How Cannabis Interacts With Antidepressants
Cannabis and antidepressants both work to boost happy brain chemicals, and even give rise to the creation of new brain cells. However, using the two together can result in potentially dangerous interactions. Some antidepressants don’t mix with cannabis, whereas others are much more compatible. Find out about these interactions in detail below.
The relationship between cannabis, mental health, and antidepressants.
Cannabis and mental health share a controversial—and at times paradoxical—relationship. Some cannabis smokers use the herb to elevate their spirits and boost their mood, and some even need the plant to help them get out of bed in the morning. In others, cannabis can invoke feelings of paranoia and other mood disturbances.
There are conflicting views in healthcare when it comes to cannabis and depression. Some practitioners hold the belief that cannabis may help to take the edge off some symptoms, whereas others believe excess cannabis use leads to symptoms of depression and interacts dangerously with conventional medication for the condition.
Continue reading to explore the relationship between cannabis, depression, and antidepressant medication.
Cannabis and Mental Health: A Complicated Relationship
Cannabis affects different people in different ways, especially when it comes to mental health. Most people familiar with the effects of the herb will vouch that it does a reliable job of improving mood. A few tokes on a joint can boost dopamine levels, reduce feelings of nervousness, and soothe the body.
These outcomes help many people across the world deal with certain mental health conditions. However, research also associates cannabis with adverse mental health outcomes. Although no research draws a direct link between consuming cannabis and depression, surveys report a high incidence of depression in heavy cannabis smokers  compared to non-smokers.
Cannabis may also trigger underlying health mental conditions in some individuals. The psychotropic effects of the herb can stoke symptoms of schizophrenia and psychosis—serious mental health disorders—in those predisposed to the conditions.
The cannabinoid THC produces the psychotropic effects of cannabis; however, over 100 cannabinoids exist in the plant, and most are non-psychotropic. In fact, molecules such as CBD can help to inhibit some of the effects of THC, and show potential in the field of mental health  .
Cannabis and Antidepressants
Staggeringly, over 260 million people  across the world suffer from depression, and millions take antidepressant medication  to manage their symptoms. However, people with depression are more likely to smoke cannabis. Both weed and antidepressants create profound short and long-term changes in the brain, and frequently interact with each other. Before we delve into the safety issues of this combination, let’s explore the unique effects of each drug.
How Does Cannabis Affect the Body?
Cannabis interacts with several major physiological systems. As their names suggest, cannabinoids primarily target the endocannabinoid system (ECS). The ECS plays a fundamental role by regulating many other systems and helping the body maintain biological equilibrium, aka homeostasis.
The ECS features three main components: receptors, signalling molecules (endocannabinoids), and enzymes that create and break down these molecules. Interestingly, cannabinoids such as THC share a similar molecular structure with endocannabinoids, allowing them to bind to the same receptors.
After taking a hit from a joint or bong, THC diffuses through the alveoli in the lungs, enters the bloodstream, and passes into the brain. Here, the molecule binds to CB1 receptors of the endocannabinoid system, where it gives rise to its psychotropic effects—a high.
This binding also boosts dopamine levels and neuronal activity in the brain. Dopamine plays a role in the brain’s reward system and makes us feel pleasure after consuming a certain substance or acting in a certain way.
This surge in feel-good neurotransmitters might help some users feel relief from their depression symptoms, at least for a while. However, with long-term use, THC begins to blunt the dopamine system  and may even block the dopamine response to other stimuli that usually release the chemical.
The neurogenesis hypothesis suggests that depression may arise from an alteration in the creation of new neurons in the brain  . The rate of neurogenesis may underpin a healthy and happy brain. Negative events, such as stressful or traumatic experiences, may alter this rate, leading to depression. Evidence suggests that the endocannabinoid system helps to regulate neurogenesis, and cannabinoids such as THC and CBD may help drive this process  in the brain.
CBD also interacts with numerous bodily systems, including serotonin pathways. As a key regulator of mood and feelings of well-being, serotonin plays an important part in how we feel. The ability of CBD to interface with this system means the cannabinoid may help to take the edge off feelings of nervousness and agitation  .
How Do Antidepressants Affect the Body?
Antidepressants ultimately aim to improve the symptoms of depression by altering brain chemistry. Although depression has no single cause, a shift in neurochemistry following addiction, emotional life events, or genetic factors may lead to feelings of hopelessness, low mood, and low self-esteem.
Antidepressant medication helps to regulate neurological activity by interacting with systems in the brain that govern mood. Some of these chemicals seek to increase and prolong the presence of brain chemicals, such as serotonin, in the synaptic space. Research also suggests that antidepressants might improve depression symptoms by improving neurogenesis rates within the depressed brain, similar to cannabis.
Interestingly, antidepressants appear to recruit the endocannabinoid system  , and prolonged use may be involved in long-lasting neuroplastic changes in the brain.
Cannabis’ Interaction With Antidepressants
Because both cannabis and antidepressants may provide symptomatic relief, some users might think taking the two together will provide even better results. However, taking cannabis alongside conventional medication can produce dangerous side effects when done incorrectly. Check out the list below to find out which antidepressants interact with cannabis.
Types of Antidepressants
The following drugs may fall into the same “antidepressant” category, but they work in a variety of ways. Varying mechanisms of action mean different drugs interact with cannabis in more or less dangerous ways. Take a dive into the most common antidepressants below and find out if they are safe to take alongside the herb.
Tricyclics are among the oldest antidepressants developed. Due to their early occurrence, they generally produce more side effects than newer medications. Known by the brand names Tofranil and Surmontil, tricyclics work by changing brain chemistry. These molecules block the reuptake of the neurotransmitters norepinephrine and serotonin, ultimately boosting their levels in the brain.
Potential Side Effects
Common side effects of tricyclics include drowsiness, constipation, blurred vision, and a drop in blood pressure. Unfortunately, these medications have a high likelihood of negatively interacting with cannabis. Possible side effects of combining the two include potentially life-threatening increased heart rate (tachycardia).
Selective Serotonin Reuptake Inhibitors (SSRIs)
Selective serotonin reuptake inhibitors include branded drugs such as Prozac. These drugs interact with serotonin receptors in the brain, latching onto these sites in the synapses of neurons and preventing cells from reabsorbing serotonin. High levels of serotonin remain in the synaptic space, where it exerts mood-enhancing effects.
Potential Side Effects
Taken alone, SSRIs can produce side effects such as anxiety, shaking, weight loss, and dizziness. These drugs also pose a low–moderate risk of negatively interacting with cannabis.
Monoamine Oxidase Inhibitors (MAOIs)
Monoamine oxidase inhibitors work by prolonging the presence of neurotransmitters in the brain. Dopamine, serotonin, and norepinephrine all fall into the monoamine chemical class. The enzyme monoamine oxidase metabolises and breaks down these molecules. By inhibiting the action of these enzymes, MAOIs lead to enhanced levels of monoamines in the synapses.
Potential Side Effects
MAOIs negatively interact with a long list of foods, including soy, salami, sauerkraut, cheese, and nuts. Common side effects of the medication include fatigue, muscle aches, insomnia, and reduced libido. MAOIs can interact dangerously with cannabis, and the combination should be avoided.
Newer Antidepressants (SNRIs)
Serotonin and norepinephrine reuptake inhibitors (SNRIs) are used to treat symptoms of depression, such as irritability and sadness. Doctors also prescribe these drugs, under the brand names Fetzima and Cymbalta, to treat anxiety disorders and nerve pain. SNRIs work by blocking the reuptake of both serotonin and norepinephrine.
Potential Side Effects
Frequent side effects of SNRIs include dry mouth and excessive sweating. SNRIs are relatively safe for most people, and they pose a low–moderate risk of negatively interacting with cannabis.
Risk Factors of Combining Cannabis With Antidepressants
Combining cannabis with antidepressants poses several risks. The herb produces the most dangerous outcomes when combined with tricyclics and MAOIs. However, it may be safe to smoke while taking newer medications such as SSRIs.
You should always consult your physician before combining cannabis with any antidepressant to ensure you’re making a safe decision that won’t put your life in danger. Depending on your personal and family history, among other factors, your risk of having an adverse reaction could be more or less likely.
Does Cannabis Interact With Other Mental Health Medication?
Cannabis may also interact with the common anti-anxiety drug class benzodiazepines (e.g. Xanax). Although no research documents any interaction between the two substances, both work as central nervous system depressants. Moreover, both substances may help to ease feelings of nervousness when taken in low doses, while high doses may give rise to paranoia and rapid heart rate.
Mixing Xanax and cannabis may result in side effects such as dizziness, drowsiness, trouble concentrating, slurred speech, and confusion. Cannabis can also interact with other mental health medication, including sedatives such as Ambien.
What About CBD and Antidepressants
CBD poses a relatively high risk of interacting with antidepressants. Although the cannabinoid doesn’t produce psychotropic effects, it does cause shifts in brain chemistry and liver metabolism. CBD can slow down how fast the liver processes antidepressants, causing elevated levels to circulate around the body. Discuss CBD with your doctor before combining it with antidepressants to make sure you do so safely.
Can You Mix Cannabis and Antidepressants?
Yes and no. Some antidepressants cause dangerous interactions with cannabis; others are relatively safe to take at the same time. Ultimately, you should consult a healthcare professional if you wish to use cannabis and antidepressants together. The combination may provide enhanced results, but you need to ensure you’re being as safe and responsible as possible.
Both cannabis and antidepressants are used by people with depression. However, taking them at the same time requires careful consideration. Find out more.
Weed & Antidepressants: Can They Work Together? [Explained]
Today, millions of Americans use marijuana for medicinal and recreational purposes. A growing number of these people try cannabis to help them combat depression. According to NBC News, up to one in six Americans take a form of psychiatric drug. Antidepressants are by far the most commonly used. As such, we get a lot of readers asking us if they can use weed and antidepressants together.
People often look to wean off prescription drugs and transition to more “natural” alternatives. As such, there is often an overlap period where people use pot and prescription drugs together.
In this article, we discuss whether cannabis can work with antidepressants. We also analyze what scientific literature has to say on the topic. Finally, we outline what your best options are if looking to use marijuana for a mental health issue.
Before You Think About Using Cannabis with Antidepressants, Understand What Depression Is…
According to the World Health Organization (WHO), major depressive disorder (MDD) is a significant cause of disability around the world. It affects nearly 300 million people from all walks of life. Sufferers of depression experience a wide range of symptoms. These include:
- A lack of focus and concentration
- Loss of appetite
- Thoughts of suicide
Depression’s most common comorbidities include alcohol, drug addiction, and anxiety disorders. Other bodily dysfunctions can consist of high blood pressure and stroke.
Sufferers of MDD are more than just “sad” or feeling down. They experience a wide variety of chemical imbalances that prevent them from enjoying and participating in many life activities. They may experience constant negative self-talk, along with feelings of hopelessness and despair.
Job and school performance and relationships can also suffer as a result of ongoing depression. There is also an increased risk of self-harm without intervention. After diagnosis by a trusted health professional, one of the most common treatments of depression include medications to mitigate chemical imbalances in the brain. This group of drugs is collectively known as antidepressants.
What Are Antidepressants… And How Do They Affect Your Body?
Antidepressants first made an appearance in the 1950s and have since become a staple in the medical community. Today, antidepressants are one of the most highly used methods of combating MDD.
We can break antidepressants down into several categories. Two of the most popular are SNRIs (serotonin and noradrenaline reuptake inhibitors) and SSRIs (selective serotonin reuptake inhibitors).
SNRIs work by artificially raising levels of certain neurotransmitters. Neurotransmitters are chemical messengers in the brain. They operate across sections of myelinated sheaths, or swathes of brain cells covered in fatty proteins.
Neurotransmitters are an essential part of the human brain chemistry and operate as ‘directives.’ These directives instruct the brain’s neural pathways on what the body needs to do, and how. The neurotransmitters affected by SNRI’s, serotonin and norepinephrine, are primarily responsible for stabilizing moods.
Examples of SNRIs include brand names like Cymbalta, Pristiq, and Effexor. Patients who take any of these medications may see an improvement in mood over time. As a result, they could see a decrease in depressive symptoms.
SSRIs function similarly, though there are some significant differences. For example, SSRIs still greatly influence neurotransmitters. However, SSRIs block the reuptake or absorption of the neurotransmitter serotonin. This causes the brain to have higher levels of free-floating serotonin. This process eventually causes mood levels to change and become better and stabilize.
Other Types of Antidepressants
Another type of antidepressant is a monoamine oxidase inhibitor, otherwise known as an MAOI. Doctors don’t prescribe MAOIs as much as SNRIs and SSRIs these days. Indeed, they are considered as a last resort when other forms of medical treatment have failed.
MAOI drugs are classified as an inhibitor; this means they inhibit the neurotransmitter monoamine oxidase. They block this enzyme from breaking down the neurotransmitter serotonin, effectively increasing the amount of serotonin in the brain. Brand names include Nardil, Parnate, and Eldepryl.
Tricyclic antidepressants are also less commonly prescribed. This group gets its name because of the shape of its chemical structure, which sits in three rings. TCA is not just described for depression but a host of other ailments, including fibromyalgia, anxiety, and chronic pain.
Lastly, doctors can also prescribe NSSAs, or noradrenaline (also known as norepinephrine) and specific serotonergic antidepressants. These antidepressants function by interrupting the messages cells get to reuptake noradrenaline.
Noradrenaline is another chemical messenger and works with dopamine, a major neurotransmitter that affects feelings of pleasure and reward. By disrupting noradrenaline’s reuptake, this NSSA helps to control the amount of dopamine in a sufferer’s system. Some examples of NSSAs include Aptazapine, Norval, and Remeron.
Antidepressants Have Horrifying Side Effects
Although MDD patients may see a marked improvement in their mood, it is not without side effects. Antidepressants can cause any number of symptoms. These include:
- Low blood sugar
- Weight loss
- Sexual dysfunction
- An increase in suicidal thoughts
- Blurred vision
- Reduced white blood cell count
The FDA has strictly regulated the use of antidepressants, and for most people, they are considered safe. However, many view the side effects as being nearly as dangerous as depression itself. Others report that the antidepressants aren’t effective.
However, antidepressants and their link to mood isn’t an exact science. Often, doctors will try a combination of medications and treatments before finding something that ultimately works for a patient. Patients and their families in today’s world are looking for additional help, and that’s where cannabis comes in.
Weed & Antidepressants – How They Potentially Interact
Cannabis is a substance that comes from the marijuana plant. It has many different connotations in popular culture. However, recent research suggests that cannabis could mitigate several types of disorders in the body. Examples include nausea, vomiting, loss of appetite, and muscle spasms.
Studies now indicate that cannabis may have a positive effect on conditions such as Crohn’s disease and more. The main active ingredient in marijuana is THC or tetrahydrocannabinol. Cannabidiol (CBD) is also an active agent found in cannabis but lacks the intoxicating effects of THC.
What is concerning is the potential interaction between cannabis and certain types of antidepressants. Here are a few examples:
Zoloft and Marijuana
There is a suggestion that Zoloft has a ‘moderately clinically significant’ interaction with cannabis. It is wise to avoid combining the two under normal circumstances.
Weed inhibits specific enzymes in the liver that metabolize SSRIs. The result is a higher concentration of the drug in your blood. Elderly patients could experience impaired judgment, motor coordination, and thinking when using Zoloft and cannabis together.
Weed and Lexapro
Lexapro is an SSRI like Zoloft, so the interaction risk is similar. Combining the two could cause an increased risk of a mild form of mania known as hypomania.
Effexor and Marijuana
Effexor is an SNRI, which is a newer type of antidepressant. As such, there is a lower risk of an adverse effect when mixed with cannabis. However, there is also minimal published research on the subject. We advise patients to err on the side of caution.
Prozac and Weed
Mixing Prozac and marijuana could increase side effects such as confusion, drowsiness, dizziness. You may also find it more difficult to concentrate.
There are also reports of interactions with such popular prescription medications, such as warfarin. The active ingredients in cannabis could cause the displacement of warfarin from some protein-binding sites. Researchers believe that cannabis could increase the effect of warfarin on the body.
Damkier et al. had one such study published in Basic & Clinical Pharmacology Toxicology in January 2019. The evidence suggests that cannabis use increases international normalized ratio (INR) values in patients who take warfarin. The researcher recommended not using the two drugs together. Interestingly, those who received CBD for epilepsy management required a 30% reduction in warfarin dose to maintain therapeutic INR values.
Does Cannabis Mix with Antidepressants?
Unfortunately, there is a lack of research on how cannabis mixes with antidepressants.
Restrictions on how marijuana is scheduled is a roadblock to truly understanding cannabis’ effect when used with other drugs.
However, there are indications that cannabis is a better first line of defense against pain than opioids. In states where medicinal use of marijuana is legal, doctors have not reported many drug-drug interactions in patients. There is a suggestion that CBD inhibits a significant enzyme (CYP 450) that the liver uses to metabolize medications such as Valium or Xanax.
Everything you need to know…
Alternatives to Smoking Pot for Depression
Pop culture may suggest that there is only one way to reap any of the benefits of cannabis. However, there are many different alternatives to only smoking pot. Users have a wide range of options.
- THC Capsules: THC pills typically contain marijuana suspended in oil. It is touted as an excellent method of ingestion as it releases a safe, steady dose of THC.
- Dabbing: In dabbing, you place an extract of cannabis on a scorching surface and allow it to vaporize. You usually accomplish this with a dab rig or torch. It is incredibly potent, so tread carefully.
- Tinctures: Alcohol such as Everclear can absorb cannabinoids. Then, you drain the solution. The result is a substance you can place under the tongue or add to food and beverages.
- Oils: Some cannabis oils are potent, but others are relatively low in THC and have little intoxicating effect. Often referred to as CBD oil, you create it by extracting CBD from the hemp plant in a solvent. Alternatively, you can use methods such as CO2 extraction. The oil is often used in its raw form or placed into capsules. You can also consume some varieties via a vape pen.
- Edibles: With edibles, cannabis is crushed, chopped, or the oils used in a variety of consumer goods, including cookies, brownies, and candies. The candies can run the gamut from lollipops to gummy bears to chocolates.
Final Verdict – Is It Safe to Use Cannabis While on Antidepressants?
There is very little research on how cannabis interacts with brand name antidepressants. We do have some anecdotal evidence from patients who use SSRIs with weed and report few to no interactions. However, there is enough evidence available to urge patients to exercise caution.
Taking cannabis while using antidepressant medications could increase the drug’s effectiveness.
This interaction is possibly dangerous to other patients. Pharmaceutical drugs carry enough side effects when used in the prescribed dosage. Things get very messy if you accidentally take too much. Another form of interaction could reduce the effectiveness of your antidepressant, which could also spell trouble.
The feeling is that using cannabis and antidepressants together is unwise, so avoid doing so whenever possible. If nothing else, make sure you speak to your doctor before attempting the process.
We take a look at using marijuana alongside antidepressant medication. Is it safe and are there any possible drug interactions? Read on to find out.