Is there any reason I shouldn't be smoking weed while taking Citalpram (Celexa)?
November 24, 2010 7:57 AM   Subscribe

Is there any reason I shouldn't be smoking weed while taking Citalpram (Celexa)?

Between the age of 22 and 28 I smoked a lot of weed; between 3-5 joints a day. I stopped as a result of really bad anxiety and panic disorder.

I'm 35 now, and have smoked pot on occasion, and then usually only enough to relax me. I was taking fluoxetine for anxiety for the past two years, but about 4 months ago switched to Citalopram, which has less side effects for me. I recently smoked weed again with my girlfriend, who is new to it, and enjoys the relaxed buzz from time to time.

I would never again smoke as heavily as I did in my twenties, but I find myself really enjoying the kind of relaxed, mindless feeling from the occasional few puffs. I'm in my fifth year at university, writing a novel and a screenplay, so if nothing else, I cannot afford to out of my bracket on a regular basis. and really, I would not want to be.

I'm wondering if anyone has some experience with the combination of Citalopram and pot, and whether these have been positive or negative. Information greatly appreciated.
posted by anonymous to Health & Fitness (12 answers total) 3 users marked this as a favorite
No reason to stop, if anything Citralopram potentiates.

posted by unixrat at 8:03 AM on November 24, 2010

i'm in my twenties, on citalopram and smoke weed semi-frequently. it's never caused a problem for me and is definitely more enjoyable than it was before i started the meds a year or so ago. seems (for me) to boost the anxiolytic effect of the meds, even.
posted by tealsocks at 8:06 AM on November 24, 2010

It's not dangerous, if that's what you're asking.

If you were to ask my psychiatrist, she would tell you that smoking pot will counteract the beneficial effects of an SSRI, so you shouldn't do it at all. Everyone is different, so my advice would be to keep a close eye on your symptoms and see if they get worse when you've smoked pot in the preceding week or so. If they do, smoke less or stop altogether, and see if you get better. Eventually you should develop a pretty good idea of what you can get away with.
posted by shponglespore at 8:17 AM on November 24, 2010 [3 favorites]

I've been using both for over five years. Never had a problem. As unixrat says, enjoy!
posted by pineappleheart at 8:35 AM on November 24, 2010

Perhaps I am naive, but this sounds like something the prescribing physician should be aware of, and they could advise you on the effects.
posted by grouse at 9:07 AM on November 24, 2010 [1 favorite]

More anecdata. Been on Celexa (10mg) for two years. Don't smoke up that often, but when I do, I've been just fine. But yes, as shponglespore said, everyone's brain is different, especially when it comes to anxiety.
posted by mykescipark at 9:16 AM on November 24, 2010

Citalpram's active isomer (sold as Lexapro/Cipralex) and weed do not mix well for me. I definitely saw an uptick in my anxiety for a few days after I got high.

Try it and see; in my experience, you'll know for sure whether it works for you.
posted by infinitewindow at 10:12 AM on November 24, 2010

IANYD, but as a physician my main concern with marijuana aside from the obvious potential to cause cancer in the long term (like anything else you smoke) is that it has been proven to be a risk factor for the development of schizophrenia and psychosis, especially in the long term.

For people who have some existing level of mental health issue, this risk may be heightened, depending on what the issue is. The mechanism of development of psychosis/schizophrenia is not fully understood, and the relationship is complex, because people who begin to experience psychotic symptoms such as delusions and hallucinations may then start to smoke more pot. However, the potential outcome of schizophrenia is devastating enough that it gives me pause about smoking pot, rare as that outcome may be.
posted by treehorn+bunny at 10:44 AM on November 24, 2010 [1 favorite]

As a biologist researching cannabinoids, I'd love to see some links to credible papers "proving" cannabis is a risk factor for schizophrenia and psychosis. This Lancet review seems to be the most widely cited basis for your belief, but what does it really prove? There's a correlation, but how about a proposed mechanism that can actually be studied?

The mentally ill consume a lot of drugs, weed included. 90% of schizophrenics smoke cigarettes, for instance, and almost all of them started smoking before they were diagnosed. There's even a dose-response effect (there are many, many more chain smoking schizophrenics than chain smoking neurotypicals). Is this proof that cigarettes cause schizophrenia?

I think it's much more likely that people with mental illness self-medicate in an attempt to alleviate their symptoms, so of course they're more likely to use cannabis (or cigarettes, or alcohol, caffeine, or whatever else they can get their hands on) before they're diagnosed and are put on FDA-approved drugs.
posted by Thoughtcrime at 12:54 PM on November 24, 2010 [3 favorites]

Oh, and there's also very little evidence linking smoking cannabis with increased cancer rates. There are carcinogens in anything you might smoke, but when what you're smoking is a substance that inhibits cancer cell proliferation, induces cancer cell apoptosis, and impairs tumor angiogenesis, the overall effect might be to actually reduce the risk of getting cancer, or at least counteract any potential harm from inhaling those carcinogens.
posted by Thoughtcrime at 1:02 PM on November 24, 2010

Here's the quote from the Lancet review article:
"The evidence is consistent with the view that cannabis increases risk of psychotic outcomes independently of confounding and transient intoxication effects, although evidence for affective outcomes is less strong. The uncertainty about whether cannabis causes psychosis is unlikely to be resolved by further longitudinal studies such as those reviewed here. However, we conclude that there is now sufficient evidence to warn young people that using cannabis could increase their risk of developing a psychotic illness later in life."

People don't understand how or why schizophrenia happens, so how do you expect them to understand this link? There are people who argue that evolution hasn't been 'proven', either, you know. It's hard to prove things in science, especially if it's not what you want to believe.

I agree with your point that people with mental illness self medicate, absolutely, but the people who do these studies do their best at taking this into account, such as by comparing sibling pairs.

Here's another one (J Psychopharmacol. 2005 Mar;19(2):187-94. Cannabis as a risk factor for psychosis: systematic review. Semple DM, et al.)
"Early use of cannabis did appear to increase the risk of psychosis. For psychotic symptoms, a dose-related effect of cannabis use was seen, with vulnerable groups including individuals who used cannabis during adolescence, those who had previously experienced psychotic symptoms, and those at high genetic risk of developing schizophrenia. In conclusion, the available evidence supports the hypothesis that cannabis is an independent risk factor, both for psychosis and the development of psychotic symptoms. Addressing cannabis use, particularly in vulnerable populations, is likely to have beneficial effects on psychiatric morbidity."

Here's another one. (Encephale. 2009 Sep;35(4):377-85. Epub 2008 Jul 9.
[Cannabis and psychosis: search of a causal link through a critical and systematic review] Le Bec PY, et al.)
"The objective of this article was to examine whether cannabis use can be an independent risk factor for chronic psychotic disorders, by using established criteria of causality. Data extracted from the selected studies showed that cannabis use may be an independent risk factor for the development of psychotic disorders. Early screening of the vulnerability to psychotic disorder should permit improved focus on prevention and information about the specific risks related to cannabis use among this population."

I think it's interesting that you come along criticizing the "lack of evidence" for my position, but then counter by putting forward a position that is far more radical and unsupported, like that smoking pot might reduce the risk for cancer. There may not be strong evidence linking smoking pot to cancer, but the scant evidence there is supports the opposite position. That is off topic.

I also have an anecdote. I've had a short career as a physician so far, but I've already seen two young people in their 20s coming in with acute psychotic breaks after smoking marijuana that day. Maybe they started having acute psychosis and immediately ran out to get some pot to try to self-medicate, I don't know, but it certainly was sad and scary. That's the main reason I posted an answer to this question.
posted by treehorn+bunny at 6:04 PM on November 24, 2010

Pot seems to make people anxious. They may not know it at the time, and maybe the duration of the buzz is super mellow time, but general anxiety and discomfort with real life always seems higher to me. No pun intended.

and treehorn+bunny is right, mixing psychoactive drugs is not a good plan. Maybe the likelihood that pot causes psychotic breaks is 1 in 100,000,000, do you want to be that person? How do you know your pot isn't laced with PCP or something? Etc.
posted by gjc at 7:03 PM on November 24, 2010

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