Can Marijuana Impact Efficacy Of Serotonin Drugs?
May 23, 2020 9:36 AM   Subscribe

I have OCD, anxiety and depression. I'm working with a new Dr who specializes in OCD. I'm not getting better and he thinks that the marijuana may be the problem. Is this lazy psychiatry?

I smoke at night and it helps me sleep. I've had all of my symptoms before I used marijuana and during. I personally doubt that that is the issue.

I'm also up to 250mg on Zoloft which seems higher than normal...

Thank you in advance
posted by kbbbo to Health & Fitness (10 answers total) 1 user marked this as a favorite
So, for any psychiatrist it does help to get a baseline without meds if at all possible (including recreational drugs), because it's hard to know if the other stuff is impacting it. It might not be, but it might be . My not-a-physician instinct would guess that it's not, but that doesn't rule it out either.

So in terms of the doctor asking to subtract instead of adding another med or going up in dose at this point isn't unreasonable. But, also psychaitry is one of those things were doctors throw different things at stuff because different combinations work differently for different people. It's not uncommon for any particular SSRI to not work for no particular discernable reason. There's usually some trial and error and dose adjustment to do.

Are you willing to stop smoking? If you are not, you need to let him know so they can work with you around that. Lots of people who use marijuana take all kinds of different medicines, I can't think of anything off hand he couldn't perscribe . If you are willing to stop, it doesn't hurt to do what they asked, though you may want to ask what else he suggests for sleep before you stop.

If you don't feel your psychiatrist listens or works with you, there are psychiatrists who are supportive people who will listen and can explain their concerns in detail to you. It's okay to try and look for another doctor of this one isn't working (though I suggest not leaving this one until you've established a new provider).
posted by AlexiaSky at 10:03 AM on May 23, 2020 [1 favorite]

Because of the stupid federal ban on research, there's very little published science about interactions between marijuana and treatments for things like OCD. So no, this isn't "lazy" because they affect similar parts of the brain and could definitely be interacting. Marijuana and SSRIs are both very poorly understood and have very different effects on different people, so it is completely possible it could be stopping a treatment from working. It's more likely that they aren't interacting, though, given your history.

Like everything else with psychiatric drug treatment, you have to keep trying things until you find what works for you. If there's something else that seems promising you can try that first. Or have you considered maybe switching to CBD oil as an experiment? That would remove the THC from the equation and maintain some of the sleep benefits.
posted by JZig at 10:06 AM on May 23, 2020 [5 favorites]

If you are paying someone to use his knowledge of the brain to help find ways to make yours work better, it does not make a ton of sense to second-guess him. Bring it up with him, by all means, but if you're going to keep seeing him, you have to try the stuff he tells you to try or what are you paying him for?
posted by less of course at 10:17 AM on May 23, 2020 [8 favorites]

Yes. Both affect dopamine.
posted by kerf at 10:48 AM on May 23, 2020 [6 favorites]

Pot may not have caused it, but yes, it could be making it worse. Pot does not relax everyone, for some it makes them more anxious.
posted by schroedinger at 10:54 AM on May 23, 2020 [10 favorites]

Given the fact that it can, in some people and some strains, cause or increase all of those, along with sleep issues, it's actually very reasonable for your doctor to want to remove that variable, at minimum as a temporary measure.

I know that isn't what you want to hear, but one more thought to put it in perspective: being unwilling or confrontational about trying medication without marijuana suggests that it's use may be less medical and more physical/emotional/mental dependence.

Anecdotally, I personally know entirely too many people who choose to continue to - or return to - self-medication even when they've taken the time to discover other options are more effective for them. Medication to stabilize so one *can* work through therapy to move forward is often more difficult, especially initially, than self-medicating and stumbling through life.
posted by stormyteal at 11:30 AM on May 23, 2020 [4 favorites]

OP here.

I have been up front with him about my reliance/dependence and the idea of not smoking making me anxious. We've agreed to slowly taper down and when I am ready, to quit for a bit
posted by kbbbo at 11:32 AM on May 23, 2020 [1 favorite]

I’ve relied on a very knowledgeable psychiatrist for years and every time (and there have been a lot) I bring up a mood altering drug he says "Things are already confused enough. You probably shouldn’t mess with it." That covers from marijuana to salvia to MDMA and many more.
posted by Tell Me No Lies at 12:05 PM on May 23, 2020 [1 favorite]

Where are you sourcing your cannabis, and do you know it's levels of THC vs CBD? Meaning, are you buying on the street, at a dispensary, or (I assume not) growing yourself?

One of the many benefits to an open legal system is knowing what you are getting and not all cannabis is even close to being the same.

I am a daily user with anxiety issues, and while I prefer a higher THC for my creative uses, I usually take a CBD in the evening to help with staying asleep. That and doing everything I can in the day to tire myself.
posted by terrapin at 10:11 AM on May 24, 2020

Is it possible for you to get a consult from a doctor associated with a dispensary who may actually know how tge marijuana you take is interacting with your other meds? They might be able to recommend MMJ (or just THC or just CBD) specifically to help with insomnia and/or your mental illnesses.
posted by epj at 1:47 PM on May 24, 2020

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