CBD and SSRI medications like Zoloft each can treat stress and depression and have similar side effects – is it safe to take both of them at the same time? CBD is a popular alternative treatment for anxiety and depression, but will it help or worsen the side effects of sertraline (Zoloft) if used together? In our latest question and answer, the pharmacist discusses whether or not Zoloft (sertraline) interacts with CBD (cannabidiol).
CBD Oil and Zoloft: Dangerous To Use CBD When On SSRI?
More than one-hundred million Americans are on antidepressant medications, and tens of millions of them take Zoloft on a daily basis. In fact, Zoloft is the most commonly-prescribed psych med in the United States, even more popular than other drugs in the “SSRI” class like Lexapro, Paxil, Celexa and Prozac. (Zoloft is the brand name for the medication sertraline.)
Nearly 35 million Americans are considered “regular users” of marijuana, with another 20 million said to indulge occasionally. As you undoubtedly know, pot contains a number of cannabinoids – not just THC, but also CBD.
And a growing number of Americans say they use CBD-based products; the latest estimate from the Gallup polling organization puts that figure at 14% of all adults.
Needless to say, there’s a decent amount of crossover between those taking Zoloft and those consuming CBD. That’s even easier to believe when you consider that:
- People take antidepressants, including SSRIs like Zoloft, to fight stress and depression.
- Existing evidence on CBD products shows that they’re often useful to fight stress and depression.
- And, of course, one of the major effects of using cannabis is that it relieves – say it with us – stress and depression.
Is using some or all of them at the same time a problem?
It’s possible; there’s very little research on the subject. But if it is a problem, it’s probably not a major issue for most people.
Cannabinoids and Zoloft: What We Know
There has only been one rigorous medical review examining the effects of combining Zoloft (or similar SSRIs) and CBD use. It was done at the University of Connecticut and considered all the evidence involving concurrent use of antidepressants (“psychotropic” drugs) and psychoactive drugs like cannabis.
What the researchers found was surprising: there are very few reports of adverse interactions.
They say that maybe because those who use pot are afraid to report any problems they may experience. However, doctors prescribe newer generations of psych meds (like Zoloft) because they’re much less likely to cause drug interactions, so the researchers believe it’s very possible that harmful interactions with CBD or THC are “relatively rare or do not happen.”
CBD and Zoloft: What Medical Experts Think
The rest of the “knowledge” that exists about combining CBD and SSRIs like Zoloft isn’t really knowledge. It’s mostly anecdotal evidence and common sense.
Drug interaction databases note that both CBD and Zoloft can cause some of the same side effects, like drowsiness, dizziness, and loss of concentration. So using them together can potentially increase the severity of those side effects. They only classify the interaction as “moderate,” though, meaning you should simply be careful when mixing the two drugs, and watch carefully for negative effects until you know how you’re affected.
There’s only one study providing more specific information about that possible interaction, and it was done nearly ten years ago in Japan. The research found that CBD may block the optimal performance of the liver enzymes which help the body absorb antidepressants. In simple terms, taking CBD may cause Zoloft and other SSRIs to build up in the body in greater amounts than normal, increasing the effects – and side effects – of the antidepressant.
The conclusions that can be drawn? You should, of course, talk to your doctor before taking any new medications (prescription or non-prescription). If you combine Zoloft with either CBD or weed, however, you should be fine. Just be careful, because you could end up more zoned out than you expect.
Aspiring political journalist & small-town stoner currently living in Los Angeles. My day job consists of studying the mental health effects of cannabis in my role as a mental health case manager at Kaiser Permanente. By night, I roll fat joints and do my best to debrief Weed News readers on the latest cannabis happenings.
Does CBD Interact With Sertraline (Zoloft)?
Information on risks & possible interactions between CBD & sertraline.
Zoloft, or sertraline, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It’s used in treating depression, panic attacks, obsessive-compulsive disorder, post-traumatic stress disorder, and premenstrual dysphoric disorder.
Cannabidiol or CBD has been gaining attention for its positive effects on anxiety, insomnia, inflammation, and depression.
Studies are still underway, though, and not much is known about the many other effects it could cause. CBD decreases particular enzymes’ abilities to metabolize Zoloft, so using them together could worsen the latter’s effects; however, the research is limited.
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Does CBD Interact With Sertraline?
CBD may act as a competitive inhibitor for the same enzymes that metabolize sertraline (Zoloft). It can prevent the actions of cytochrome P450 enzymes, the same enzymes that metabolize sertraline; theoretically, using them together could decrease sertraline’s metabolization and, thus, increase its effects.
Because of this, sertraline might remain in the body for longer and could cause some side effects, ranging from simple ones to serious ones, such as serotonin syndrome.
However, there are not enough studies to determine exactly how much of an effect there will be by using sertraline and CBD together.
Other Names For Sertraline
Sertraline is sold under many different names. All share the same risk and potential interactions.
Other names for sertraline include:
Similar Medications: CBD & SSRIs
Sertraline is classified as an SSRI (selective serotonin reuptake inhibitor). CBD and SSRIs all share similar risks for interaction and side effects.
Here’s a list of similar medications that share a similar level of risk when combined with CBD:
- Citalopram (Cipramil & Celexa)
- Dapoxetine (Priligy)
- Escitalopram (Cipralex & Lexapro)
- Fluoxetine (Prozac, Rapiflux, Sarafem, Selfemra & Oxactin)
- Fluvoxamine (Faverin)
- Paroxetine (Seroxat)
- Vortioxetine (Brintellix)
Is It Safe to Take CBD & Sertraline Together?
Because of CBD’s effects on the enzymes that metabolize sertraline (Zoloft), the latter drug is likely to be more potent than usual. This could lead to side effects and, at worst, may cause excessive serotonin levels, leading to symptoms similar to serotonin syndrome.
There’s not much information on the side effects of mixing these two drugs, but be on the safe side and exercise extreme caution.
If you want to mix CBD with sertraline (Zoloft), talk to your doctor first.
Is CBD a Viable Alternative to Sertraline?
Because CBD lacks extensive studies on its effectiveness, it cannot be considered a good alternative to sertraline (Zoloft). For now, it’s best to continue your regular dosage of Zoloft and talk to your doctor.
Under the advice of your medical practitioner, you may take both medications, but if you experience any abnormal symptoms, immediately stop CBD and contact your doctor.
What Is Sertraline (Zoloft)?
Sertraline hydrochloride was invented and marketed by Pfizer with the brand name Zoloft. It was approved for use by the FDA in 1999.
Sertraline is metabolized in the liver by several cytochrome enzymes, including CYP2B6, CYP2C19, CYP2C9, CYP3A4, and CYP2D6.
|Other Names (other generics)||Lustral, Setrona, Zosert, Certrafine, Psyline, Sertima|
|CYP Metabolism||CYP2B6, CYP2C19, CYP2C9, CYP3A4, and CYP2D6|
|Interaction With CBD||Metabolic Competitor|
|Risk of Interaction||Moderate; patient needs careful monitoring|
What Does Sertraline (Zoloft) Do?
Sertraline (Zoloft) is an SSRI and inhibits the reuptake of serotonin in the brain.
Zoloft is used in treating depression, panic attacks, obsessive-compulsive disorder, post-traumatic stress disorder, social anxiety disorder, and premenstrual dysphoric disorder. Zoloft can also improve mood and sleep and make the patient feel a better sense of well-being.
Depression is a mental disorder characterized by persistent low mood and lack of interest in activities that the person had previously enjoyed. In most patients with depression, serotonin levels are deficient.
Serotonin is the hormone that stabilizes mood, feelings of happiness, and well-being. Its level decreases in conditions such as depression.
Sertraline binds to the serotonin transporter (SERT) and inhibits the CNS neuronal retaking of serotonin (5HT). It prevents the fast metabolism of serotonin, thus allowing it to last longer in the brain, long enough for the person to function well again.
Side Effects of Sertraline
Like most other medications, sertraline (Zoloft) also has side effects. It affects the body as a whole and not just one system. These side effects usually happen on overdosing or incorrect dosing of the medication.
Side Effects In More Than 10% of Patients:
- Ejaculation disorder
- Dry mouth
Side Effects In Less Than 10% of Patients:
Rare Side Effects:
- Back pain
- Chest pain
- Increased appetite
- Weight gain
Possible Complications With Sertraline
There are some things about sertraline (Zoloft) that one should know before taking it. In some instances, Zoloft can be more dangerous. Here are a few situations:
1. Monoamine Oxidase Inhibitors (MAOI)
It can interact with MAOIs causing a decrease in serotonin metabolism, leading to an increased serotonin level, called Serotonin Syndrome. Its symptoms are high blood pressure, rapid heart rate, nausea, vomiting, and anxiety, and can be dangerous.
The oral solution of sertraline contains alcohol, so using them together can cause flushing, headaches, nausea, and vomiting.
3. Liver & Kidney Impairment
Patients with liver and kidney problems cannot properly remove sertraline from the body; low doses under supervision are required.
Using sertraline during pregnancy can cause congenital heart defects in the newborn.
Breastfeeding mothers with depression can use sertraline since its appearance in breast milk is minimal.
6. Patients Under 25
One of sertraline’s significant side effects is an increased risk of suicide in people under 25 years. This age group requires constant monitoring.
What Is CBD?
CBD, or cannabidiol, is a compound extracted from cannabis, usually hemp, to comply with federal law. It’s the second most common cannabinoid in cannabis, making up almost 40% of it.
There are many ways to take CBD, including inhalation, orally, or topically — topical application only works on the area it’s applied to. It does not cause alterations in mood or intoxication like another popular cannabinoid, delta-9 tetrahydrocannabinol (THC).
CBD has been the topic of many studies over the past few decades. It’s useful in treating anxiety, cognition, movement disorders, and pain.
In 2018, a cannabidiol drug, Epidiolex, was approved by the FDA. Epidiolex is used for the treatment of two rare epilepsy conditions. In some parts of the world, CBD combined with THC in a 1:1 combination is approved for use in symptomatic relief for adults with Multiple Sclerosis.
What Does CBD Do?
CBD interacts with the endocannabinoid system (ECS); this complex system is found throughout the body and is composed of endocannabinoids, enzymes, and cannabinoid receptors.
There are two receptors of most importance in the ECS, called CB1 and CB2. CB1 is associated with the nervous system, while CB2 is found mainly in the immune system.
THC binds directly to the CB1 and CB2 receptors. CBD, however, alters the behavior of the receptors, causing a reaction.
CBD can activate 5-HT1A/2A/3A serotonergic receptors. While it doesn’t necessarily increase serotonin levels in the brain, it may affect the chemical receptors’ response to the already available serotonin .
CBD is metabolized in the liver by several cytochrome P450 enzymes and acts as a competitive inhibitor for these same enzymes. It occupies sites of enzymatic activity and displaces its chemical competitors. Due to this, these enzymes of cytochrome P450 are unable to metabolize other compounds.
CBD may have a benefit over other medications used in depression. While antidepressants take a few weeks to start working, CBD can show antidepressant-like effects much sooner.
CBD does not have side effects like most antidepressants do. There are no side effects like insomnia, sexual dysfunction, or mood swings with CBD .
Side Effects of CBD
- Potential liver damage
- Decrease in blood pressure
Important Points To Consider About CBD
You need to know a few things about CBD that may impact how you buy and use it.
The FDA Does Not Regulate CBD
Two drugs, Epidiolex and Sativex, contain CBD and have received approval for use.
CBD and CBD products are largely unregulated and are not FDA-approved. Unfortunately, this leaves a large gap, and the quality and safety of these products are often called into question. There are many good companies, but you have to watch out for the bad ones.
Often, companies lie about the amount of CBD in the products or add chemicals to make them seem more potent.
Even though many studies find CBD to be beneficial, the research is still lacking. We don’t know the full extent of its abilities and side effects yet, especially long-term.
Types of Drug Interactions With CBD
There are three different ways that CBD can interact with other drugs.
1. Agonistic Interaction (Increased Effect)
This happens when two substances have the same effects in the body due to both of them acting on the same receptors to push in the same direction.
These include drugs like:
- Antihypertensive medications — ACE inhibitors, alpha-blockers, angiotensin II receptor blockers, beta-blockers, calcium channel blockers, central agonists, and diuretics.
- Anti-anxiety medications — Benzodiazepines and barbiturates.
- Antidiabetic medications — Alpha-glucosidase inhibitors, biguanides, DPP-4 inhibitors, GLP-1 receptor agonists, meglitinides, SGLT-2 inhibitors, sulfonylureas, and insulin.
Antagonistic Interaction (Decreased Effect)
This decreases the effects of the medication.
These include medications like:
- Stimulants — Amphetamine, modafinil
- Immunomodulators — Antihistamines like carbinoxamine, desloratadine, levocetirizine
- Immunosuppressants — Azathioprine, mycophenolate cyclosporine, methotrexate
These medications need similar enzymes to break down the drug molecules, causing both types of medications to compete against each other, leading to a slow metabolism rate for both of them. They may increase the effects or decrease the effects.
These include medications like:
- Blood Thinners — Enoxaparin, heparins, and others
- NSAIDs — Ibuprofen, naproxen, high-dose asprin
- Opiate analgesics — Morphine, codeine, hydrocodone
- Antidepressants — Trazodone, mirtazapine, vortioxetine, and vilazodone
Key Takeaways: Is it Safe to Take Sertraline (Zoloft) With CBD?
While theoretically, taking sertraline with CBD could cause some serious side effects, the studies are still limited. It’s better to exercise caution and talk with your doctor before you use CBD with sertraline. If you feel any side effects on using these drugs together, seek medical attention immediately.
Does CBD Interact With Zoloft (Sertraline)?
In our latest question and answer, the pharmacist discusses whether or not Zoloft (sertraline) interacts with CBD (cannabidiol).
I currently take 50mg of Sertraline, I have tried increasing Sertraline but I don’t like the side effects. The 50mg of Sertraline has improved my overall mood but I still feel anxious. Would it be safe to also use CBD oil alongside Sertraline?
At a glance
- Drug interaction studies with CBD are lacking, but preliminary evidence suggests a variety of potential interactions based on what we know of CBD metabolism.
- The chance of CBD having a clinically significant interaction with Zoloft (sertraline) is low based on available data.
Cannabidiol, also known as CBD, is a major component of cannabis (i.e. marijuana).
While THC (delta-9-tetrahydrocannabinol) is likely more well-known due to its psychoactive and euphoric effects, CBD makes up almost 40% of cannabis extracts and has a wide range of potential benefits when used medicinally, although more studies are certainly needed to better understand the compound.
While the exact dosing of CBD explored in studies ranges wildly (from 1 mg to over 600 mg), there is preliminary positive evidence for a variety of indications, including:
- Multiple Sclerosis
- Parkinson’s Disease
Further adding to the potential benefit of CBD, is the fact that it is considered CBD is considered “non-euphoric”, even at high doses.
CBD has recently exploded in popularity, with multiple products and brands available at a number of natural health food and supplement stores. It is even being mixed with traditional consumer products, like water!
With this, it is important to consider potential drug interactions with prescription medication.
Due to the relatively recent nature of CBD use for medicinal purposes, there is a distinct lack of studies when it comes to potential drug interactions between CBD and prescription medication, like Zoloft (sertraline).
Zoloft – CBD (Cannabidiol) Interaction
Zoloft (sertraline), an SSRI (Selective Serotonin Re-uptake Inhibitor), is metabolized extensively by a variety of CYP enzymes, including:
As discussed above, research indicates that CBD can inhibit many of the metabolizing enzymes listed above.
Therefore, the use of CBD and Zoloft together could theoretically increase the risk of adverse effects, due to increasing Zoloft concentrations in the body.
However, additional data on CBD drug interactions indicate the risk of an interaction between CBD and Zoloft specifically is low.
There are many studies that postulate that while CBD does inhibit metabolizing enzymes, it is not significant and the blood concentrations needed to affect these metabolizing enzymes in humans far exceeds what is possible with usual dosing.
In addition, since Zoloft is metabolized in the body by a number of enzymes, it is thought that it would be difficult for a single agent to cause a clinically significant interaction. In the words of one study:
“The observation that multiple enzymes appear to be involved in sertraline [Zoloft] metabolism suggests that there should be no single agent that could substantially alter the pharmacokinetics of sertraline, nor should there be any single drug-metabolizing enzyme genetic polymorphism (e.g., CYP2D6, CYP2C19, CYP2C9, UGT1A1) that could profoundly impact the pharmacokinetics of sertraline.”
Nevertheless, until studies are completed that specifically look at how CBD interacts with Zoloft (sertraline), we can only make educated guesses. It would be prudent to let your doctor know you are interested in trying CBD, so you can be appropriately monitored, just in case.