CBD Gummies And Zoloft

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What happens when someone takes Zoloft and marijuana at the same time? Here are the side effects and reactions can occur between these two substances. Zoloft (Sertraline) is used to treat depression and other mental conditions. Read here to know the interaction between CBD and Zoloft. In our latest question, our cannabis pharmacist discusses whether using CBD alongside the antidepressant medication sertraline is safe.

Marijuana and Zoloft: Interactions, Effects, & Reactions

By The Recovery Village | Editor Melissa Carmona
Medically Reviewed By Dr. Jessica Pyhtila, PharmD A licensed behavioral health or medical professional on The Recovery Village Editorial Team has analyzed and confirmed every statistic, study and medical claim on this page. | Last Updated: May 25, 2022

Though not enough research has been conducted on marijuana and Zoloft interactions, people combining these two substances may experience intensified side effects.

When you take a prescription medication, particularly one intended for long-term use, it’s important to be aware of any possible interactions, effects, and reactions that may come with its use. One example of a long-term medication that’s commonly prescribed is Zoloft.

Zoloft is a prescription antidepressant, and people frequently wonder how it might interact with other substances or what the potential side effects may be. Here is more information about one substance in particular: marijuana, what interactions, effects, and reactions it may have with Zoloft.

Article at a Glance:

  • Marijuana and Zoloft interactions may be mild.
  • Marijuana may worsen anxiety and amplify Zoloft’s side effects.
  • At this time, there has not been much research conducted on marijuana use with Zoloft.

Combining Marijuana and Zoloft

At this time, there is no known drug interaction between marijuana and Zoloft. Little research has been done on the topic of marijuana and antidepressant interactions. However, how a person will react to combining the substances can be difficult to predict. Because the THC content of marijuana can worsen anxiety, someone taking Zoloft for anxiety or a panic disorder may have worsened symptoms if they take marijuana, especially if it has a high THC content or they take a high dose.

That said, there could be some other negative consequences to taking both substances together. They share some similar side effects, including nausea and dizziness. Taking both substances at the same time may intensify these side effects.

It can also be difficult to determine if Zoloft is working when you’re also using marijuana. It may make the Zoloft appear less effective when, in reality, it’s the marijuana and Zoloft interaction you’re experiencing. Your doctor will likely recommend that you abstain from using marijuana when you’re first prescribed Zoloft, so they will be able to determine how well it’s working to treat your symptoms.

What is Marijuana Used For?

Marijuana is legal for medical use in many states, and recreationally in a few. Some people use marijuana to treat mood disorders like depression and anxiety. One of the main components of marijuana, cannabidiol, or CBD, may be beneficial in anxiety. However, another main component of marijuana, tetrahydrocannabinol, or THC, is linked to mood problems, including psychosis, especially when used in large amounts. Cannabis use disorder is common in people with depression and may contribute to the development of depression.

What is Zoloft Prescribed For?

Zoloft is a prescription medicine that’s FDA-approved to treat mood problems like depression and anxiety. The generic name is sertraline, and it’s a selective serotonin reuptake inhibitor or an SSRI. The way Zoloft and other SSRIs work is by increasing the level of serotonin in the brain, which improves mood. This can also help with sleep problems and boost energy levels.

When someone is first prescribed Zoloft, the doctor will likely start them on the lowest possible dose that will treat symptoms but minimize side effects, and over time the dose may be adjusted as needed. Some of the common side effects of Zoloft can include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Nervousness
  • Dizziness
  • Sexual problems
  • Weight changes

Zoloft tends to be more likely than other SSRIs to cause diarrhea. In younger people, it may create severe side effects such as suicidal tendencies.

Zoloft and many other SSRIs may interact with other drugs such as monoamine oxidase inhibitors, or MAOIs. It’s important when discussing Zoloft with your doctor that you let them know of any prescription drugs, over-the-counter medicines, or herbal supplements you may be taking.

CBD and Zoloft (Sertraline) – August 2022

According to Mayo Clinic, antidepressants are a popular treatment choice for depression. Although antidepressants may not cure depression, they can reduce the symptoms (4 ) .

Many types of antidepressant medications are available to treat depression, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), atypical antidepressants, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). Zoloft (sertraline) is an antidepressant that belongs to a group of SSRIs.

Enzymes are the proteins that speed up chemical reactions in the body and help with vital body functions like digestion and respiration.

CYP34A enzymes belong to the class of CYP450 or Cytochrome P450 enzymes, which is essential for the metabolism of many medications (5 ) .

An article by CBD Oil Review explains that CBD blocks the cytochrome P450 enzyme system’s ability to metabolize certain drugs, including SSRIs, resulting in an overall increase in processing times (6 ) . Thus, taking CBD supplements while on these medications could interfere with how the body absorbs these medications.

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This mechanism mirrors that of the grapefruit as it inhibits the same set of liver enzymes, the CYP34A, that CBD blocks, according to an article published by Harvard Health Publishing (7 ) .

In an article on grapefruit juice and medications, also published by Harvard Health Publishing, grapefruit was shown to be dangerous when combined with some drugs used for high blood pressure, high cholesterol, and depression, as the fruit can impair how the body absorbs the drugs (8 ) .

When the CYP450 system’s ability to metabolize certain drugs is affected, a high concentration of drugs remains in the body at one time. This increased level can cause unwanted side effects and, sometimes, an overdose (9 ) .

Taking CBD oil with SSRIs may reduce the efficacy of the antidepressants, or inversely, the efficacy of CBD oil may be reduced by antidepressants (10 ) .

Still, there is no substantial evidence to suggest any definite adverse reaction that may occur when taking CBD oil together with SSRIs.

Stipulations are not definite because of limited research published on CBD and drug interactions.

Another reason for the lack of conclusive evidence is because CBD possesses anti-depressive characteristics of its own .

In a 2014 study published in the CNS & Neurological Disorders – Drug Targets Journal, CBD was shown to possess antidepressant-like and anxiolytic-like effects (11 ) .

Adverse interactions between CBD oil and antidepressants are rare (12 ) . However, seeking the advice of a physician or psychiatrist is recommended before combining the two substances.

Also, when taking medications that interact with CBD, consulting with a doctor is advised to ensure that supplementing a personal therapy with CBD oil is without risk. The doctor may have to adjust the dosage of the medications so that they can be safely used with CBD oil (13 ) .

Can Another Antidepressant Be a Substitute for Zoloft So CBD Oil Can Be Taken ?

Zoloft (sertraline) is an antidepressant that works by increasing levels of serotonin in the brain.

As a neurotransmitter, serotonin modulates the activity of the nervous system and a wide range of processes linked to brain function and behavior, as indicated in a review published in the Annual Review of Medicine in 2018 (14 ) .

SSRIs are called selective because they primarily impact serotonin, not other neurotransmitters. SSRIs inhibit the reuptake or reabsorption of serotonin into the neurons, making serotonin accessible to improve the transmission of messages between neurons.

Mayo Clinic lists the SSRIs approved by the FDA to treat depressio n (15 ) :

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil, Pexeva)
  • Sertraline (Zoloft)

There are fewer side effects and drug interactions with SSRIs than with other types of antidepressants, according to Mayo Clinic.

However, for the same reason that CBD could interfere with how the human body metabolizes SSRIs, replacing Zoloft with any of the drugs listed above is likely to cause the same metabolic impact.

Can CBD replace Zoloft?

A 2018 study published in the Frontiers in Immunology Journal demonstrated CBD as a potential remedy to depression (16 ) . In the study, researchers examined the experimental and clinical use of CBD and found that it showed anxiolytic (anti-anxiety), antiepileptic, and antipsychotic properties that may help reduce depression linked to stress.

CBD’s potential benefits for depression may be linked to its positive impact on serotonin receptors in the brain.

A 2018 study published in Progress in Neuro-Psychopharmacology & Biological Psychiatry Journal shows how antidepressant-like effects induced by CBD are dependent on brain serotonin levels (17 ) .

Researchers of a study , which was published in World Psychiatry Journal in 2015, found that impairing serotonin function can cause clinical depression in some circumstances (18 ) .

In another study , which was published in Frontiers in Neuroscience in 2018, it was shown that CBD might help treat a variety of psychological conditions, including mental health and post-traumatic stress disorder (PTSD) (19 ) .

Research published in Trends in Pharmacological Sciences in 2009 examined the therapeutic potential of the endocannabinoid system (ECS) (20 ) .

The ECS works to maintain balance among the essential functions of the body, including sleep, mood, appetite, and bowel movements.

The authors of that study concluded that the endocannabinoid system could be the target of “the development of a novel class of antidepressants.”

Researchers of another study , which was published in Neuropharmacology Journal in 2016, arrived at the same conclusion (21 ) .

CBD also appears to have some benefits over most antidepressant medications that take weeks to start working.

Researchers in a study published in the British Journal of Pharmacology found that CBD induced fast and sustained antidepressant-like effects in animal models comparable to those of imipramine, a tricyclic antidepressant (TCA) used mainly in the treatment of depression (22 ) .

However, there has been no study that would provide evidence that CBD can be used specifically to replace Zoloft.

Meanwhile, it is not advisable to stop taking prescribed medications, especially antidepressants, without talking to a healthcare provider first.

Medical experts caution against stopping taking sertraline, even when the person feels better. Missing doses of sertraline may increase the risk of relapse in symptoms, according to the National Alliance On Mental Illness (NAMI) (23 ) .

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Abruptly stopping sertraline use may result in one or more of the following withdrawal symptoms:

  • Irritability
  • Nausea
  • Vomiting
  • Having nightmares
  • Prickling sensation on the skin

Before discontinuing sertraline intake or adjusting to low doses, work with a doctor or healthcare provider to devise a plan for gradually decreasing its dosage.

Even though CBD is becoming an increasingly popular alternative for a range of health issues, studies on how CBD may help with depression are limited. Thus, the best course of action is still to consult with a doctor before starting a CBD regimen.

What to Look for in a CBD Product

Zoloft interacts with CBD. Thus, consulting with a doctor is advised before supplementing a personal therapy with CBD oil. The doctor may consider adjusting the dosage of the medications so that they can be safely used with CBD oil (24 ) .

Full-spectrum CBD oil contains all phytonutrients from hemp, including trace amounts of THC, terpenes, flavonoids, and essential oils. Meanwhile, CBD isolates carry only pure, isolated cannabidiol.

Regardless of the form of CBD products that one chooses, careful consideration must be employed in selecting the best CBD oil to use, especially when trying to manage depression.

The following factors are essential to ensure the safety and reliability of the CBD products purchased:

  1. Research on the exact legal stipulations applicable to CBD in the area where it would be purchased and used.
  2. Purchase only high-quality CBD products from legitimate and reliable brands. The majority of companies that manufacture the best CBD oil products grow their own hemp from their own farm, or they purchase from licensed hemp producers.
  3. When buying from an online store, research product reviews. When buying from a physical store or dispensary, check whether the store is authorized by the government to sell CBD.
  4. One important thing to look for in CBD products is certification codes. Several certification authorities approve certain products only after some thorough screening tests.
  5. Compare company claims about their products’ potency with that of the third-party lab reports.
  6. Consulting with a trusted medical professional who is experienced in CBD use is ideal before one purchases his or her first bottle of CBD.

Depression vs. Anxiety Disorder

According to the Anxiety and Depression Association of America (ADAA) , depression and anxiety disorder are not the same. However, people with depression often experience symptoms comparable to those of an anxiety disorder, such as irritability, nervousness, and problems concentrating and sleeping (25 ) .

ADAA explains that each disorder has its own behavioral and emotional symptoms, as well as causes. Still, many people who have depression have a history of an anxiety disorder earlier in life.

Symptoms of both conditions usually improve with psychological counseling, medications, like antidepressants, or both.

In a 2914 study published in BMC Psychiatry Journal , researchers suggest that lifestyle changes like increasing social support, improving sleep habits, getting regular exercise, and using stress-reduction techniques may also help manage depression (26 ) .

However, alcohol, smoking, and recreational drugs can make depression and anxiety disorder worse and interfere with treatment, according to the authors of the study.

Having high blood pressure may also contribute to poor management of depression. Results of a 2013 study published in Experimental & Clinical Cardiology Journal suggest that depression is a typical feature in people experiencing uncontrolled high blood pressure (27 ) .

Screening for depression in people with high blood pressure is an easy and cost-effective tool that may improve results.

Zoloft (Sertraline) for Depression

A 1994 study published in Clinical Therapeutics Journal examined the role of sertraline in the management of depression (28 ) . Researchers concluded that this SSRI showed promise as a therapeutic alternative in the management of depression.

However, a study published in Lancet Psychiatry Journal recently has found that, despite being marketed as an antidepressant, sertraline may be unlikely to alleviate depressive symptoms within six weeks. Meanwhile, their data showed improvements in anxiety (29 ) .

The unexpected results prompted Professor Glyn Lewis, lead researcher and head of division at the University College London (UCL) Psychiatry, to say, “We definitely need better treatments for depression – we need more research in this area.”

Understanding CBD

Cannabidiol, more recognized as CBD, is becoming increasingly popular as a remedy for common ailments. It is one of the many chemical compounds known as cannabinoids found in the cannabis plant, which is also occasionally called hemp or marijuana, depending on the degree of tetrahydrocannabinol (THC) it contains.

THC is another cannabinoid that is linked to a “high,” being the psychoactive constituent of marijuana. Unlike THC, however, CBD keeps one alert and energetic. CBD counters the effects of THC by decreasing the level of stress or anxiety. Because of this action, CBD is frequently extracted to use distinctly for medical use that is non-psychoactive.

CBD oil is the undiluted liquid decoction of Cannabis sativa, a plant commonly known as marijuana. Consumers can purchase CBD oil separately and use it orally. CBD oil or tincture is a popular CBD product that one may purchase online like an over-the-counter supplement.

Conclusion

CBD continues to gain popularity as scientists discover more of its potential health benefits.

However, a Harvard Health article by Peter Grinspoon, M.D., author of the memoir Free Refills: A Doctor Confronts His Addiction warns that CBD use may potentially cause side effects, including irritability, nausea, and fatigue (30 ) . Also, CBD may increase the level in the blood of the blood thinners like coumadin, and it can raise levels of other prescription medications in the blood as well.

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In its Consumer Update , the U.S. Food and Drug Administration (FDA) also warned against some CBD products that are being marketed with unsubstantiated medical claims and are of inferior or unknown quality (31 ) . Thus, choosing products carefully is essential as getting a safe and potent CBD product from a reliable supplier may prove challenging.

Given that the studies on CBD interactions with antidepressants are limited, it is not easy to conclude what can potentially happen when a dose of CBD is taken with antidepressants like Zoloft.

Discontinuing Zoloft use without the advice of a doctor is not recommended. The best course of action is still to consult with a medical professional before considering CBD as one of the treatment options for depression and starting a CBD regimen.

Is it Safe to Use CBD and Zoloft (sertraline) at the same time?

In our latest question and answer, the medical cannabis pharmacist discusses if it is ok to use CBD oil while taking sertraline.

Answered by: Dr. Geoffrey Brown, PharmD

Khia Asked

I take Zoloft for my depression and would like to start supplementing CBD to reduce inflammation and help with anxiety. Is it safe to use with Zoloft?

Summary

There is limited data available on CBD’s potential to cause interactions with sertraline (Zoloft).
CBD may inhibit metabolic enzymes involved in the metabolism of sertraline but, the chances of CBD causing clinically significant interactions with sertraline are rather low.
Be sure to let your psychiatrist or doctor that manages your sertraline therapy know that you’re using CBD.

Answer

Hi Khia, and thank you for your question. While I couldn’t find any studies investigating this interaction in particular, I was able to find some information regarding the metabolism of both of drugs which can help us answer questions about the likelihood of an interaction.

In short, CBD may inhibit some of the enzymes that’re involved in the metabolism of sertraline (Zoloft). Therefore, theoretically, there is a possibility the two could interact. However, the likelihood that this interaction would be clinically significant or something you need to be concerned with is rather low.

Sertraline (Brand name Zoloft) is a selective serotonin reuptake inhibitor or SSRI and is the most commonly prescribed antidepressant medication in the United States. Sertraline is metabolized by a number of CYP enzymes present in the liver including CYP2B6 and to a lesser extent CYP2C19, CYP2C9, CYP3A4, and CYP2D6 . According to the manufacturer’s package insert for sertraline, that’s reviewed by the FDA, dose reductions may be warranted in patients treated with sertraline that are taking other drugs metabolized by these enzymes.

Cannabidiol (CBD) is the primary non-euphoric cannabinoid in cannabis/hemp and is now a common ingredient in many health and consumer products. One of the most commonly claimed indications for CBD is anxiety. Preliminary evidence suggests CBD shows promise as a potential treatment for anxiety, but the doses researched vary greatly between studies.

CBD is also metabolized by CYP enzymes in the liver, so using CBD may alter the way these enzymes function in regard to their ability to metabolize other drugs such as sertraline.

According to the package insert for the FDA approved CBD oral solution, CBD is metabolized by CYP3A4 and CYP2C19, and has the potential to inhibit CYP1A2, CYP2B6, CYP2C8, CYP2C9, and CYP2C19. Therefore, because CBD can inhibit some of the same enzymes that’re responsible for the metabolism of sertraline, there’s a possibility that CBD could reduce the metabolism of sertraline leading to increased concentrations of the drug in the body increasing the risk of adverse effects due to sertraline.

While there’s certainly a theoretical basis for this interaction, I would not be too concerned about this from a safety standpoint for two reasons. For one, the blood concentrations of CBD needed to inhibit these enzymes aren’t likely to be achieved by CBD taken at usual doses. The second reason is because multiple CYP enzymes are responsible for the metabolism of sertraline it would be difficult for CBD alone to cause a serious interaction by interfering with just one or even a couple of those enzymes. That being said, i t’s still a good idea to let your doctor of psychiatrist that manages your sertraline therapy know that you’re using CBD. That way they can monitor for any changes or adverse effects from changes in sertraline metabolism.

To summarize, there’s a possibility an interaction between CBD and sertraline could occur, but unless you’re consistently using high doses of CBD (upwards of 100 mg multiple times per day) I wouldn’t worry too much about it. I hope this helps answer your question.

Thanks again Khia. Please don’t hesitate to reach out again in the future with any cannabis questions you have.

References

Zoloft [package insert]. New York, NY: Pfizer, Inc. 2016.

Epidiolex [ package insert ]. Carlsbad, CA: Greenwich Biosciences, Inc. 2020.

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