed that their behavior has become strange: mood swings, paranoia,
More Using Pot When Depressed — But Does it Help?
THURSDAY, Sept. 10, 2020 (HealthDay News) — Folks struggling with depression are much more likely to turn to marijuana to ease their symptoms these days, and that’s not necessarily a good thing, researchers report.
Depressed people are more than twice as likely to have used pot within the last month and three times more likely to use it nearly every day in 2015-2016, a far higher number than 10 years before, the new study found.
Experts say this boom in use among the depressed is probably linked to the spread of marijuana legalization across the United States, particularly for medical purposes.
“Its accessibility has increased over the specific time period that this study measures,” noted Michael Wetter, director of adolescent and young adult medicine with the UCLA David Geffen School of Medicine.
The problem is that previous studies have shown pot actually can worsen mood disorders like anxiety or depression, said Dr. Elie Aoun, assistant professor of clinical psychiatry with the Columbia University College of Physicians and Surgeons.
“Marijuana does not change anything in the underlying brain pathology that contributes to depression,” Aoun said. “It just numbs your feelings so you can get through a couple of hours without thinking about your problems. When the effect dissipates, you’re going to be more depressed than you were before.” He and Wetter were not part of the research.
The new study relied on data drawn from the National Health and Nutrition Examination Survey, a federal poll regularly conducted by the U.S. Centers for Disease Control and Prevention.
The researchers, led by Deborah Hasin, from Columbia University Medical Center, analyzed responses from two periods — 2005-2006 and 2015-2016 — to identify people with symptoms of depression and track their self-reported marijuana use.
A depressed person had 2.3 times greater odds of reporting any cannabis use during the previous month in 2015-2016, a nearly threefold increase in risk from the decade before, researchers found.
The odds of daily use were nearly 3.2 times higher, an almost sixfold increase from 2005-2006.
Because the study is observational, it can’t say in which direction this association runs — if depressed people are more likely to turn to pot, or if marijuana use fuels depression.
“I think it’s probably both of these things at the same time,” Aoun said. “Marijuana could be causing depressive symptoms. Also, people who are depressed who are looking for treatment are seeking out options to help reduce the impact or burden of their depressive symptoms. When traditional treatment options are insufficient, they are turning to marijuana.”
THC, the chemical in pot that causes intoxication, has been shown to increase levels of dopamine in the brain, Wetter said. Dopamine is a “feel good” neurotransmitter that directly stimulates the pleasure centers in the brain.
That might make a depressed person feel better temporarily, but it’s really masking feelings that will return, Aoun said.
“Drugs don’t introduce new feelings that you don’t have in you,” Aoun said. “They just allow for disinhibition. If you’re depressed and you smoke marijuana, it’s not going to cure your depression.”
What’s more, these dopamine rushes alter your brain chemistry in ways that can exacerbate your depression.
“It requires more use in order to feel good,” Wetter said. “When you don’t have that, you will start to feel the symptoms of more increased depression. You experience the crash, if you will.”
Eleven states have adopted laws permitting recreational marijuana use, but Aoun said he’s more concerned about the 34 states that have passed laws allowing medical marijuana.
“When states are pushing for the legalization of medical marijuana without credible evidence, you’re sending so many wrong messages,” Aoun said.
Not enough medical research has been done to firmly establish marijuana’s health benefits, but legalization has nonetheless made pot into a seemingly legitimate alternative for folks struggling with a mood disorder, Aoun said.
He compared pot to insulin, a treatment for diabetes tested in large-scale research studies before it became available to patients.
“With marijuana, it’s been a completely different story where these decisions are really driven primarily by companies with a significant financial interest in promoting marijuana use,” Aoun said.
People with depression or anxiety would be better off talking to their doctor about taking an approved prescription medication, Wetter said.
“People will tend to say I would rather use something that is natural and organic versus something synthetic, like Prozac or an SSRI,” Wetter said. “It is organic, it is natural, so it can’t be bad for you. If you’re feeling bad and this makes you feel better, how can it be bad? How can it be wrong?”
The new study was published recently in JAMA Network Open.
Folks struggling with depression are much more likely to turn to marijuana to ease their symptoms these days, and that’s not necessarily a good thing, researchers report.