English (English)
Deutsch (German)
Čeština (Czech)
Italiano (Italian)
Hrvatski (Croatian)
Română (Romanian)
български език (Bulgarian)
Magyar (Hungarian)
Español (Spanish)
Français (French)
Nederlands (Dutch)
Polski (Polish)
Slovenčina (Slovak)
- Cannabis can make people feel more relaxed, less stressed and, of course, happier.
-
People suffering from depression or anxiety reach for cannabis much more often than people who do not suffer from these conditions.
Many people are, of course, also prescribed antidepressants. However, both doctors and patients should know how these two substances can affect each other when they are used at the same time.
Interestingly, although research into the links between cannabis use and mental illness has been going on for years, there are very few studies that look more closely at the interaction between cannabis and antidepressants. Even extensive searches of Google Scholar and the National Institutes of Health PubMed website yielded only a few relevant studies. And not even the website of the National Institute on Drug Abuse (NIDA) offers much information on this topic.
Researchers from the University of Connecticut Health Center, specifically from the Division of Child and Adolescent Psychiatry, compiled an extensive summary of the limited scientific literature and published a report entitled Psychotropic Medications and Substances of Abuse Interactions in Youth. They noted - and I am paraphrasing here – that while one would think that combining psychoactive drugs and psychotropic medications would increase the chance of adverse effects in patients, surprisingly only a few reports have confirmed this.
The researchers also explain why this is probably the case. It is possible that adverse effects occur “only very rarely, or not at all”. Furthermore, “newer psychotropic medications have a relatively high therapeutic index,” which means that adverse effects are unlikely to occur with them. However, the researchers also noted that a lack of acceptance and poor awareness of cannabis may also be to blame, so patients who experience adverse effects may be reluctant to disclose that they use it.
Nevertheless, it can be said that newer antidepressants carry a low to moderate risk of interaction, while older antidepressants carry a higher risk. RxList, an index of substances published online on WebMD, advises patients who use cannabis to “be cautious” and “consult their doctor.”
Risk of interaction
One of the problems faced by doctors who prescribe antidepressants to patients who also use cannabis (or other similar substances) is the difficulty of determining the right medication and its correct dosage. Cannabis acting at the same time can prevent them from correctly assessing the effectiveness of the prescribed medication.
Doctors have noted that when it comes to patients and combining substances (both prescribed and illicit), the most important variable is the ability to measure to what extent each of them causes side effects and how they affect behaviour and mood. Clearly, the more substances a patient takes, the more difficult it is to isolate the effectiveness of each of them. That is why doctors often start by prescribing one substance and add others only later.
Cannabis users who are considering having a new medication prescribed for depression or anxiety should consider stopping cannabis (at least temporarily) and observing what effect the newly prescribed antidepressants have on the body. Allan Schwartz, LCSW, PhD, a psychotherapist and clinical social worker in Colorado and New York, has found that (especially in some cases) patients should leave out cannabis completely during treatment. “Sometimes I managed to persuade patients to stop using cannabis for a few weeks so that they could determine for themselves whether their mood had improved in any way,” says Schwartz. “These individuals were surprised, but they were willing to admit that they felt a real improvement in their mood and overall functioning.”
There is also evidence suggesting that patients suffering from depression are much more prone to cannabis abuse and to moving from occasional to chronic use. People who suffer from anxiety or depression use cannabis two to eight times more than people without these conditions.
When asked, many doctors said that some patients (especially those with depression or bipolar disorder) who use cannabis, alcohol or other substances during treatment adhere much less to the prescribed treatment procedures (taking prescribed medication, therapy).
Schwarz has seen many people stop taking their medication, which very often had disastrous consequences. “I have witnessed people with bipolar disorder stop their medication, use cannabis and eventually end up hospitalised in a much worse state than before,” Schwarz describes. “From my own experience I know that a large number of these unfortunate people went through several relapses and remained in an endless vicious circle of hospitalisations alternating with periods of instability.”
Apart from the general risks, each group of antidepressants is unique and can be associated with different side effects and potential interactions. Based on a study of the scientific literature, below you will find a summary of the most common groups of antidepressants and the risks associated with them:
1. Selective serotonin reuptake inhibitors (SSRIs)
Prozac, Paxil, Zoloft, Celexa and Lexapro are selective inhibitors that are most frequently prescribed for the treatment of depression. They have fewer side effects than other types of antidepressants, and their interaction with other medications is also lower.
Potential risk of interaction with cannabis: low to moderate
Adverse interaction with cannabis occurs only very rarely. Even so, there is speculation that in isolated cases the combination of SSRIs and cannabis may lead to hypomania (a milder form of mania), particularly in “vulnerable people” (for example, people with bipolar disorder).
2. Serotonin and noradrenaline reuptake inhibitors (SNRIs)
Examples include duloxetine (Cymbalta) and venalfaxine (Effexor XR).
Potential risk of interaction with cannabis: low to moderate
A newer group of antidepressants; adverse interaction with cannabis and other medications is rare.
3. Serotonin, noradrenaline and dopamine reuptake inhibitor (NDRI)
Examples include bupropion (Wellbutrin, Aplenzin, Forfivo XL). It is important to mention that NDRIs are among the few antidepressants that do not have sexual side effects. They are sometimes also prescribed for ADHD and smoking cessation.
Potential risk of interaction with cannabis: Low to moderate
Very few cases of adverse interaction have been reported.
4. Monoamine oxidase inhibitor (MAOI)
Examples include tranylcypromine (Parnate), phenelzine (Nardil) and isocarboxazid (Marplan). These medications have fallen out of favour because of frequent side effects and dangerous interactions (which can be fatal) with a large number of foods and medications.
Potential risk of interaction with cannabis: High
A search on PubMed for case reports documenting adverse interactions between cannabis and MAOIs was unsuccessful. Even so, the use of cannabis is not recommended, because the risk of adverse interaction with medications and certain foods is high.
5. Tricyclic antidepressants
Examples include imipramine (Tofranil), amitriptyline, doxepin and trimipramine (Surmontil). Adverse interactions and side effects are less frequent with these antidepressants than with MAOIs. Compared with newer antidepressants, however, they bring many more undesirable side effects. They are usually prescribed to patients for whom other treatment does not work.
Potential risk of interaction with cannabis: High
One case report describes the case of a seventeen-year-old boy who suffered from depression and insomnia and whose doctor prescribed him 25mg of amitriptyline. His parents spoke to his friends and searched his room and found that the only other substance he was using was cannabis. He was admitted to the emergency department because of an accelerated heart rate (tachycardia), and the attending doctor stated that without timely intervention the interaction of these two substances could have been “life-threatening”. He therefore warned doctors not to prescribe tricyclic antidepressants to patients who use cannabis or other drugs. Other case reports describing very similar situations have also been found.
6. Sedatives
Sedatives are not strictly classed as antidepressants, but doctors prescribe them to patients for depression quite often. Both cannabis and sedatives can make a person feel tired and drowsy. These effects are often experienced by people who take sedatives such as clonazepam (Klonopin), lorazepam (Ativan), phenobarbital (Donnatal) or zolpidem (Ambien). Combining cannabis with these medications can increase such effects even further.
Potential risk of interaction with cannabis: High
From a pharmacological point of view, the likelihood of an adverse interaction between cannabis and antidepressants is very low (with very few exceptions). However, it is important to consider other risks as well. The main risks include the possibility that antidepressants may be less effective and may take longer to start working. Patients may also break their treatment more often, which needlessly prolongs their recovery. The main problem, however, is that patients with depression are much more likely to move from occasional use to chronic use.
For patients suffering from several depressive episodes (or bipolar disorder), these risks are even greater. Individuals should weigh them carefully and adjust their cannabis use accordingly.
High-CBD cannabis and anxiety
Patients should also bear in mind that although a small amount of THC can bring the desired effects (such as euphoria or a feeling of relaxation), too large an amount can cause the exact opposite. It can intensify feelings of anxiety or even trigger a panic attack. The second most significant cannabinoid, CBD, can counteract many of the negative effects of THC, and preliminary results also suggest that it could be a significant fighter against anxiety, depression and other mental illnesses. So if you suffer from anxiety or depression and decide to use cannabis, look for varieties with a high CBD content.
Source: leafly.com