CBD and Antidepressants: Benefits & Risks

CBD and antidepressants

You’re on antidepressants but are considering Cannabis or CBD. Is it safe? Do they interact?

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Want to know if CBD is safe to take while on antidepressants? Find out the latest conclusions.

CBD has 65 known targets in the body, including enzymes, transporters, ion channels, and receptors, which is why CBD is therapeutic in so many physical and psychological ways.

You’ve been on antidepressants for some time, and you’ve heard that CBD can help with depression. Is it safe to take them together? Many people have been able to wean off of antidepressants while opting for a more natural and plant-based way to manage anxiety and depression. From a cannabis nurse getting her masters in medical cannabis here’s what the latest research is saying!

Cannabis vs CBD

While CBD comes from the cannabis plant, for the purpose of this article, CBD references mostly oral tinctures, oils, and gummies that are ingested. 

Does CBD interact with antidepressants?

CBD oils and gummies are metabolized in the liver, through the same pathway as a select few antidepressants. This can cause a potential interaction, but research is showing that it’s only happening at high doses of CBD (200-800mg), and with only some antidepressants. Not all antidepressants are metabolized the same way, so let’s dig into the different types, but first, what actually happens when they interact?

What exactly does an interaction mean?

 If an interaction does occur, it means that CBD and the other medication are essentially competing for the same liver enzyme. CBD usually wins, which means the antidepressant will be at higher levels in your blood, which can cause side effects.

Let a pharmacist help you!

Trusted Canna Nurse just teamed up with a board-certified pharmacist to check medications against CBD and to make sure you’re taking them safely and effectively. Every consultation gets a complementary medication check with our pharmacist. Find more information here.

CBD and SSRI
CBD and SSRI

Can you mix SSRIs and CBD?

The most common SSRIs are Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil), Fluvoxamine (Luvox), and Sertraline (Zoloft). 

Lexapro, Celexa and CBD are metabolized by the same enzyme in the liver, which can cause an interaction. The interaction is a slowed metabolism of the SSRI (which increased plasma levels), and reported symptoms have been mild. They included nausea, diarrhea, and fatigue. Again interactions have occurred at doses over 100mg of CBD, which is higher than what most people take. A drug interaction is not lethal, but may cause uncomfortable symptoms.

Prozac, Paxil, Zoloft and Luvox and CBD are metabolized by different liver enzymes, so there is low risk for interactions with these SSRIs.

Do Tricyclic Antidepressants interact with CBD?

Tricyclic antidepressants (TCAs) like amitriptyline and imipramine (Anafranil) are metabolized by the same liver enzyme as CBD, so there is potential for interaction with high CBD doses, but there is no research or reported cases from which to draw conclusions.

Nortriptyline, desipramine, are metabolized by a different liver enzyme than CBD, so the risk of interaction is much lower.

CAN I TAKE MAOIs AND CBD?

Monoamine oxidase inhibitors, or MAOIs, consist of Emsam (Selegiline) Nardil (Phenelzine), Parnate (Tranycypromine) and Marplan (Isocarboxazide) All of these are metabolized by different liver enzymes than CBD.

SNRIs and CBD

Selective norepinephrine reuptake inhibitors, or SNRIs, include Desvenlafaxine (Pristiq), Duloxetine (Cymbalta), Levomilnacipran (Fetzima), and Venlafaxine (Effexor XR).

Pristiq and Fetzima are metabolized by the same enzyme as CBD, so there is a chance for an interaction, whereas Cymbalta and Effexor are metabolized by different enzymes than CBD, so there is less of a chance of interaction. The quality research specific to SNRI’s and CBD is severely lacking to be able to give a definitive yes or no answer. 

Using CBD for Antidepressant Withdrawal

CBD is all about managing symptoms, and symptoms of antidepressant withdrawal can include nausea, vomiting, insomnia, flushing, dizziness, mood swings, and others. Many people find that CBD helps with these symptoms. Remember, it acts on dozens of sites throughout the body to help in reducing nausea, helping with sleep, decreasing stress and restoring balance.

Many people find that CBD does help with these symptoms, but finding the right dose for you may take some trial and error. Remember to start low and go slow. It’s important to talk to your doctor about weaning off your medications to find the best and safest way to wean. You have the right to choose to use CBD, and your doctor can’t prescribe CBD or tell you not to use. Talk with a nurse today about using CBD to manage your symptoms. 

Benefits of taking CBD with Antidepressants

Since CBD interacts with our serotonin receptors and has been shown to increase serum serotonin. Unlike antidepressants, which can take weeks to take effect, CBD has been shown to have a more immediate effect on increasing serotonin. Some people find that the usual low doses (25-50mg) may help enhance the effects of antidepressants in what is called a synergistic effect. Others find that it helps bridge the gap with starting antidepressants. 

Risks of mixing CBD and antidepressants

Theoretically, combining CBD that can increase serotonin with antidepressants that also increase serotonin, leading to a rare yet serious condition known as serotonin syndrome, but we so far don’t have any documented cases.

The other risk is combining the medications metabolized by the same liver enzyme, which then slow the metabolism of the antidepressant, increasing serum levels, and causing some unwanted side effects. So far, we know that those medications metabolized by the same enzyme include Lexapro, Celexa, and possibly amitriptyline and imipramine.

Antidepressants and CBD
Antidepressants and CBD

The final word on mixing CBD and antidepressants

Drug interactions with antidepressants and CBD are rare, and they appear to happen at doses over 100mg of CBD day. It all comes down to the type of liver enzyme that metabolizes the drug, and so far we know that Celexa, Lexapro, amitriptyline, and anafranil are metabolized by the same liver enzymes.

The recommendation from a cannabis nurse is to start low (low is about 50mg or less) and go slow (increase dose every few days). Track your progress with a journal. Make sure you’re taking quality CBD with test results readily available. Pay attention to how your body feels throughout the day, and remember that CBD often takes weeks of consistent dosing to bring your body’s inflammatory response.

If you’re still unsure and want a pharmacist to check, we can have a pharmacist look at your medications to make sure they don’t interact. See more here.

1 thought on “CBD and Antidepressants: Benefits & Risks”

  1. It’s difficult to find experienced people about this topic, however, you sound like you know what you’re talking about! Thanks

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