Does THC have any negative interaction with SSRIs?

January 17, 2009 7:31 PM

Does THC have any negative interaction with SSRIs?

Let's say there's this guy who's been taking 20 mg of Citalopram for almost as long as they've been making it in a largely successful campaign against atypical depression. He likes to unwind after a day on the job with several pinches of nature's bounty. Yet invariably, in the first throes of the buzz, he experiences a frontal assault of morbid thoughts. He quickly recognizes it as part of the ride, shakes it off, and proceeds to enjoy the remainder of his time at the fair.

It's as if the THC is abruptly removing a levee against the chemical basis of his depression - or even having some kind of negative slingshot effect. He's reluctant to ask the prescribing physician about the phenomenon. Any knowledge out there?

posted by anonymous to health & fitness (17 comments total)

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posted by infinitewindow at 7:59 PM on January 17

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posted by onoj at 8:16 PM on January 17

I can't say specifically, nor do I have experience, but I was cautioned pretty strongly by my doc against using pot when I started taking SSRIs. I don't think it was simple anti-drug fear, either, because I've seen the same warning from a variety of sources. I have also heard that THC can both reduce and increase serotonin levels, depending on dosage.
posted by spaceman_spiff at 8:37 PM on January 17

Not an SSRI, but since I've been taking Wellbutrin XL, I have noticed a definite increase in anxiety associated with my pot smoking habits. It's gotten to the point where I'm seriously considering cutting it out altogether. I had a short stint with citalopram and did not notice the same effect, mind you. Everyone's different!

I suggest he get over himself and come clean with his doctor- they should be on the level about this because he's self medicating with weed. It undoubtedly has some effect on his condition if not his prescription.
posted by sunshinesky at 8:53 PM on January 17

I'm almost positive I read a few studies linked in a previous post of this nature on ask mefi showing a link between psychotic breaks, antidepressants and marijuana use. I have no experience in any of the areas, but I remember reading that people linked a few studies and shared anecdotal evidence and mostly agreeing that it was possible and very likely true.
posted by sanka at 8:57 PM on January 17

According to my friend, weed had no abnormal effects while taking Zoloft (an SSRI) or Wellbutrin (not an SSRI). Ecstasy, though, was not fun at all on Wellbutrin. YMMV.
posted by ludwig_van at 9:04 PM on January 17

Here's a few links that might be worth checking out:
Illict drugs and drug interactions (Erowid)
Cannabis in Medical Practice (Google Books)
Cannabis and other drugs (Drug Library)
posted by sperose at 9:10 PM on January 17

Yet invariably, in the first throes of the buzz, he experiences a frontal assault of morbid thoughts.

Holy hell, this guy needs to stop getting high. Thats not normal. Whether its caused by the drugs or by his depression is really besides the point. He should also be 100% open with his doctor about his drug use. He may not be getting the treatment he needs if he still is using pot as a crutch. Googling pubmed articles isnt going to help this guy. He needs to take responsiliby for his illness and his drug usage.
posted by damn dirty ape at 9:34 PM on January 17 [1 favorite has favorites]

He quickly recognizes it as part of the ride, shakes it off, and proceeds to enjoy the remainder of his time at the fair.

This is, quite literally, the period your brain goes through while adjusting to new and suddden circumstances. It's different for everyone. So long as the morbid thoughts don't persist, don't sweat it - you are possibly paying more attention to them than they warrant. If they do persist, however, absolutely consult someone you trust.
posted by Sparx at 10:18 PM on January 17

Plenty of people have paranoid or morbid thoughts when smoking pot *without* being on an SSRI.

Plenty of people have intrusive morbid thoughts *without* smoking pot. Especially people depressed enough to be on medication for it. (Hel-lo!)

Correlation, causation, and all that stuff. Just saying.

The usual response from a shrink would be that smoking pot is itself symptomatic of depression or some other underlying problem for which the user (or addict) is self-medicating.

If you like (or are psychologically addicted to) pot enough that you won't be swayed by your doctor telling you "we haven't studied THC enough to know how it interacts with any particular medication in any given class of patient" (which is the damn truth, and certainly for chronic users of either pot or long-term takers of SSRIs) then prepare for a standoff unless you've got a very engaged and unusual doctor who's willing to extend the already entirely empirical question of "which anti-depressant works best for you" into a domain where there are few studies to support any particular clinical approach, and no control or comparison data relevant to any particular individual patient (you). You're on your own with the THC. Any doctor will tell you it has to come out of the mix, at least for some long period of time, before you even know how it might be interacting with your meds our your brain chemistry, and *not just when you are high,* by the way. Long-term ("chronic") marijuana use has deep and far ranging effects on the brain that don't only occur when you are smoking and that interact with *any* psychotropic pharmaceutical you might use.

So it all depends on more than the moment of "morbid thoughts." Is your friend otherwise reasonably happy, functional, relational, well adjusted, and productive on the SSRI? Or are there other signs that his/her depression is still a major factor in her/his life? Has s/he ever tried other anti-depressants? Or gone off the current SSRI for an extended period of time? Can/does s/he go for long periods without smoking pot and seem basically "the same" with or without it? Or is the pot a necessary part of her/his regimen? Is s/he a daily user?

These are all questions to raise with a doctor, however, and not questions to be answered on AskMe. As usual, I find myself appalled at the use of AskMe for speculative medical diagnosis.
posted by fourcheesemac at 3:43 AM on January 18

I remember a friend of mine, fairly heavy weed smoker, starting to take Paxil in college. He called an Ask-A-Nurse service to see if there was any massive danger of mixing the two, and she said she didn't think there was. And indeed, it didn't seem to cause a problem for him. So that's one possible data-point.

However: this was years ago, it was one isolated case, and I cannot vouch for the intelligence of the nurse who "okayed" it, or even what language she used; it might have been as noncommital as "Well, it won't kill you," and my friend took that to mean "You'll be absolutely fine!" Like I said, though, it didn't seem to have a huge impact on my friend.

So yes, it's doable, and might be just peachy, but given that everyone's brain chemistry is different, I can't recommend anything more specific than just "keep an eye on your psyche."
posted by Greg Nog at 6:28 AM on January 18

(I'm bipolar lol)

And to answer your question, yes. I've experienced negative effects doing what you're doing, several times, on different SSRIs. Including, as you mentioned, really bizarre, morbid thoughts that come out of nowhere and then leave after a few minutes, which has just started happening recently. I'm taking Wellbutrin and a few other meds fwiw.

Granted, I've always thought about serious things like death, the afterlife, meaning/pointlessness etc, but these morbid ones are like little thought bubbles which have given me a 'wtf where did that come?' from moment. They pop in and I can't force them out of my mind for a minute. It's like they are these couple minute sessions just dwelling on something really morbid is totally new in my rather extensive pot smoking experience, and when I was on no medication of any kind these specific types of thoughts never happened.

As for talking to your doctor, I told my psych doc I smoke weed, he knows it and just tells me over and over again it is not good for my stability without ever giving a detailed reason why. He probably also doesn't like it because it does muddy the picture in terms of what is going on chemically. But yeah, tell your doctor. It's confidential and it's stupid not to give your treating physician all the relevant information.

I'm a chronic pot smoker. I've been self-medicating (again), and I'm being irresponsible about it. I have been having a bad time on my meds recently and have been blaming them and pretending like the pot isn't that big a deal. Sounds like you and I are in the same boat.
posted by chlorus at 6:42 AM on January 18 [2 favorites has favorites]

I've been on citalopram 20mg—30mg (dependent on season) for years. I have also been smoking pot for a few years longer than the meds prescription. There have been no side effects, other than the usual munchies, astoundingly good sex, and the usual temptation to be stoned a lot more than would be wise.

YMMV IANAD.

Feel free to memail.

[FWIW, I went off the meds this xmas. It's been almost a month. Used to be that within a couple days I'd be drowning in the black tarry pit. Not this time. I'm beginning to feel hope that the beast is dead.]
posted by five fresh fish at 9:37 AM on January 18

I agree that "self-medicating" can be bad, like if it takes a liter of bourbon daily to keep the demons away. But you sound self aware enough to know what the smoke is doing and how to deal with it. Others will say yes or no on general principles but only you know if there's a problem happening. You go to work, you come home, you relax in a way that works and is fun for you. Getting the curtain pulled back briefly on these "negative" thoughts might be good for you in that you might want to move gradually past your fear of the topic these thoughts are concerned with.
posted by Joe13 at 9:40 AM on January 18

Yeah, this is truly a YMMV situation. SSRI's can have all manner of effects-- from fighting depression to make it worse in some people. Same exact drug can have opposite effects on different people-- even on the same person at a different time.

The same seems to be true of marijuana. A few studies suggest that it can have an antidepressant effect-- and there are also people who definitely find that it makes their depression worse.

The key to avoiding addiction is recognizing whether a substance is making your life better or worse. If you are getting compulsive about using but not experiencing benefits, you need to reconsider your use.
posted by Maias at 10:21 AM on January 18 [1 favorite has favorites]

Reiterating - it depends on the person. It bumped me up into BAD mania (before I got on meds). I'm on Wellbutrin SR and have stopped rec. drugs altogether (sigh) in exchange for stable brain chemistry and stable mood.

If said person likes to unwind after work, there's medication s/he can add to the cocktail.

I've found that a glass or two of wine doesn't cause much med interference for me so that's how I get my kicks now.
posted by HolyWood at 10:45 AM on January 18

Stable brain chemistry is nice. Peeps don't know how lucky they are to have good brains.
posted by five fresh fish at 12:03 PM on January 18 [2 favorites has favorites]