Mixing Marijuana and Antidepressants: What You Need to Know
You don’t need a study to recognize that mood elevation is one of the prime reasons people consume marijuana. It is, after all, called “getting high.” Still, studies do exist, such as one in the journal Depression and Anxiety that notes that easing anxiety is among the top five symptoms for which people in North America use medical marijuana.
When a blue mood persists or anxiety is chronic, however, many people choose to take an antidepressant medication, such as fluoxetine (Prozac), citalopram (Celexa), or sertraline (Zoloft). According to the American Psychological Association , nearly 8% of people between the ages of 20 and 39 have taken prescription antidepressants in any given month.
If you’re already among this population, or you’re considering trying a prescription antidepressant and you’re a regular cannabis user, you’ll probably want to know how these meds and weeds interact. Do they enhance each other? Undermine the benefits? Are there any dangers to continuing weed use while you’re on an antidepressant?
Daniele Piomelli, Ph.D. , director of the University of California , Irvine, Center for the Study of Cannabis , said, “Truth be told, there is precious little work done” on this topic.
“There have been a few trials that looked at CBD or THC for anxiety and depression going back to the 1980s,” he said. “In general, the results have been positive, showing that cannabis has some effectiveness in countering mood disorders.” But, he added, the number of study participants was so small — just 25 in one case — “that it’s impossible to draw any medical conclusions.”
What we do know, he said, is that our built-in endocannabinoid system (ECS) plays an important role in mood regulation, including stress disorders and major depression. An endocannabinoid called anandamide, which has been dubbed “the bliss molecule,” is especially vital to our body’s ability to cope with stress in a healthy manner.
A study that Piomelli led in 2015 demonstrated that anandamide heightens motivation and happiness. Now, he’s looking at whether an anandamide deficiency might be linked to post-traumatic stress disorder (PTSD).
Synergies for Weed and Antidepressants
This research raises the prospect of synergy between marijuana and antidepressants. Could a few hits of your favorite strain along with 10 or 20 milligrams of paroxetine (Paxil) or Prozac counter distress more effectively than either alone?
“That is very possible,” Piomelli said. “We’ve certainly heard anecdotally from a lot of people that cannabis helps them with stress and depression and I have no problem believing them. But, the endocannabinoid system is a very fine-tuned, delicate machine. It’s evolved over millennia to regulate our ability to deal with stress in a positive way and it can easily be thrown off balance.”
The challenge in self-medicating with marijuana for depression or anxiety is it’s difficult to find the right dose. Too little, and there’s no impact; too much, and especially for novice users, there’s a risk of experiencing a panic attack. Without professional oversight, self-medicators also may overlook some other underlying condition.
“When physicians prescribe antidepressants or antipsychotic drugs,” Piomelli said, “they’re very careful, typically starting out with a very low dose and if that’s insufficient, increasing the dose slowly until the response is satisfactory.
“Now imagine a plant, like cannabis, that comes in a thousand different shapes and forms. You go to a dispensary and you’re relying on budmasters to help you navigate everything.” Even the most astute budmaster can’t guarantee you’ll be able to repeat the experience you had a week ago.
“Reproducibility is complicated,” Piomelli said. “Because cannabis products aren’t regulated by the FDA, you can’t count on consistency. You might find a product that is useful to you but when you go back to the same dispensary and purchase it again, the amount of THC, cannabidiol (CBD) , or other cannabinoids it contains might be slightly different and you’ll have a different response.”
One challenge to researching how cannabis might interact with antidepressant medications has been the difficulty to reproduce conditions for clinical study, argues Daniele Piomelli, Ph.D., director of the University of California, Irvine, Center for the Study of Cannabis. Any variation in the THC, cannabidiol (CBD), or other cannabinoid levels in marijuana could produce different experiences and interactions. (Gina Coleman/Weedmaps News)
How Weed Impacts Potency of Meds
There’s another knotty issue: Namely, experts don’t know how weed affects what’s known as the “pharmacokinetics” properties of antidepressant medication. That term refers to how the body absorbs, processes, and disposes of a drug.
“If cannabis consumption inhibits the metabolization of an antidepressant drug that would essentially increase its potency because there’s more of the drug hanging around the body,” Piomelli said. “This is a very important element of which we really have no understanding.” The lack of data, he said, can put physicians in danger of prescribing an inappropriate dose of an antidepressant medication. And that, in turn, could mean a delay in relieving depression or even a worsening of the symptoms.
To safeguard against this, Piomelli recommended a few things. First, have a frank conversation with your physician about your cannabis use in the past, present, and future. If your doctor isn’t open to this conversation, you’ll probably want to find one who is.
“This is something we have to work on as a society,” Piomelli said. “As a physician, your job is to help your patients feel better. Cannabis is used by millions and millions of people in the U.S. It’s now a legal product in a majority of the states. There’s no excuse for doctors not knowing how it interacts with the body.”
Still, since there’s so much we don’t know about potential interactions between antidepressants and cannabis, Piomelli said that finding the right balance between both substances takes a lot of experimentation and has to be personalized to each patient. “That might not be what people want to hear,” Piomelli said, “but it’s where we are right now.”
The Case Against Quitting Cold Turkey
Whatever you do, Piomelli said, if you decide to start taking an antidepressant, don’t quit cannabis cold turkey, especially if you’ve been a heavy user.
“The effects of cannabis withdrawal include depression, irritability, anxiety, loss of sleep and appetite, even suicidal ideation,” he said. Plus, keep in mind that it takes several weeks for antidepressants to begin working, and even longer to find the optimal dose.
If you intend to cut down your cannabis use as you introduce antidepressants, or, conversely, if you’re currently taking an antidepressant and want to see if you can lower the dose by combining it with nightly vaping, go slow on titrating the dosages of both. As much as you can, try to be consistent in the cannabis products you use.
“If you shift to another kind of cannabis with a higher or lower level of THC, you might imbalance your endocannabinoid system and lose the ability to control your symptoms or precipitate a deeper depression or greater anxiety,” Piomelli said.
You might also want to throw non-psychoactive tools into the mix, like mindfulness meditation, yoga, or tai chi.
“There are lots of things,” Piomelli said, “that don’t come in a pill and can help lift your mood and counter stress.”
Feature image: With antidepressant medication and cannabis use prevalent in segments of the population, what happens when weed and meds are combined? Health experts cannot say for certain. (Gina Coleman/Weedmaps News)
Mixing Marijuana and Antidepressants: What You Need to Know You don’t need a study to recognize that mood elevation is one of the prime reasons people consume marijuana. It is, after all, called
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,