As marijuana use continues to grow across the US, an increasingly frequent inquiry that we have been seeing is whether or not medical cannabis can be used with antidepressants – that is, whether or not you can use various forms of marijuana along with prescription antidepressant medication(s).
Indeed, this may seem like an odd inquiry given the fact that cannabis itself is often used to help treat depression, anxiety, and other mental health disorders. However, as more and more people are looking to wean off prescription drugs and transition to more “natural” alternatives, there is often an overlap period where both pot and prescription drugs are taken together.
In this article, we discuss whether or not cannabis can work with antidepressants, what some of the published scientific literature has to say on the topic, and what your best options are if you are indeed looking to use cannabis to treat depression or other mental health ailments.
Before You Think About Using Cannabis with Antidepressants, Understand What Depression is…
According to the World Health Organization, major depressive disorder (MDD) commonly known as depression, is a major 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 including insomnia, lack of focus and concentration, loss of appetite, and suicidal ideation.
Depression’s most common comorbidities also include alcohol and drug addiction and anxiety disorders. Other bodily dysfunctions can include 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 deter 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, and life chances are significantly reduced and the risk of self-harm can increase 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 medications 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. Their prevalence greatly expanded over the ensuing decades. Today, antidepressants are one of the most highly used methods of combating MDD.
Antidepressants can be broken down into several categories. Two of the most popular are SNRIs and SSRIs. SNRIs, or serotonin and noradrenaline reuptake inhibitors, work by artificially raising levels of certain neurotransmitters in the brain. Neurotransmitters are chemical messengers in the brain. These messengers operate across sections of myelinated sheaths, or swathes of brain cells that are covered in fatty proteins.
Neurotransmitters are an important part of the human brain chemistry and operate as directives. These directives instruct the brain’s neural pathways on what needs to be done in the body and how. The neurotransmitters affected by SNRI’s, serotonin and norepinephrine, are largely 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 and, as a result, see a decrease in depressive symptoms.
SSRIs, or selective serotonin reuptake inhibitors, function in the same way, though there are some major 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, eventually causing the mood levels to change and become better and stabilize.
Another type of antidepressant is a monoamine oxidase inhibitor, otherwise known as an MAOI. MAOIs are not prescribed today as much as SNRIs and SSRIs, as they are considered the last resort when other forms of medicinal treatment have failed. MAOI drugs are classified as an inhibitor; this means that they inhibit the neurotransmitter monoamine oxidase. It blocks 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 is so named because of the shape of its chemical structure, which sits in three rings. TCA is not just described for depression but for 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 has been known to work with dopamine, a major neurotransmitter that has an effect on 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.
Although MDD patients may see a marked improvement in their mood, it is not without side effects. Antidepressants can cause any number of symptoms, including low blood sugar, weight loss, headache, sexual dysfunction, and in some cases, an increase in suicidal thoughts. The FDA has strictly regulated the use of antidepressants and for most, they are considered safe. Other kinds of antidepressants can cause some other symptoms such as blurred vision, arrhythmia, reduced white blood cell count, and seizures.
One of the many criticisms of antidepressants is their side effects. Many view the side effects as being nearly as dangerous as depression itself, while others report that the antidepressants aren’t really 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 supplementary help and that’s where cannabis comes in.
How Cannabis Potentially Interacts with Antidepressant Medications
Cannabis is a substance that comes from the marijuana plant. It has many different connotations in popular culture, however, recent research has suggested that cannabis is responsible for mitigating several types of disorders in the body including nausea, vomiting, loss of appetite, and muscle spasms.
Studies now indicate that cannabis may have a positive effect on treating conditions such as Crohn’s disease and cancer. A main active ingredient in cannabis is THC or tetrahydrocannabinol. Cannabidiol (CBD) is also an active agent found in cannabis but is said to lack the psychoactive effects of THC.
In some studies of cannabis, interactions with such popular prescription medications such as warfarin have been documented. The studies suggested that the active ingredients in cannabis could cause the displacement of warfarin from some protein-binding sites. This indicated to researchers that cannabis could increase the effect of warfarin on the body. Other studies suggest that this is true of other prescription medications, including the interaction between injectable insulin and the body. Cannabis may in fact lower the body’s resistance to insulin.
So… Does Cannabis Mix with Antidepressants?
Unfortunately, there are not many studies on how cannabis mixes with antidepressants. However, the few studies that have been published indicate that there are no adverse effects and that, if there are, they rarely happen.
Anecdotal evidence would suggest that this is true for many patients undergoing treatment for depression and taking SSRIs. Restrictions on how marijuana is scheduled is a roadblock to truly understanding cannabis’ effect with other drugs.
However, there are indications that cannabis can be a better first line of defense against pain than opioids, thus helping to stem the increase in their prescription by doctors. In states where the medicinal use of cannabis is legal, doctors have stated that there have not been any drug-drug interaction that they’ve observed in patients. Some providers have suggested that CBD does inhibit a major enzyme that the liver uses to metabolize medications such as Valium or Xanax. However, there isn’t conclusive evidence to suggest this is true.
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 simply smoking pot. There are an array of choices, and users have a wide range of options.
- THC Capsules: THC pills typically contain marijuana that has been suspended in oil. It has been touted as a great method of ingestion as it releases a safe, steady dose of THC.
- Dabbing: In dabbing, an extract of cannabis is placed on an extremely hot surface and allowed to vaporize into the air. This is usually accomplished with a dab rig or torch and can be highly effective and potent.
- Tinctures: Alcohol such as Everclear is used to absorb cannabinoids and then the solution is strained. The result is a substance that can be used under the tongue or added to food and beverages.
- Oils: Some cannabis oils are potent but others are relatively low in THC and have little psychoactive effect. Often referred to as CBD oil, this substance is made by extracting CBD from the hemp plant in a solvent or using methods such as CO2 extraction. The oil is often used in its raw form or placed into capsules. They can also be consumed by using vape pens.
- 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?
Although there is very little research on how cannabis interacts with brand name antidepressants, the few studies out there indicate that there aren’t many adverse effects. And considering the anecdotal evidence of patients who have been prescribed SSRIs and have reported little to no interactions – as well as cannabis’ ability to help with pain and other symptoms of nausea and vomiting – it is more likely that cannabis is quite safe to use while consuming antidepressants.
If many of the indicators can be believed, taking cannabis while using antidepressant medications may in fact increase the drug’s effectiveness. This is a boon to those who may suffer from a wide variety of maladies in addition to depression. In short, cannabis may be a substance that is safe, has little interaction, and can assist in helping in the long run with symptoms of depression.