ssri and smoking weed

We Asked Experts What Really Happens When You Mix Weed with Anti-Anxiety Meds

For my first year in college, weed was an old reliable for me. It was a way for me to cope with stress about grades and life in general.

But on April 26 of 2016, that all changed for me. That day, I finished my first year of university. My best friend and I bought some Headband from a guy I knew on residence. We smoked up; I had to finish his joint and that was when I had one of the worst trips of my life.

It sounds weird to say that about weed, that I had such a traumatic experience that I became afraid of something herbal and natural. I don’t know if the buds I got from my guy were laced with something (maybe smoking 1.5 grams in one sitting isn’t a good idea?) but all I remember is hallucinating. I remember seeing what looked like ghosts walk around my residence building; faint grey shadows milling about. I began feeling anxious; there was something bad was going to happen, I just didn’t know what. It was like I was trapped on one of those nauseating, forever-spinning teacup rides in Disneyland and I just couldn’t get off.

I eventually slept it off but the days following were ones that changed my life. Since the end of April till today and likely for the foreseeable future, I’ve been strapped onto the crazy roller coaster that is OCD. Intrusive thoughts, self-hatred, self-harm, never ending guilt, that’s all just the tip of the iceberg. I’ve been struggling but after much trial and error, I finally found a doctor and an anti-anxiety and anti-OCD med to help me cope.

So when a new friend handed me a pipe recently, I was apprehensive about smoking up. I was worried about my OCD getting worse and also extremely concerned of how my medication, Celexa, would interact with THC and CBD. I couldn’t afford to backslide. But I can’t lie, the temptation to take a hit was there.

For anyone else in the same boat, who takes daily medication for anti-anxiety or OCD for that matter, I wanted to look at if it’s possible for us to get the best of both worlds. As in, can we smoke up while medicated?

Selective serotonin reuptake inhibitors, or as they’re commonly known, SSRIs, are a common method of long-term treatment for many mental health issues like Generalized Anxiety Disorder and OCD. SSRIs work to increase serotonin levels in the brain.

On the other end of the spectrum, when smoking a joint, the THC (tetrahydrocannabinols) enters your bloodstream. Consumption of pot also can increase the levels of serotonin in the brain.

This all begs the question, if an SSRI and marijuana both increase levels of serotonin in the body, is this potentially dangerous? How do pot and anti-anxiety meds interact with one another?

VICE spoke to Dr. Ian Mitchell, an emergency physician at Royal Inland Hospital in Kamloops, British Columbia to get a medical perspective on this issue. Dr. Mitchell also is a Clinical Associate Professor at the UBC Department of Emergency Medicine and also works at the Medical Cannabis Resource Centre.

According to Dr. Mitchell, “there’s no known effect or interaction with those medications. We know that THC itself can bring on anxiety and paranoia. Especially in higher amounts. The cannabidiols, which is another cannabinoid, can upset that and can actually be used as an anti-anxiety treatment on its own.”

As for the medical perspective on what can occur physiologically within the body, Dr. Mitchell says, “I think that is very dependent on the person. So, it absolutely can worsen symptoms if it has THC in there. I think you also have to look at what people are currently taking as anxiety medications. When you talk about benzodiazepines for example, they are very addictive. So some people may find that marijuana can be a useful substitute and I would say that that’s not a bad trade if it helps them. But, there are certainly people out there that do have anxiety provoked from marijuana and they should avoid using it. It’s probably as simple as that.”

I was also curious if Mitchell had ever treated someone in hospital who claimed to have a bad reaction to weed while on anti-anxiety medication.

“I can’t say I’ve seen that very much. We see so few emergency presentations for marijuana. Occasionally, yeah we do see people who have smoked too much or eaten too much. Edibles are more likely where people come to the emergency because when they take edibles, they’re often taking a much higher dose and they are not prepared for it. That can cause anxiety issues,” Dr. Mitchell says.

I also spoke to Craig Jones, executive director of NORML Canada, a non-profit group lobbying for the decriminalization of marijuana, about the cocktail of marijuana, anxiety and anti-anxiety meds. He began by telling me that there are three rules of thumb to go off of here, “First, we are still in the early days of research with marijuana and anxiety. Ten years down the road from now, we will know more. I cannot predict those findings at the moment. Second, evidence suggests that people with family histories or pre-existing mood disorders like anxiety and depression should avoid all psychotropics. Third, notwithstanding the second point, many people with anxiety come into contact with harsher chemicals. On a scale that has methamphetamine, heroin and cocaine, marijuana is on the less harmful end of the spectrum. Still, refer back to the second point.”

Jones was critical of the relationship between marijuana and anxiety. “It can certainly trigger anxiety or OCD. It’s also dose-related. Two lungfuls might push you over the edge into full-blown panic attacks. The combination of pharmaceuticals and marijuana is a blackhole. We don’t know the effects. We have to be careful. The combination can be multiplicative rather than additive,” he says.

“To be honest, not a great deal of research has been done on this and I’ll tell you why. It’s very difficult to do randomized control tests because the experience of a cannabis high is a learned experience,” he added in reference to the lack of studies on the subject.

Ultimately, there appears to be no concrete verdict here. Not enough research has been done to definitively answer how marijuana and SSRIs interact. Weed itself is experienced so differently by each user that adding medication to the equation will yield a reaction that current research can’t quantify.

So, all we can really leave you with today is: user discretion is advised.

Is the combo a black hole?

Mixing Marijuana and Antidepressants: What You Need to Know

You don’t need a study to recognize that mood elevation is one of the prime reasons people consume marijuana. It is, after all, called “getting high.” Still, studies do exist, such as one in the journal Depression and Anxiety that notes that easing anxiety is among the top five symptoms for which people in North America use medical marijuana.

When a blue mood persists or anxiety is chronic, however, many people choose to take an antidepressant medication, such as fluoxetine (Prozac), citalopram (Celexa), or sertraline (Zoloft). According to the American Psychological Association , nearly 8% of people between the ages of 20 and 39 have taken prescription antidepressants in any given month.

If you’re already among this population, or you’re considering trying a prescription antidepressant and you’re a regular cannabis user, you’ll probably want to know how these meds and weeds interact. Do they enhance each other? Undermine the benefits? Are there any dangers to continuing weed use while you’re on an antidepressant?

Daniele Piomelli, Ph.D. , director of the University of California , Irvine, Center for the Study of Cannabis , said, “Truth be told, there is precious little work done” on this topic.

“There have been a few trials that looked at CBD or THC for anxiety and depression going back to the 1980s,” he said. “In general, the results have been positive, showing that cannabis has some effectiveness in countering mood disorders.” But, he added, the number of study participants was so small — just 25 in one case — “that it’s impossible to draw any medical conclusions.”

What we do know, he said, is that our built-in endocannabinoid system (ECS) plays an important role in mood regulation, including stress disorders and major depression. An endocannabinoid called anandamide, which has been dubbed “the bliss molecule,” is especially vital to our body’s ability to cope with stress in a healthy manner.

A study that Piomelli led in 2015 demonstrated that anandamide heightens motivation and happiness. Now, he’s looking at whether an anandamide deficiency might be linked to post-traumatic stress disorder (PTSD).

Synergies for Weed and Antidepressants

This research raises the prospect of synergy between marijuana and antidepressants. Could a few hits of your favorite strain along with 10 or 20 milligrams of paroxetine (Paxil) or Prozac counter distress more effectively than either alone?

“That is very possible,” Piomelli said. “We’ve certainly heard anecdotally from a lot of people that cannabis helps them with stress and depression and I have no problem believing them. But, the endocannabinoid system is a very fine-tuned, delicate machine. It’s evolved over millennia to regulate our ability to deal with stress in a positive way and it can easily be thrown off balance.”

The challenge in self-medicating with marijuana for depression or anxiety is it’s difficult to find the right dose. Too little, and there’s no impact; too much, and especially for novice users, there’s a risk of experiencing a panic attack. Without professional oversight, self-medicators also may overlook some other underlying condition.

“When physicians prescribe antidepressants or antipsychotic drugs,” Piomelli said, “they’re very careful, typically starting out with a very low dose and if that’s insufficient, increasing the dose slowly until the response is satisfactory.

“Now imagine a plant, like cannabis, that comes in a thousand different shapes and forms. You go to a dispensary and you’re relying on budmasters to help you navigate everything.” Even the most astute budmaster can’t guarantee you’ll be able to repeat the experience you had a week ago.

“Reproducibility is complicated,” Piomelli said. “Because cannabis products aren’t regulated by the FDA, you can’t count on consistency. You might find a product that is useful to you but when you go back to the same dispensary and purchase it again, the amount of THC, cannabidiol (CBD) , or other cannabinoids it contains might be slightly different and you’ll have a different response.”

One challenge to researching how cannabis might interact with antidepressant medications has been the difficulty to reproduce conditions for clinical study, argues Daniele Piomelli, Ph.D., director of the University of California, Irvine, Center for the Study of Cannabis. Any variation in the THC, cannabidiol (CBD), or other cannabinoid levels in marijuana could produce different experiences and interactions. (Gina Coleman/Weedmaps News)

How Weed Impacts Potency of Meds

There’s another knotty issue: Namely, experts don’t know how weed affects what’s known as the “pharmacokinetics” properties of antidepressant medication. That term refers to how the body absorbs, processes, and disposes of a drug.

“If cannabis consumption inhibits the metabolization of an antidepressant drug that would essentially increase its potency because there’s more of the drug hanging around the body,” Piomelli said. “This is a very important element of which we really have no understanding.” The lack of data, he said, can put physicians in danger of prescribing an inappropriate dose of an antidepressant medication. And that, in turn, could mean a delay in relieving depression or even a worsening of the symptoms.

To safeguard against this, Piomelli recommended a few things. First, have a frank conversation with your physician about your cannabis use in the past, present, and future. If your doctor isn’t open to this conversation, you’ll probably want to find one who is.

“This is something we have to work on as a society,” Piomelli said. “As a physician, your job is to help your patients feel better. Cannabis is used by millions and millions of people in the U.S. It’s now a legal product in a majority of the states. There’s no excuse for doctors not knowing how it interacts with the body.”

Still, since there’s so much we don’t know about potential interactions between antidepressants and cannabis, Piomelli said that finding the right balance between both substances takes a lot of experimentation and has to be personalized to each patient. “That might not be what people want to hear,” Piomelli said, “but it’s where we are right now.”

The Case Against Quitting Cold Turkey

Whatever you do, Piomelli said, if you decide to start taking an antidepressant, don’t quit cannabis cold turkey, especially if you’ve been a heavy user.

“The effects of cannabis withdrawal include depression, irritability, anxiety, loss of sleep and appetite, even suicidal ideation,” he said. Plus, keep in mind that it takes several weeks for antidepressants to begin working, and even longer to find the optimal dose.

If you intend to cut down your cannabis use as you introduce antidepressants, or, conversely, if you’re currently taking an antidepressant and want to see if you can lower the dose by combining it with nightly vaping, go slow on titrating the dosages of both. As much as you can, try to be consistent in the cannabis products you use.

“If you shift to another kind of cannabis with a higher or lower level of THC, you might imbalance your endocannabinoid system and lose the ability to control your symptoms or precipitate a deeper depression or greater anxiety,” Piomelli said.

You might also want to throw non-psychoactive tools into the mix, like mindfulness meditation, yoga, or tai chi.

“There are lots of things,” Piomelli said, “that don’t come in a pill and can help lift your mood and counter stress.”

Feature image: With antidepressant medication and cannabis use prevalent in segments of the population, what happens when weed and meds are combined? Health experts cannot say for certain. (Gina Coleman/Weedmaps News)

Mixing Marijuana and Antidepressants: What You Need to Know You don’t need a study to recognize that mood elevation is one of the prime reasons people consume marijuana. It is, after all, called