User perspectives on cannabis and SSRIs as treatment for depression
Publication date: 17 January 2020
The purpose of this paper is to explore the qualitative relationship between cannabis and the most commonly used antidepressant drugs known as selective serotonin reuptake inhibitor (SSRIs) through the narratives of depressed individuals who have used both drugs at one point during their lifetime. Despite their prevalence, depression, cannabis use, and SSRI use have not been previously studied together through the perspective of those who have experienced them. Using a exploratory approach, this paper investigates and compares the user experiences of these drugs.
Semi-structured interviews were conducted involving participants who were between the ages of 16–59 in the UK and have used both SSRIs and cannabis either simultaneously or at any point in their lives. Five interviews were conducted either via telephone or in person, and the method of analysis was an inductive approach which was inspired by grounded-theory.
While the two drugs were used by participants in order to relieve symptoms of depression, they were used for very different reasons and typically at different stages of their lives. Though participants did not state that the drugs were interchangeable for improving mood, their responses indicated that these drugs were viewed as two alternatives to alleviate symptoms of depression. Participants’ relationships with their doctors also played a crucial role and affected interviewees’ decisions to use either SSRIs or cannabis, as well as perceptions of the medical industry.
This research shows the importance of doctor and patient interactions as they were crucial influences on patients’ decisions related to drugs. Participants’ experiences with SSRI and cannabis were subjective and varied, therefore, the value of personalised treatment (which may or may not include psychotropic drugs) is highlighted. These findings can help health practitioners gain a better understanding of the rationale of depressed patients in choosing treatments and thereby improve healthcare outcomes.
Given that depression is stigmatised, and cannabis use is both illegal and stigmatised, this paper examines the opinions of a difficult to reach population. Previous work involving cannabis, antidepressants and mood-elevating effects is primarily written with a biochemical or medical perspective which paid more focus on the efficacy of these drugs and had less emphasis on the beliefs of the users. This paper highlights the opinions of cannabis and SSRI users regarding these two drugs specifically, which had not been previously explored.
- Selective serotonin reuptake inhibitors
There are no conflicts of interest or external sources of funding to declare.
Castañeda, J. (2020), “User perspectives on cannabis and SSRIs as treatment for depression”, Drugs and Alcohol Today, Vol. 20 No. 1, pp. 74-83. https://doi.org/10.1108/DAT-08-2019-0038
Emerald Publishing Limited
Copyright © 2020, Emerald Publishing Limited
User perspectives on cannabis and SSRIs as treatment for depression – Author: Judy Castañeda
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.
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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.