Despite this, Grinspoon explains that this is typically not a large cause of concern for a majority of people on antidepressants or other psychiatric medications. “Certainly, if someone is on a very delicately balanced medical regiment, CBD could knock that out of whack because of the two different enzyme systems it inhibits. In terms of actual clinical practice, I haven’t heard any stories of people having clinical decompensation because of adding CBD to their regime,” he says.
The reason for this is that CBD inhibits two main enzyme systems, Grinspoon explains. Enzymes are proteins that speed up chemical reactions in the body, and play an important role in functions like digestion and respiration. They also help you metabolize antidepressants. “One system is the same one that grapefruit inhibits — the technical name is the CYP34A enzyme system. So, just like grapefruit juice, CBD can cause your body to have higher doses of benzodiazepines [anti-anxiety medications], or certain antipsychotic medications,” Grinspon explains.
According to statistics from the National Alliance on Mental Illness (NAMI), one in five U.S. adults live with a mental illness in any given year. Furthermore, as NBC News reported, a 2016 study revealed one in six people in the U.S. take some type of psychiatric medication, with antidepressants being the most widely prescribed. Limited research has shown that CBD may help alleviate symptoms of anxiety and sleep issues, as well as lower levels of inflammation in the body, though this research (and the dosages needed for these effects) is nowhere near conclusive. And that means you need to be careful if you’re choosing to consume it.
What’s more, Grinspoon says that CBD also inhibits “the system that metabolizes a lot of serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and antipsychotics as well.” Meaning, taking CBD supplements while on these psychiatric medications could hypothetically interfere with how these medications are metabolized.
Readers should note that the regulations and data surrounding marijuana, CBD, and other related products are still developing. As such, the information contained in this post should not be construed as medical or legal advice. Always consult with your doctor before trying any substance or supplement.
So, what can potentially happen if you take CBD oil and antidepressants? Unfortunately, because there’s a limited amount of studies to draw from, Grinspoon says, “CBD does have hypothetical drug interactions; the question is whether these are clinically important or not.”
There’s no denying that CBD, aka cannabidiol, has been the reigning trend of the last few years, and shows no signs of stopping. From edible products and tinctures, to bath and beauty products, CBD was (and is) everywhere. Though touted as a natural, holistic, and safe way to manage a variety of health issues, you may be wondering if you can take CBD and antidepressants together. And while CBD is touted as an all-natural supplement with some evidence that it can be good for your health, it’s possible that your CBD latte can still impact the efficacy of different medications — including antidepressants.
“Generally speaking, you can safely use CBD supplements when you’re taking antidepressants. However, there are a couple of concerns,” Dr. Peter Grinspoon, M.D., an instructor in medicine at Harvard Medical School, and the author of the memoir Free Refills: A Doctor Confronts His Addiction, tells Bustle. “The first concern is that CBD isn’t regulated by the FDA. You have to be careful that the CBD you’re getting is from a reliable supplier. For example, Consumer Reports recently put out an article on how to go shopping for CBD because they’ve done tests, and found some [supplement] formulations had no CBD. Some were inaccurately labeled, and other formulations even had some THC in them.” (THC is the cannabis compound that, unlike CBD, can get you high.)
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.
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.
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.
Are there some people who should stay away from CBD?
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.
“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.
Is there an online source I can use to figure out which of my medications might interact with CBD?
“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.
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.
CBD has the potential to interact with many other products, including over-the-counter medications, herbal products, and prescription medications. Some medications should never be taken with CBD; the use of other medications may need to be modified or reduced to prevent serious issues. The consequences of drug interactions also depend on many other factors, including the dose of CBD, the dose of another medication, and a person’s underlying health condition. Older adults are more susceptible to drug interactions because they often take multiple medications, and because of age-related physiological changes that affect how our bodies process medications.
The researchers further warned that while the list may be used as a starting point to identify potential drug interactions with marijuana or CBD oil, plant-derived cannabinoid products may deliver highly variable cannabinoid concentrations (unlike the FDA-regulated prescription cannabinoid medications previously mentioned), and may contain many other compounds that can increase the risk of unintended drug interactions.
Absolutely. Inhaled CBD gets into the blood the fastest, reaching high concentration within 30 minutes and increasing the risk of acute side effects. Edibles require longer time to absorb and are less likely to produce a high concentration peak, although they may eventually reach high enough levels to cause an issue or interact with other medications. Topical formulations, such as creams and lotions, may not absorb and get into the blood in sufficient amount to interact with other medications, although there is very little information on how much of CBD gets into the blood eventually. All of this is further complicated by the fact that none of these products are regulated or checked for purity, concentration, or safety.
Products containing cannabidiol (CBD) seem to be all the rage these days, promising relief from a wide range of maladies, from insomnia and hot flashes to chronic pain and seizures. Some of these claims have merit to them, while some of them are just hype. But it won’t hurt to try, right? Well, not so fast. CBD is a biologically active compound, and as such, it may also have unintended consequences. These include known side effects of CBD, but also unintended interactions with supplements, herbal products, and over-the-counter (OTC) and prescription medications.
Does the form of CBD matter?
Researchers from Penn State College of Medicine evaluated existing information on five prescription CBD and delta-9-tetrahydrocannabinol (THC) cannabinoid medications: antinausea medications used during cancer treatment (Marinol, Syndros, Cesamet); a medication used primarily for muscle spasms in multiple sclerosis (Sativex, which is not currently available in the US, but available in other countries); and an antiseizure medication (Epidiolex). Overall, the researchers identified 139 medications that may be affected by cannabinoids. This list was further narrowed to 57 medications, for which altered concentration can be dangerous. The list contains a variety of drugs from heart medications to antibiotics, although not all the drugs on the list may be affected by CBD-only products (some are only affected by THC). Potentially serious drug interactions with CBD included
Many drugs are broken down by enzymes in the liver, and CBD may compete for or interfere with these enzymes, leading to too much or not enough of the drug in the body, called altered concentration. The altered concentration, in turn, may lead to the medication not working, or an increased risk of side effects. Such drug interactions are usually hard to predict but can cause unpleasant and sometimes serious problems.
While generally considered safe, CBD may cause drowsiness, lightheadedness, nausea, diarrhea, dry mouth, and, in rare instances, damage to the liver. Taking CBD with other medications that have similar side effects may increase the risk of unwanted symptoms or toxicity. In other words, taking CBD at the same time with OTC or prescription medications and substances that cause sleepiness, such as opioids, benzodiazepines (such as Xanax or Ativan), antipsychotics, antidepressants, antihistamines (such as Benadryl), or alcohol may lead to increased sleepiness, fatigue, and possibly accidental falls and accidents when driving. Increased sedation and tiredness may also happen when using certain herbal supplements, such as kava, melatonin, and St. John’s wort. Taking CBD with stimulants (such as Adderall) may lead to decreased appetite, while taking it with the diabetes drug metformin or certain heartburn drugs (such as Prilosec) may increase the risk of diarrhea.
CBD can alter the effects of other drugs
People considering or taking CBD products should always mention their use to their doctor, particularly if they are taking other medications or have underlying medical conditions, such as liver disease, kidney disease, epilepsy, heart issues, a weakened immune system, or are on medications that can weaken the immune system (such as cancer medications). A pharmacist is a great resource to help you learn about a potential interaction with a supplement, an herbal product (many of which have their own drug interactions), or an over-the-counter or prescription medication. Don’t assume that just because something is natural, it is safe and trying it won’t hurt. It very well might.