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can weed cause serotonin syndrome

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In 2017, the National Institutes of Mental Health reported that a staggering 17.3 million adults, or 7.1% of all American adults had at least one major depressive episode in that year. Of that number, 65% of those folks received support from a health professional, medication or both. Surprisingly, a whopping 35% had no treatment whatsoever.

Because of the difficulty in accessing mental health care, stigmas about disclosing mental illness and the high cost for treatment and medication, it’s not surprising that some people turn to cannabis to help manage their depression.

Many often take marijuana alongside antidepressant medications. But is this safe? Let’s examine the information currently available so that you can make safe, informed choices.

What Are SSRIs & How do They Work?

Selective Serotonin Reuptake Inhibitors (SSRIs) are often prescribed for depression. These medications include:

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil, Pexeva)
  • Sertraline (Zoloft)
  • Vilazodone (Viibryd)

Serotonin is a neurotransmitter that carries chemical signals through the brain’s nerve cells. It has many important functions, including:

  • Balancing mood
  • Regulating sleep cycles
  • Managing digestion
  • Aiding memory
  • Controlling sexual function

The brain and the intestines produce serotonin, and it’s found throughout the body. Though scientists don’t yet know what causes depression, it’s widely believed that imbalances of the body’s neurotransmitters, particularly low levels of serotonin, are significant factors. SSRIs work by blocking the body from reabsorbing serotonin, making it more available for neurotransmission.

But as many people with depression will attest to, SSRIs aren’t a global fix for depression. There’s currently no way to measure the serotonin levels in the brain, and scientists don’t yet know whether SSRIs added to the bloodstream actually increase serotonin levels in the brain.

Folks Are Already Experimenting With Marijuana for Depression

Because of side effects and the sometimes-limited effectiveness of SSRIs, a significant number of people are substituting cannabis for a variety of antidepressant medications.

According to a 2017 study of 2,774 individuals who had taken cannabis in the previous 90 days, 12.7% of respondents stated they were consuming cannabis as a substitute for antidepressants.

The Medical Community Is Split on How Safe It Is to Mix Marijuana & SSRIs

Some doctors feel strongly that cannabis and antidepressants aren’t a good mix, primarily because you’re combining two medications that may both have psychoactive effects. Is it your Prozac, your Purple Haze or a panic attack that’s causing your increased heart rate? At this point, there’s virtually no way to tell.

However, other physicians, including Dr. Richard Kim, have a different point of view, noting that small amounts of cannabis can be beneficial to those with depression when taken strategically and carefully.

Dr. Kim cites two studies which point to the importance of consuming low doses of cannabis when addressing depression. Because heavy cannabis consumers can become less sensitive to dopamine, the pleasure-pain neurotransmitter, too much marijuana use can sometimes lead to increased depressive symptoms.

The second study points to a research project where researchers gave high doses of tetrahydrocannabinol (THC) to animals, which resulted in reduced serotonin.

Though humans may react differently, both studies point to a simple rule of thumb: When consuming cannabis to augment SSRIs or address symptoms of depression without medication, less is definitely more.

Can Cannabis & SSRIs Increase the Risk of Serotonin Syndrome?

Dr. Kim also notes that both THC and cannabidiol (CBD) can inhibit the enzymes that are involved with metabolizing SSRIs. This could create the possibility of a rise in SSRI serum, which can lead to Serotonin Syndrome, a potentially life-threatening condition when the body has too much serotonin.

Fortunately, for those experimenting with CBD, Dr. Kim explains that it would require an extremely high amount of CBD to produce this dangerous condition.

Some patients using SSRIs also have concerns about their long-term effects on the liver. Because cannabis is considered to be neuroprotective, there’s currently no evidence pointing to any connection between cannabis consumption and liver toxicity.

Tips for Combining Cannabis & SSRIs Safely

When consuming cannabis as an adjunct treatment for any disorder, it’s imperative to work with your doctor, disclose your cannabis consumption and seek out products that have been regulated and tested, so that you can be confident you’re consuming a safe, clean product.

If you’re taking antidepressants and wish to incorporate cannabis into an overall wellness program, be sure to start very slowly and document your results. If you’re a cannabis consumer interested in trying antidepressants, talk it over with your doctor and if you have one, your therapist or mental health practitioner.

Because there has been very little research on the interaction between marijuana and SSRIs, it’s important to know what some of the risks may look like. These risks are low-to-moderate for those taking SSRIs, but increase markedly for patients using other types of antidepressants.

Here are a few tips to help you decide if you should combine SSRIs and cannabis:

  • Tell your doctor/counselor about your plans to try SSRIs and marijuana.
  • Don’t try to add cannabis to a new SSRI prescription until you’ve fully adjusted to your medication and are on a stable dosage.
  • Conversely, if you’re already consuming cannabis and adding an SSRI to your wellness program, consider stopping cannabis consumption until you’ve adjusted to your dosage.
  • Closely document your cannabis consumption. Journal the type of product you’re taking, the dosage and how often you consume it.
  • Start or resume your cannabis regime slowly, even if you’re a seasoned consumer. Try microdosing to ensure a safe, smooth transition.
  • Remember that low doses of cannabis are far less likely to result in negative side effects.
  • Remember that cannabis isn’t a one size fits all product. What works for a friend or relative may not work for you, and that’s perfectly OK.

And always remember to reach out to friends, family or your mental health professional if you feel that your depressive symptoms are getting the best of you.

Photo credit: panitanphoto/Shutterstock.com

If you’re new to cannabis and want to learn more, take a look at our Cannabis 101 index of articles. And if you have questions about cannabis, ask them and our community will answer.

  • Depression
  • Health Conditions

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Many folks take marijuana and SSRIs, but is this safe? Let’s look at the science behind combining cannabis and SSRIs so that you can make informed choices.

Does cannabis interact with antidepressants or lithium?

Cannabis and antidepressants

Cannabis or marijuana can interact with tricyclic antidepressants (TCAs), such as amitriptyline, imipramine and dothiepin.

Both cannabis and TCAs can cause an abnormally fast heartbeat (tachycardia) and high blood pressure (hypertension). There’s also a risk of other side effects, such as confusion, restlessness, mood swings and hallucinations.

There’s a risk that using cannabis while you’re on any of these medicines could lead to problems such as tachycardia, even if you don’t already have a heart condition.

Little research has been done into the interaction of cannabis with other types of antidepressants, such as SSRIs.

Cannabis and lithium

Lithium is used to treat bipolar disorder, a condition where people can switch between depression and extreme excitement and agitation (mania).

There’s little evidence to suggest that people who use cannabis should normally not take lithium, but this hasn’t been properly researched.

Side effects of cannabis

It’s not clear how often cannabis itself can cause anxiety or depression, but research suggests this can happen.

It’s therefore recommended that if you’re anxious or depressed and you use cannabis regularly, you should try giving up and see if that helps.

Tachycardia, dizziness, anxiety, drowsiness, nausea and vomiting, difficulty sleeping and confusion are all possible side effects of cannabis.

These side effects can also be caused by certain antidepressants, so using cannabis at the same time can make them worse.

Getting advice

If you have any concerns about the medicines you’re taking, talk to your GP or pharmacist.

You can also phone NHS 111 or Talk to Frank, a friendly confidential drugs helpline, on 0300 123 6600.

Further information:

  • Antidepressant drugs
  • Can I drink alcohol if I’m taking antidepressants?
  • Depression
  • Medicines information

Page last reviewed: 27 March 2018
Next review due: 27 March 2021

Cannabis or marijuana is usually smoked and typically mixed with tobacco. It can interact with certain types of antidepressants, such as tricyclic antidepressants (TCAs), which share similar side effects. ]]>