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We Asked Experts What Really Happens When You Mix Weed with Anti-Anxiety Meds

For my first year in college, weed was an old reliable for me. It was a way for me to cope with stress about grades and life in general.

But on April 26 of 2016, that all changed for me. That day, I finished my first year of university. My best friend and I bought some Headband from a guy I knew on residence. We smoked up; I had to finish his joint and that was when I had one of the worst trips of my life.

It sounds weird to say that about weed, that I had such a traumatic experience that I became afraid of something herbal and natural. I don’t know if the buds I got from my guy were laced with something (maybe smoking 1.5 grams in one sitting isn’t a good idea?) but all I remember is hallucinating. I remember seeing what looked like ghosts walk around my residence building; faint grey shadows milling about. I began feeling anxious; there was something bad was going to happen, I just didn’t know what. It was like I was trapped on one of those nauseating, forever-spinning teacup rides in Disneyland and I just couldn’t get off.

I eventually slept it off but the days following were ones that changed my life. Since the end of April till today and likely for the foreseeable future, I’ve been strapped onto the crazy roller coaster that is OCD. Intrusive thoughts, self-hatred, self-harm, never ending guilt, that’s all just the tip of the iceberg. I’ve been struggling but after much trial and error, I finally found a doctor and an anti-anxiety and anti-OCD med to help me cope.

So when a new friend handed me a pipe recently, I was apprehensive about smoking up. I was worried about my OCD getting worse and also extremely concerned of how my medication, Celexa, would interact with THC and CBD. I couldn’t afford to backslide. But I can’t lie, the temptation to take a hit was there.

For anyone else in the same boat, who takes daily medication for anti-anxiety or OCD for that matter, I wanted to look at if it’s possible for us to get the best of both worlds. As in, can we smoke up while medicated?

Selective serotonin reuptake inhibitors, or as they’re commonly known, SSRIs, are a common method of long-term treatment for many mental health issues like Generalized Anxiety Disorder and OCD. SSRIs work to increase serotonin levels in the brain.

On the other end of the spectrum, when smoking a joint, the THC (tetrahydrocannabinols) enters your bloodstream. Consumption of pot also can increase the levels of serotonin in the brain.

This all begs the question, if an SSRI and marijuana both increase levels of serotonin in the body, is this potentially dangerous? How do pot and anti-anxiety meds interact with one another?

VICE spoke to Dr. Ian Mitchell, an emergency physician at Royal Inland Hospital in Kamloops, British Columbia to get a medical perspective on this issue. Dr. Mitchell also is a Clinical Associate Professor at the UBC Department of Emergency Medicine and also works at the Medical Cannabis Resource Centre.

According to Dr. Mitchell, “there’s no known effect or interaction with those medications. We know that THC itself can bring on anxiety and paranoia. Especially in higher amounts. The cannabidiols, which is another cannabinoid, can upset that and can actually be used as an anti-anxiety treatment on its own.”

As for the medical perspective on what can occur physiologically within the body, Dr. Mitchell says, “I think that is very dependent on the person. So, it absolutely can worsen symptoms if it has THC in there. I think you also have to look at what people are currently taking as anxiety medications. When you talk about benzodiazepines for example, they are very addictive. So some people may find that marijuana can be a useful substitute and I would say that that’s not a bad trade if it helps them. But, there are certainly people out there that do have anxiety provoked from marijuana and they should avoid using it. It’s probably as simple as that.”

I was also curious if Mitchell had ever treated someone in hospital who claimed to have a bad reaction to weed while on anti-anxiety medication.

“I can’t say I’ve seen that very much. We see so few emergency presentations for marijuana. Occasionally, yeah we do see people who have smoked too much or eaten too much. Edibles are more likely where people come to the emergency because when they take edibles, they’re often taking a much higher dose and they are not prepared for it. That can cause anxiety issues,” Dr. Mitchell says.

I also spoke to Craig Jones, executive director of NORML Canada, a non-profit group lobbying for the decriminalization of marijuana, about the cocktail of marijuana, anxiety and anti-anxiety meds. He began by telling me that there are three rules of thumb to go off of here, “First, we are still in the early days of research with marijuana and anxiety. Ten years down the road from now, we will know more. I cannot predict those findings at the moment. Second, evidence suggests that people with family histories or pre-existing mood disorders like anxiety and depression should avoid all psychotropics. Third, notwithstanding the second point, many people with anxiety come into contact with harsher chemicals. On a scale that has methamphetamine, heroin and cocaine, marijuana is on the less harmful end of the spectrum. Still, refer back to the second point.”

Jones was critical of the relationship between marijuana and anxiety. “It can certainly trigger anxiety or OCD. It’s also dose-related. Two lungfuls might push you over the edge into full-blown panic attacks. The combination of pharmaceuticals and marijuana is a blackhole. We don’t know the effects. We have to be careful. The combination can be multiplicative rather than additive,” he says.

“To be honest, not a great deal of research has been done on this and I’ll tell you why. It’s very difficult to do randomized control tests because the experience of a cannabis high is a learned experience,” he added in reference to the lack of studies on the subject.

Ultimately, there appears to be no concrete verdict here. Not enough research has been done to definitively answer how marijuana and SSRIs interact. Weed itself is experienced so differently by each user that adding medication to the equation will yield a reaction that current research can’t quantify.

So, all we can really leave you with today is: user discretion is advised.

Is the combo a black hole?

How Cannabis Interacts With Mental Health Medication

Today, marijuana law is still lingering around in a grey area, despite a growing number of patients using cannabis for medicinal relief. To date, there are still no recorded deaths related to marijuana, yet it might dangerously interact with a patient’s prescribed mental health medication.

Before diving right into the potential interactions of combining cannabis with pharmaceuticals, first we should understand what’s in cannabis. Each variety or strain of marijuana contains hundreds of compounds, many of which are medicinal. The most important and abundant medicinal ingredients in cannabis are compounds called cannabinoids, with THC and CBD being the most abundant constituents. Whether psychoactive or non-psychoactive, marijuana comes in many varieties, so this is why the cause and effect needs to be carefully monitored.

EFFECTS OF MARIJUANA ON MENTAL HEALTH

For most patients, marijuana is relatively safe and can make one feel more relaxed, less stressed, and of course, happier. However, its use can also result in a range of adverse mental health effects. Some individuals are more vulnerable than others to experiencing negative effects on high doses of marijuana, especially those with a personal or family history of mental illness. There are some cases where cannabis has the potential to decrease the potency or effectiveness of other drugs. For example, one may feel overly sedated when consuming cannabis with a sedative.

Doctors prescribe medication for different mental issues to bring relief from the unpleasant symptoms that a patient may be experiencing. Continuing marijuana use while taking prescribed medications may cause unpredictable reactions and/or worsen a patient’s condition. It may also make it difficult for one’s prescribing doctor to properly diagnose. Being aware of which pharmaceutical drugs shouldn’t be taken in combination with cannabis will allow for a safer and more enjoyable experience. Below are the most common drugs people combine with marijuana.

CANNABIS INTERACTIONS WITH ANTIDEPRESSANTS

Surprisingly, despite years of investigative research between cannabis use and mental disorders, there have been few studies published that closely examine how it interacts with antidepressants. Nonetheless, today, it’s likely that newer antidepressants carry a low to moderate risk for contraindications, while older antidepressants carry a much higher risk. Those suffering from depression are usually prescribed antidepressants belonging to one of four main groups.

Tricyclics:
  • Allegron
  • Anafranil
  • Tryptanol
  • Imipramine
  • Prothiaden
Selective Serotonin Reuptake Inhibitors (SSRIs):
  • Zoloft
  • Aropax
  • Cipramil
  • Prozac
  • Luvox
Monoamine Oxidase Inhibitors (MAOIs):
  • Aurorix
  • Nardil
Newer antidepressants:
  • Avanza
  • Effexor
  • Edronax

There has been little conducted research on the effects of using marijuana while taking prescribed antidepressant medication, however, there have been reports of numerous contraindications. Symptoms include:

  • Rapid heart rate
  • Dizziness
  • Anxiety
  • Panic
  • Drowsiness
  • Nausea
  • Mental confusion
  • Headache
  • Muscle twitching
  • Gastrointestinal distress

Using marijuana while on antidepressants can be potentially dangerous, as it can intensify any or all of these side effects, making a patient’s condition even worse. This is also very similar with sedatives. Alcohol or drugs like Ativan, Valium, and other antidepressants work to produce a calming effect when interacting with the neurotransmitters in the central nervous system. The problem here is that cannabis can also have a sedative effect at different degrees of intensity, depending on cannabinoid content. Mixing cannabis with antidepressants can result in a major central nervous system depression. It’s been advised that cannabis users exercise caution when using sedative drugs, as the combination can be extremely risky.

CANNABIS INTERACTIONS WITH ANTIPSYCHOTICS

Antipsychotic medications work as tranquilisers and are most effective in treating people who have had psychotic episodes, hallucinations, and delusions associated with schizophrenia and other psychotic disorders. Some common antipsychotic medications people use include:

  • Zyprexa
  • Seroquel
  • Abilify
  • Geodon

Cannabidiol has many therapeutic attributes as a safe and non-addictive cannabis compound, however it’s interactions may be problematic in some cases. When consumed, the way cannabidiol interacts with enzyme cytochrome P450 is pivotal; in essence, they deactivate each other. At sufficient doses, this compound consumed along with certain antipsychotics can intensify a drug and may cause increased side effects or potentially serious adverse reactions.

Marijuana alters the metabolism when interacting with drugs broken down by cytochrome P450 enzymes in the liver. These enzymes are found in certain classes of antipsychotics that function to metabolise potentially toxic compounds in the body. Unfortunately, once cannabidiol interacts with these enzymes, it prevents the proper breakdown of the drugs. This is why people with schizophrenia can experience severe depression, which may need to be treated. Users should be watchful of these symptoms:

  • Excessive sedation
  • Slow motor skills
  • Decreased cognitive function
  • Confusion
  • Impaired driving

WHAT YOU CAN DO

Using marijuana while taking certain medications can have adverse side effects, which may cause symptoms to become more severe and difficult to manage in the long-term. Remember that medications are prescribed to make people feel better. It has been suggested by research that those who seek counseling can greatly improve their chances of giving up or cutting down their marijuana use while taking medication. If you use marijuana regularly and also take prescribed medications, or know someone who does, the following things may help:

  1. Be honest with your doctor: Before prescribing, make him/her aware of your marijuana use, both how frequent and how much you’re using.
  2. Time matters: Give your medication a chance to take effect, as it can take up to six weeks or more.
  3. Listen to your body: If there are any serious complications experienced when consuming prescription medication and marijuana together, seek help from a healthcare professional to determine what is best for you.

EACH PERSON IS DIFFERENT

Even if avoiding cannabis for an extended period of time may sound inconceivable to some, it may need to be given up (at least temporarily) if it poses dangerous health risks when combined with another drug. However, cannabis itself is experienced differently by each user. Consequently, adding prescriptions to the equation will more than likely cause unique reactions in people that current research can’t exactly quantify.

Marijuana is known to treat a number of diseases, but despite this, using it with prescribed medications can cause unpredictable interactions.