Can You Take CBD Oil With Antidepressants

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Learn how CBD oil and antidepressants may interact when taken together so you can decide if it’s safe to use them in tandem. According to studies, CBD has antidepressant-like properties. Does taking CBD together with conventional antidepressants make sense? Let’s find out. Before you start treating depression and anxiety with CBD, make sure you speak to a doctor about how this may interact with your medication.

Antidepressants and CBD Oil Interaction

In a recent review of data, the New York Times published that 25 million Americans have been on antidepressants for at least two years, a 60% increase from 2010. While antidepressants have helped millions of people, their efficacy as a long-term solution for managing depression and anxiety is debated due to users experiencing unwanted side effects and having difficulty getting off the medication.

CBD oil shares many beneficial qualities with antidepressants without producing the same potential for negative side effects. Using CBD oil for depression can improve sleep quality, reduce anxiety, and improve general mood. In fact, some people find that after a period of adjusting to the right dosage of CBD oil they are able to reduce, or even altogether remove, the use of antidepressants.

If you’ve considered transitioning from antidepressants to CBD oil, or are thinking about combining the two, here’s what you need to know.

Interactions Between CBD and Antidepressants

While CBD oil is generally well-tolerated and taken without side-effects, there are a few medications which, when used with CBD oil, can create adverse reactions. These interactions occur because CBD oil inhibits the cytochrome P-450 enzyme system.

The cytochrome P-450 system, found in the liver, breaks down medications into smaller substances that the body can more easily process. There are a range of natural foods and compounds that slow down this system, including grapefruit, St. John’s Wort, and of course, cannabidiol (CBD). When the system is inhibited, some medications, like monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs), remain in the system for a longer period, increasing the chance you will experience some of their unpleasant side effects.

While other antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) also use this pathway, there is no definitive evidence to suggest the same adverse reactions are likely to occur.

These stipulations are not definite, partially because there is little research published on CBD and drug interactions, and partially because CBD oil possesses anti-depressive qualities of its own.

Side Effects of CBD Oil and Antidepressants

While it’s rare for adverse interactions to occur between CBD oil and antidepressants, you should still seek the advice of your physician or psychiatrist before combining the two.

Additionally, combining CBD oil with TCAs or MAOIs can put you at increased risk of experiencing the adverse side effects of the antidepressant. This is because these older groups of antidepressants have been shown to interact negatively with a range of medications and consumables, including those that inhibit the P-450 enzyme system. As such, there is a greater potential for an unfavorable interaction with CBD oil.

Knowing what potential interactions may occur will enable you to be aware of any warning signs. For reference, the table below breaks down the most common antidepressant medications and their side effects, many of which you may feel more keenly if a negative interaction occurs with CBD oil.

Antidepressant Type Brands Include Common Drug Side Effects Possible Side Effects of Combining Medication + CBD Oil
SSRIs Zoloft; Prozac; Sarafem; Celexa; Lexapro; Paxil; Luvox Nausea; insomnia; nervousness; tremors; decreased libido The effectiveness of SSRIs should not decrease when combined with CBD oil
SNRIs Pristiq; Khedezla; Cymbalta; Fetzima; Effexor XR Nausea; drowsiness; fatigue; constipation; dry mouth The effectiveness of SNRIs may be decreased when combined with CBD oil
TCAs Anafranil; Norpramin; Tofranil; Pamelor; Surmontil Constipation; dry mouth; fatigue. May also result in low blood pressure and irregular heart rate Due to the high-risk of adverse side effects when combining TCAs with other medications the use of CBD oil is not advised
NDRIs Wellbutrin; Forfivo; Aplenzin Nausea; vomiting; constipation; dizziness; blurred vision The effectiveness of NDRIs may be decreased when combined with CBD oil
MAOIs Marplan; Nardil; Emsam; Parnate Nausea; dizziness; drowsiness; insomnia; restlessness Due to the high-risk profile of MAOIs in producing adverse reactions it is not advised to combine with CBD oil

Avoiding the Side Effects

Given the above list of potential side effects, you may feel discouraged from using CBD oil if you take antidepressants. However, many people actually go on to replace their antidepressants with CBD oil completely. As well as its’ host of other health benefits, CBD oil has been shown to relieve anxiety, encourage relaxation, and improve mood.

To learn more about taking CBD to manage depression, head over to our guide: Depression and CBD Oil: Benefits, Effectiveness, and Dosage.

How to Safely Take CBD and Antidepressants Together

When combining CBD oil and antidepressants, or replacing current medication with CBD oil, it is always recommended to seek medical advice. Together, you and your doctor can create a plan to ensure there is minimal disruption to your system.

To minimize the risk of adverse reactions between CBD and antidepressants it is recommend that you start with a lower dose of CBD than what your product recommends and incrementally increase the dosage over time if needed. This will allow you to get used to the effects of CBD, and also allow you to decrease your antidepressant strength, if desired. Ultimately, starting slow and being conservative with dosage will allow you to more easily monitor any changes to your body and mental state.

To find information on CBD dosage, including how to find the right starting dose for your needs, read the CBD Oil Dosage Guide. You can also get more personalized help by speaking with a naturopathic doctor who specializes in using CBD oil to treat medical conditions.

Safest CBD Oils to Take with Antidepressants

Choosing the best CBD oil product can seem a daunting task. With thousands of products on the market, the range of options can leave you overwhelmed before you even start. Here are our tips for finding the safest CBD oils to take with antidepressants.

First, choose what type of CBD delivery method you’d like to use according to your needs and lifestyle. CBD oil comes in a number of forms including flower, capsules, vapes, edibles, and drops.

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CBD oil vapes and drops/tinctures provide the fastest effects while capsules and edibles must pass through the digestive system, slowing down their onset. However, when matching dose-for-dose, an edible will typically yield longer lasting effects than CBD oil drops, and drops will typically yield longer lasting benefits than a vape.

After you’ve decided which type(s) of delivery format you’d like to use, you’ll need to decide on a brand to buy your CBD product from. Search for high-quality CBD companies, which will use organically grown and sustainably sourced hemp and perform third-party lab tests on their products.

Testing by independent laboratories is the only way to ensure you’re receiving the best quality CBD oil, free from any added herbicides, pesticides, or chemicals. A trustworthy company will post the resulting lab reports, called Certificates of Analysis, on their site, or make them readily available to consumers.

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.

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?

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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.

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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Can you take CBD when you’re on antidepressants? What you need to know

The UK has the second largest market for CBD in the world – after the US – with a current value of around £690 million. It’s estimated that the market will be worth a whopping £1 billion by 2025.

CBD (short for cannabidiol) comes from the cannabis plant, and is one of over 110 chemical compounds called cannabinoids that are found in the plant.

These compounds interact with cannabinoid receptors in the brain and body as part of its endocannabinoid system, which helps balance things like pain, memory, mood and appetite.

Can CBD help with anxiety and depression?

Many people take CBD in the form of oil tinctures, capsules or gummies, to help alleviate symptoms of anxiety and depression.

A study on 103 patients with anxiety found that ingesting CBD capsules helped decrease anxiety symptoms in 79% of subjects, as well as improving sleep.

Another study following 90 people with depression revealed that 53% felt better overall after self-medicating with CBD oil, and 93% didn’t observe any negative side effects of taking CBD.

While research is limited, due to the high costs associated with clinical studies, results do look promising.

‘Sadly most studies on CBD are small scale, due to the high costs associated with clinical studies,’ explains Professor Mike Barnes, consultant neurologist, medical cannabis expert and advisor to hapihemp.

‘However, there is an increasing amount of “real world” evidence regarding the efficacy and safety of CBD for anxiety in particular, as well as insomnia and epilepsy, though there’s slightly less evidence regarding depression.’

What are potential interactions of CBD with antidepressants?

‘Commonly with antidepressants, it might be that CBD-based products will make other medications more or less effective,’ advises Dr Hana Patel, private GP and mental health coach.

‘This can cause unwanted side effects such as increased drowsiness, confusion and dizziness, for example.’

There are a couple of reasons for this – firstly, CBD side effects can include drowsiness, dry mouth, dizziness and diarrhoea, which can also be unwanted effects of antidepressants (who doesn’t love a bit of sertraline cotton mouth, eh?). So, you’re potentially doubling up on side effects, which may be unpleasant.

Secondly, CBD has the potential to affect the concentration of your medication.

‘Generally, antidepressants are metabolised in the liver, and CBD can affect liver enzymes,’ explains Professor Barnes.

‘With some drugs it can speed up metabolism (thus reducing the amount in the blood) or in other cases it can slow down metabolism (thus building up more in the blood).’

Research shows that CBD may inhibit the liver enzymes that metabolise most prescription meds, in the same way that grapefruit is thought to.

One study found that CBD minimally affected metabolism of common antidepressants fluoxetine, mirtazapine and sertraline, in vitro (in test tubes). However, significant interactions were observed in patients taking citalopram, with CBD causing higher concentrations of the drug in the body, though researchers couldn’t confirm whether this also increased SSRI-related side effects.

Another study in adolescents showed that even small doses of CBD could increase levels of sertraline and citalopram, raising the risk of concentration-related side effects.

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Can you get CBD from your doctor?

Currently, you can only be prescribed cannabis-based medicine – both on the NHS and privately – by a specialist doctor, and only for certain conditions like epilepsy and MS, or for chemotherapy side effects. FYI, it’s actually incredibly rare to get a medical cannabis prescription on the NHS.

The cannabis products prescribed by doctors are not the same as the ones available to purchase, which are classed as food supplements and aren’t legally allowed to make any health claims.

Thankfully, this year the Food Standards Agency (FSA) took steps to regulate the UK’s murky CBD market, becoming the first country in the world to do so. Before, you often didn’t know if the product you were splashing cash on was legit or contained what it said it did.

Now, you can check if a product in the UK is FSA-approved, by searching UK CBD List. A worrying three quarters of products submitted to them didn’t meet approval, so it’s well worth checking your products.

The Medical Cannabis Clinicians Society also recommends buying from CBD Shopy, Savage Cabbage and Mellow.

There are all sorts of products on the market – but make sure you’re getting your CBD from a reputable source (Picture: Getty Images)

Always speak to your GP before self-supplementing with CBD while on medication

A study of 90 people self-medicating with CBD while on antidepressants found that only 19% consulted their doctor before taking it. Over half never told their doctor that they were supplementing with CBD.

While interactions do appear to be minimal, they can’t be ruled out, so it’s imperative you tell your GP if you plan on taking store-bought CBD at the same time as prescription meds.

‘I often have patients ask me questions about this as they choose to self-medicate with preparations obtained from unregulated sources,’ says Dr Patel.

‘I encourage patients to tell me about other medications that they may be taking in conjunction with their prescription medications, in order to avoid potentially dangerous drug interactions.

‘Whilst it is an individual’s decision to take CBD-based medicinal products that have not been prescribed by a doctor, I would recommend getting advice from your GP first.’

Their advice might be something as simple as taking CBD at a different time of day to your meds, but it’s best to check as different antidepressants carry different risks, and no two humans are the same.

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