How Cannabis Interacts With Antidepressants

Depression symptoms can be circumstantial or clinical. Today, we understand that patients who have mental health conditions benefit from treating depression with a variety of different therapies, from counseling to prescription medications and lifestyle changes.

In the United States, depression is the most commonly diagnosed mental disorder. Approximately 8% of adults living in America have depression, according to Mental Health America (MHA). Depression has been diagnosed in about 15% of adolescents aged 12-17 years, according to 2022 data.

Some patients experience improved mood and energy when they use medical cannabis. Fatigue and low mood are two common mental health conditions associated with clinical depression. It is understandable, then, that some patients who are coping with depression may want to try medical cannabis to see if it helps.

There is increasing interest in studying marijuana and depression. However, there are some important things to know about how cannabis interacts with antidepressant medications. Not only could cannabis impact treatment outcomes, but it may cause harm when combined with drugs commonly prescribed for depression.

Understanding How Antidepressant Drugs Work

The most important place to start is understanding how antidepressant drugs work. Physicians do not recommend taking antidepressants and using medical cannabis because cannabis can change the way the medications work. In some cases, that can result in harm and health risks.

Cannabis can either amplify the effects of certain medications or compound the psychoactive and physical effects of prescription drugs. It can also reduce the efficacy of certain prescription medications.

What Are The Most Commonly Prescribed Antidepressants?

Six categories of antidepressant drugs may be prescribed to patients diagnosed with clinical depression. Each type of medication targets and alters brain chemistry and impacts the central nervous system.

1. Selective Serotonin Reuptake Inhibitors (SSRIs)

This class of antidepressant medication includes Fluoxetine (Prozac), Sertraline (Zoloft), and Escitalopram (Lexapro). The SSRIs target the reuptake transporters for serotonin and increase overall levels of serotonin in the synaptic cleft of the brain, which regulates mood and fatigue.

2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Prescription medications like Venlafaxine (Effexor) and Duloxetine (Cymbalta) belong to the SNRI class of antidepressants. These medications reduce the reuptake of norepinephrine and serotonin, which causes increased levels of the two neurotransmitters in the human brain.

3. Tricyclic Antidepressants (TCAs)

Tricyclic antidepressant medications include Amitriptyline, Nortriptyline, Imipramine, Desipramine, and Clomipramine. The compounds in TCAs interact with histamine and acetylcholine receptors. They act as serotonin reuptake and norepinephrine reuptake inhibitors.

The name for tricyclic antidepressants comes from their chemical structure, which has three rings of atoms in the molecule, which effectively inhibit serotonin reuptake.

4. Monoamine Oxidase Inhibitors (MAOIs)

Monoamine Oxidase Inhibitors are a class of medications used to treat depression, and they work by reducing the activity of an enzyme called monoamine oxidase (MAO). This enzyme helps break down neurotransmitters like dopamine, serotonin, and norepinephrine in the human brain. This can help improve mood and energy.

This class of medication can help alleviate other symptoms of depressive disorders but is highly susceptible to disruption. For example, foods like aged cheese, fermented vegetables, and certain alcoholic beverages must be avoided, and any dietary source high in tyramine.

5. Atypical Antidepressant Drugs

Other types of medications may address mild to average symptoms of depression and fall into the atypical antidepressant drugs category. This includes Bupropion, Remeron, Trazodone, Nefazodone, and Brintellix.

Each medication offers unique potential benefits. For example, Remeron helps improve the release of serotonin and norepinephrine while blocking serotonin 2 and 3 receptors. By activating selective serotonin reuptake inhibitors, atypical antidepressants can promote sedation and can help people who suffer from anxiety disorders fall asleep.

Bupropion functions primarily as norepinephrine and dopamine reuptake inhibitors. It is sometimes also prescribed to help people with smoking cessation. It has a lower rate of negative side effects relating to changes in sex drive than other types of antidepressant prescription drugs.

6. Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs)

Wellbutrin is one of the most recognized antidepressant medications, and it belongs to the NDRI class. These drugs used to help with depressive symptoms disrupt the reuptake of dopamine and norepinephrine, the two receptors most responsible for mood regulation.

Patients suffering from seasonal affective disorder (SAD) are sometimes prescribed NDRI-class medications. However, this type of depression medication is not recommended for people who have seizures, and it can cause insomnia, elevated heart rate, and symptoms of dry mouth.

Why You Shouldn’t Combine Antidepressants And Cannabis Use

Antidepressants and cannabis can affect the central nervous system. Combining weed and antidepressants can cause dizziness, impaired coordination and balance, and drowsiness. The level of impairment can be far more hazardous when both drugs are combined.

Some types of antidepressants affect serotonin levels; they are classified as SSRIs and SNRIs. These drugs, when combined with cannabis, increase serotonin, which is one of the human body’s “feel good” hormones.

However, too much serotonin can cause a life-threatening condition called serotonin syndrome, with symptoms of rapid heart rate, hypertension, confusion, and fever.

Many types of medications used for antidepressant treatment have a known potential cannabis interaction risk. Individuals with hypertension (high blood pressure), a previous history of heart attack(s) or stroke, or seizures should avoid cannabis with antidepressant intake.

Dangerous Interactions Between Cannabis and Antidepressants

It would be great to know how much cannabis you could safely consume if you are taking antidepressants regularly. However, there is insufficient scientific research to determine any safe amount because the results vary by individual and a number of unique factors.

Some people have a higher tolerance to cannabis than others and may not experience the same level of side effects compared to those who use cannabis infrequently. There are unknown interactions between THC, CBD, and antidepressant medications.

Other factors such as health conditions, diet, age, and other mental disorders may also increase the risk of adverse effects when combining cannabis use with prescription antidepressants. Some antidepressant drugs target the same receptors and brain chemicals as cannabis. Often, that can lead to extreme drowsiness or sedation, which can increase the risks of an accidental injury.

One of the other things that antidepressant prescriptions can do when combined with cannabis is increase heart rate. That may not be a concern for some people; however, individuals who have been diagnosed with cardiovascular problems or moderate to severe hypertension may increase their risk of a heart attack or stroke.

We don’t know enough about cannabis yet to be able to say that a small amount of cannabis may be okay for patients who are taking antidepressants. The safest plan is to choose one or the other to help moderate symptoms of depression, not both.

Can I Get a Medical Cannabis Card If I Have Depression?

Yes. If you are a patient who has been clinically diagnosed with depression, you may be eligible to get your medical card. Many states include a diagnosis of depression as a qualifying health condition. Increasingly, more patients are exploring medical marijuana and mental health treatments.

There are many reasons to consider doctor-supervised cannabis as an alternative to prescription antidepressant therapies. Some people who have been using medications to treat depression may have developed a tolerance over time to specific types of drugs, particularly if they were taking high doses. Over time, prescription antidepressants may become less effective.

In some cases, patients have tapered off their use of prescription antidepressants by using cannabis with a doctor-supervised treatment plan, and some have experienced fewer side effects, as well as improved symptom management.

A qualified healthcare professional would recommend choosing one or the other but advise against mixing marijuana with most commonly prescribed antidepressants. Adverse reactions can occur when combining marijuana, monoamine oxidase inhibitors, SSRI interactions, or other antidepressants.

Protect your health and talk to a physician before mixing antidepressants with cannabis.

Robert Dotson Jr., M.D.

A U.S. Army Reserve Veteran (Major), Dr. Dotson graduated from the University of Tennessee Center for the Health Sciences, College of Medicine. Dr. Dotson also served as Clinical Adjunct Faculty at the Debusk College of Osteopathic Medicine. For more than thirty years, Dr. Dotson has provided quality patient care specializing in ophthalmology and family medicine, and he is a Certifying Physician for DocMJ.