Can You Take CBD Oil With Antidepressants

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When taking CBD and antidepressants together the side effects may be amplified. Neither CBD nor the medication will have the ideal effect Learn more about CBD interactions with drugs and how to stay safe when you use CBD for pain or other symptoms. According to studies, CBD has antidepressant-like properties. Does taking CBD together with conventional antidepressants make sense? Let’s find out.

Can I take CBD oil with antidepressants like Prozac?

What interactions are there between CBD oil and antidepressants like Prozac? Can you take CBD oil with antidepressants at all?

Avik Das (Wednesday, June 16, 2021):

If you take antidepressants like Prozac and CBD simultaneously, then it might lead to unwanted and irksome side effects, which might not be a good decision. With a light dose, it might give decent results but still, it wouldn’t be a very safe option. To battle depression issues, a high-quality CBD oil could get the job done without side effects.

Osasere Okunloye (Sunday, September 26, 2021):

CBD and most antidepressants are metabolised by the same liver enzyme, called CYP450. CBD inhibits some of these enzymes, makes them break down these antidepressants slowly, and this may lead to increased side effects. To take CBD with any medication, you should see a doctor. Your doctor may be able to dose the medications in a way that wouldn’t cause any interaction.

Petal Mashraki (Thursday, January 13, 2022):

Always consult your doctor before taking CBD and prescription medication simultaneously! When taking CBD and antidepressants together the side effects may be amplified. Neither CBD nor the medication will have the ideal effect. It could all depend on the dose. Your doctor can recommend the best dose, and type of CBD to go with your medication.

Does CBD Have the Potential to Replace Antidepressants?

Pure CBD oil, which has no THC, can be utilized as a natural means of treating depression. When used in conjunction with medicinal mushrooms, such as Cannabotech’s M2CBD mix, body’s Endocannabinoid system could be supported and aid in the fight against depression.

Products like Boost Drops and Uplift Drops can help keep you afloat when your depression starts to overtake you.

Does CBD Interact or Interfere with Medication? What Arthritis Patients Must Know Now

CBD (cannabidiol) is seemingly everywhere, with oils, tinctures, pills, chocolates, gummy bears, and creams available all over the internet, at national drugstore chains, and perhaps at your local farmer’s market — even if you don’t live in a state where medical or recreational marijuana is legal.

CBD, a type of chemical known as a cannabinoid, is a mainingredient in hemp, one type of cannabis plant. Marijuana, another type of cannabis plant, also has some CBD but an abundance of THC (tetrahydrocannabinol), an intoxicating cannabinoid known for making users feel “stoned” or “high.” While CBD won’t get you high, it interacts with cannabinoid receptors in your body and may have effects that are sought by people with arthritis, such as pain relief, reduced inflammation, and improvements in sleep and anxiety.

According to CreakyJoints research presented at the 2019 Annual European Congress of Rheumatology meeting earlier this year, 52 percent of respondents reported having tried CBD for a medical reason. Of those who did, 93 percent said it helped. More than half said they wanted more information on CBD from their doctor, but 58 percent of those who told their doctors about their CBD use did not get the information on safety, effectiveness, and dosing they were looking for.

One common concern among people with chronic illness who use CBD is whether CBD can interfere with prescription drugs you may take for arthritis or other conditions.

We put commonly asked questions to Nina M. Bemben, PharmD, BCPS, a specialist in drug interactions who is trying to educate other pharmacists about possible drug-drug interactions with CBD, as well as Rachna Patel, DO, a physician who does consultations about medical marijuana and CBD and sells her own line of CBD products.

What kind of drug interactions can happen with CBD?

A huge number of medications, including CBD, are broken down by the same large family of liver enzymes, called CYP450.

CBD inhibits some enzymes in this family. This makes them break down certain drugs more slowly, which could potentially increase side effects unless your doctor adjusts the dose. On the other hand, CBD induces other enzymes in this family, which speeds the breakdown of certain drugs so they may potentially be less effective unless the dose is increased.

As examples, you may experience increased side effects if CBD is used along with these drugs:

  • Antidepressants (such as fluoxetine, or Prozac)
  • Medications that can cause drowsiness (antipsychotics, benzodiazepines)
  • Macrolide antibiotics (erythromycin, clarithromycin)
  • Heart medications (some calcium channel blockers)

“There is still a lot of uncertainty about how CBD interacts with drug-metabolizing enzymes in the body. We know that there are some drug-metabolizing enzymes that are affected by CBD, some that are not, and many others where we just don’t have any information yet,” says Dr. Bemben.

What do we know for sure about CBD’s interactions with other drugs?

The most direct information comes from studies on the only FDA-approved CBD product, Epidiolex, which is used to treat rare forms of epilepsy. Epidiolex has been found to increase blood levels of the blood thinner warfarin about 30 percent, which raises the risk of bleeding. It also interacts with other medications used for epilepsy.

“The manufacturer of Epidiolex was asked by the FDA to conduct more drug-drug interaction studies, so we will learn more about CBD’s interactions with other drugs in the future,” says Dr. Bemben.

Can CBD interact with medications I take specifically for arthritis?

“Based on what we know now about the way CBD is metabolized, I would not expect significant drug-drug interactions with drugs commonly used in arthritis treatment, such as methotrexate, and most nonsteroidal anti-inflammatory drugs (NSAIDs). I would advise caution on one NSAID, diclofenac, because there isn’t information on how CBD affects — if at all — the enzyme that metabolizes it,” says Dr. Bemben.

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Rheumatologists are always on the alert for liver problems that may result from arthritis medications, and that includes CBD as well as NSAIDs and methotrexate.

Are older people more at risk of CBD drug interactions?

Yes, for several reasons. “As we age, our livers and kidneys may be slower to eliminate drugs from the body. In addition, older patients and those with chronic health problems are more likely to be using multiple medications, so the risk for drug interactions increases,” says Dr. Bemben.

Dr. Patel worries in particular about any side effects or interactions that result in dizziness and may increase the risk of falls in the elderly. For example, using the antidepressant fluoxetine together with cannabis products can increase dizziness and drowsiness.

Are there some people who should stay away from CBD?

Hold off if you have known liver damage, says Dr. Patel. In a study done on mice published earlier this year, the dose of CBD used to protect against seizures was found to induce liver damage. According to other animal research, CBD may increase levels of liver enzymes, raising concerns about liver toxicity in patients taking methotrexate.

“We use other therapies that cause liver injury, like nonsteroidal anti-inflammatories (NSAIDs). If liver enzymes go up in someone on methotrexate, we would generally hold the drug other than methotrexate [for example, CBD or an NSAID] to see if the enzyme levels normalize,” says Michael Weinblatt, MD, professor of medicine at Harvard Medical School in Boston.

People who take Epidiolex for epilepsy are more likely to develop abnormal liver enzymes, as well as sleepiness and other symptoms, if they are also using valproic acid to control seizures.

“This is important for people with arthritis to know because valproic acid is sometimes used for pain that isn’t controlled by other medications,” says Dr. Patel.

If I stick with a CBD cream, does that reduce the risk of drug interactions?

Probably, since little if any of a topical product is likely to be absorbed into your system. “Unfortunately, we just don’t have good information about how much of a topical CBD product gets absorbed. This can be influenced by the inactive ingredients in the product, where on the body it’s applied, and whether you apply a bandage over the area after applying it,” says Dr. Bemben.

While topical CBD products may not be absorbed deeply enough to raise concerns about drug interactions, that also means they may not be as effective for arthritis pain. “If you just have one joint hurting and it’s close to the surface, using a topical would be appropriate. It’s not as likely to help a hip or other deep joint,” says Dr. Patel.

Which health professionals need to know I’m trying CBD?

Tell your rheumatologist and anyone else who prescribes medication for you. If you need surgery, an anesthesiologist may choose a different dose or type of anesthesia if you’re using CBD.

“If you fill all of your medications at the same pharmacy, your pharmacist will be able to assess for drug interactions for all of them, regardless of who prescribed them. You should still let the pharmacist know about over-the-counter medications, herbs, and supplements — including CBD — that you don’t get through the pharmacy. It is important to bring the CBD product to your doctor and pharmacist so they can check the amount of CBD and other ingredients it contains,” says Dr. Bemben.

“While patients may be wary of stigma surrounding CBD products, I believe most health care providers understand this is a growing area and one strategy patients are trying in hopes of getting relief,” she says.

Is there an online source I can use to figure out which of my medications might interact with CBD?

Online databases are available to help health professionals evaluate potential drug-drug interactions, at a price. “Freely available resources tend to be less reliable, and this highlights the importance of discussing all your medications, including CBD, with your doctor and pharmacist,” says Dr. Bemben.

One source available to patients is drugs.com, where you can plug in either cannabidiol (which will give you the FDA-approved oral product Epidiolex) or cannabis (which will give you both THC and CBD) and check for possible interactions with other medications you take.

Has anyone had a life-threatening drug interaction with CBD?

“There haven’t been reports of serious drug-drug interactions with over-the-counter CBD products. However, these products are relatively new and it typically takes time for reports to be published. We have very little information about over-the-counter CBD products and how they may interact with other drugs,” says Dr. Bemben.

CBD and Antidepressants: Can You Take Them Together?

Depression has many faces, but it’s usually characterized by mood disorders, persistent feelings of sadness, and loss of satisfaction from previously enjoyed activities.

It rarely stems from a single event but rather as the combination of many factors, both individual and environmental ones. The symptoms of depression can range from mild to severe.

Depression can be treated with psychotherapy or with the use of medicines, although the most benefits are experienced by combining these two methods.

Since conventional antidepressants can have undesired side effects, people are starting to explore alternative remedies that are derived from nature — such as CBD.

CBD is a major cannabinoid found in hemp plants. It supports the endocannabinoid system (ECS) and helps maintain homeostasis throughout the body. Recent studies also show that CBD has anxiolytic and antidepressant-like properties.

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In this article, we cover the topic of CBD and antidepressants; we’ll break down the pros and cons of each substance, compare their safety profiles, and explain what happens when you take them together.

Is CBD Good for Depression?

There is no single cure for depression because it’s a disease caused by multiple factors — and these factors often affect different areas of your life. There are many contributors to depression, including poor stress management, sleep deprivation, the loss of someone close or other traumatic events, and more.

There is some scientific evidence that CBD can alleviate the symptoms of depression, although these results haven’t been yet replicated in large-scale clinical trials.

Nevertheless, at least several high-quality studies have outlined CBD’s ability to help us cope with the whole set of symptoms and mental health problems commonly experienced together with depression.

Addressing these secondary conditions can indirectly improve your management of depression — lifting up your daily life.

Benefits of CBD for Depression

Depression is often accompanied by low mood, anxiety, apathy, and the loss of interest in activities that a person had considered joyful prior to their diagnosis.

Hopefully, CBD may help regulate certain processes in your body that can reduce the severity and frequency of these symptoms.

Here’s how you can use CBD for depression.

CBD May Reduce Anxiety

There’s a growing body of evidence to support the hypothesis that CBD has anxiolytic (anti-anxiety) properties in many individuals.

CBD has been studied in many types of anxiety disorders, including PTSD, obsessive-compulsive disorder, panic disorder, social phobias, and fear of public speaking.

One mechanism that helps CBD achieve such positive effects is the activation of the GABA receptor. GABA is the primary inhibitory neurotransmitter in our bodies; in simple words, it works like a hand brake for the brain — preventing neuroexcitation. Higher levels of GABA and lower levels of glutamate are associated with a better response to stress and lower levels of anxiety.

Another way CBD can help alleviate anxiety is by interacting with serotonin receptors in the brain. Serotonin is another important neurotransmitter that controls emotions, mood, and feelings of happiness. Low levels of serotonin are linked to depression, and while CBD isn’t a direct serotonin booster, it can block its reuptake so that the body can use it more efficiently — resulting in an elevated mood.

CBD May Improve Mood and Reduce Stress

As mentioned earlier in the article, CBD interacts with the endocannabinoid system (ECS). The ECS is the major regulatory system in all mammals, helping the body achieve and maintain homeostasis.

Homeostasis is a scientific term for the balance between all vital functions performed by other systems and organs. The ECS regulates memory, mood, pain perception, emotional processing, fertility, body temperature, appetite, sleep cycles, and more.

Anandamide, one of the two major endocannabinoids (endo = produced in the body) has a major role in the regulation of mood and pain threshold. Poor anandamide signaling can lead to a worse response to stress and cause a low mood. Permanent anandamide deficiencies may even result in anxiety disorders and depression.

That’s why anandamide has been dubbed as the “bliss molecule” in sanskrit.

CBD can improve anandamide signaling and slow down its breakdown by inhibiting the Fatty Acid Amino Hydrolase (FAAH) enzyme. As a result, your body can achieve higher and more stable concentrations of anandamide — improving your mood and reactions to stressors.

CBD Contributes to Neurogenesis

Studies have shown that CBD can stimulate the formation of new neurons in the brain, improving the plasticity of the hippocampus. The hippocampus is an important region in the brain that controls our cognitive performance, emotions, and mood.

Improved neuroplasticity of the hippocampus has been associated with better cognitive performance and a lower frequency of suicidal thoughts in patients with depression.

Can You Take CBD and Antidepressants Together?

“Antidepressants” is an umbrella term that covers a wide range of different products that use different mechanisms to treat depression. However, one common feature shared by all classes of antidepressants is that they are metabolized by the liver before they can start working in your body.

The liver contains a number of different enzyme systems that facilitate chemical reactions. One of these systems is the cytochrome P450 (CYP450) enzymes that metabolize the majority of medications, including antidepressants.

CBD has demonstrated potent inhibitory actions on these enzymes, suggesting that there could be interactions between CBD and antidepressants.

What kind of interactions are they? Does taking CBD and antidepressants together mean they produce a stronger effect? Or, as a result of that inhibitory mechanism, maybe they shouldn’t be taken at the same time?

What May Happen When You Take CBD with Antidepressants

CBD is generally considered safe, but it’s one thing when you take it alone, and the other thing when you combine it with other substances, such as antidepressants.

The most common side effects of CBD include lightheadedness, dry mouth, sedation, and (rarely) diarrhea. Taking CBD with other medications that have similar side effects may increase the likelihood of unwanted symptoms or toxicity.

Doubling Up On Side Effects

To put it simply, taking CBD at the same time with substances that cause sleepiness, such as benzodiazepines, antipsychotics, antidepressants, or alcohol may lead to increased fatigue, sleepiness, and possibly accidental accidents when driving.

Increased sedation may also occur when you combine CBD with other herbal supplements, such as melatonin, St. John’s wort, and kava.

Taking CBD together with stimulants — like Adderall — may lead to decreased appetite, while interactions between CBD and the diabetes drug metformin or certain heartburn medications may increase the risk of diarrhea.

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CBD Can Alter the Effects of Antidepressants

Since CBD interferes with the enzymes in the liver that break down many drugs, including antidepressants, their interactions may lead to insufficient concentrations of the drug in the body — resulting in a subtherapeutic effect.

Depending on the type of interaction, CBD may also increase the drug concentration in your bloodstream, inducing toxicity and increased risk of side effects.

Researchers from Penn State College of Medicine analyzed existing data on five cannabis-based medications. Overall, the team found 139 medications that may be affected by cannabinoids. They further narrowed down that list to 57 medications, for which altered concentrations can be hazardous.

Among these medications, the researchers identified blood thinners, heart rhythm medications, thyroid drugs, and several medications for seizures.

However, antidepressants weren’t included in that list.

Does the Form of CBD Matter In CBD-Drug Interactions?

Inhaled CBD enters the blood the fastest, reaching peak levels within 30 minutes and increasing the chances of acute side effects.

CBD edibles for anxiety need more time to be processed in the digestive system and are less likely to produce high concentration levels. However, they may eventually reach high enough levels to interact with other medications.

Topical formulations are the safest from that trio because they do not absorb and reach the bloodstream; therefore, they can’t interact with other medications.

The problem with estimating the likelihood of CBD-drug interactions is the lack of regulations regarding CBD products, which may cause issues with purity, concentration, or safety.

That’s why reading third-party lab reports is critical if you want to make a well-informed decision when choosing your CBD product. These reports analyze the entire chemical profile of the tested sample, including its purity levels.

Common Antidepressants and Their Risks

Since there are different classes of antidepressants, some demonstrate a higher risk when taken with CBD oil than others.

Selective Serotonin Reuptake Inhibitors (SSRIs)

This is the most common type of antidepressant that doctors prescribe. They work similarly to CBD in the way they block the reabsorption of serotonin into the brain, leading to higher concentrations in the bloodstream and improved mood.

Common SSRI’s include:

  • Citalopram
  • Escitalopram
  • Fluoxetine
  • Paroxetine
  • Sertraline
  • Vilazodone

The reason why SSRIs are the go-to treatment for depression is that they generally have fewer side effects than other antidepressants. Taking CBD with SSRIs would cause similar effects, as is the case for all antidepressants belonging to a specific drug category.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

They use a similar mechanism to SSRIs and entail the same level of risk, but some individuals may tolerate them better than others.

Common SNRIs include:

  • Desvenlafaxine
  • Duloxetine
  • Levomilnacipran
  • Venlafaxine

Tricyclic Antidepressants

These drugs work by increasing levels of serotonin and norepinephrine in the brain. They can be very effective but also entail a higher risk than other antidepressants. For that reason, they’re only prescribed when SSRIs or SNRIs haven’t been working.

Common tricyclic antidepressants include:

  • Amitriptyline
  • Desipramine
  • Imipramine
  • Nortriptyline
  • Trimipramine

Wrapping It Up: Talk to Your Doctor Before Taking CBD with Antidepressants

CBD may have more benefits in the long term than conventional antidepressants. One of the main reasons why people choose CBD instead of these treatments is that it doesn’t cause the user to build up dependencies on it.

CBD can exhibit the same degree of antidepressant effects but without getting you addicted to it.

Even though there’s no clinical evidence that would recommend the use of CBD as the go-to treatment for depression, it’s only a matter of time before such studies will start emerging on the surface.

Taking CBD and antidepressants together can lead to certain interactions that can change the way both substances are metabolized in the liver. Despite the lack of hard evidence that CBD directly interacts with antidepressants, there’s a well-grounded belief that taking them at the same time presents some concerns.

If you want to make sure you get the right CBD dosage and avoid potential interactions with antidepressants, consult your doctor before buying CBD oil.

References:

  1. Pretzsch, C.M., Freyberg, J., Voinescu, B. et al. Effects of cannabidiol on brain excitation and inhibition systems; a randomised placebo-controlled single dose trial during magnetic resonance spectroscopy in adults with and without autism spectrum disorder.Neuropsychopharmacol. 44, 1398–1405 (2019). https://doi.org/10.1038/s41386-019-0333-8 [1]
  2. Sales, A. J., Crestani, C. C., Guimarães, F. S., & Joca, S. (2018). Antidepressant-like effect induced by Cannabidiol is dependent on brain serotonin levels. Progress in neuro-psychopharmacology & biological psychiatry, 86, 255–261. https://doi.org/10.1016/j.pnpbp.2018.06.002 [2]
  3. Leweke, F. M., Piomelli, D., Pahlisch, F., Muhl, D., Gerth, C. W., Hoyer, C., Klosterkötter, J., Hellmich, M., & Koethe, D. (2012). Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. Translational psychiatry, 2(3), e94. https://doi.org/10.1038/tp.2012.15 [3]
  4. Beale, C., Broyd, S. J., Chye, Y., Suo, C., Schira, M., Galettis, P., Martin, J. H., Yücel, M., & Solowij, N. (2018). Prolonged Cannabidiol Treatment Effects on Hippocampal Subfield Volumes in Current Cannabis Users. Cannabis and cannabinoid research, 3(1), 94–107. https://doi.org/10.1089/can.2017.0047 [4]
  5. Brown, J. D., & Winterstein, A. G. (2019). Potential Adverse Drug Events and Drug-Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use. Journal of clinical medicine, 8(7), 989. https://doi.org/10.3390/jcm8070989 [5]
Nina Julia

Nina created CFAH.org following the birth of her second child. She was a science and math teacher for 6 years prior to becoming a parent — teaching in schools in White Plains, New York and later in Paterson, New Jersey.

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