Does Marijuana Interfere With Psychiatric Medications?
Article written by
Emma Stone
Content reviewed by
Dr. Lewis JasseyMedical Director - Pediatric Medicine
Approximately 15% of adults in the United States take prescription medications for mental health disorders. And it’s likely that quite a few of them also use cannabis, as cannabis is one of the most commonly used drugs in the country, with almost 50 million Americans trying it at least once.
While the use of cannabis is common, is it okay to take it with psychiatric medications? Ultimately, it depends on the type of medication and how your body responds to it. Research shows that marijuana may significantly impact the effects of certain psychiatric medications, so it’s recommended that you speak with your doctor if you plan on combining the two.
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Types of Common Psychiatric Medications
Prescription drugs for psychiatric disorders can be categorized into four main types: antidepressants, anti-anxiety medications, stimulants, and antipsychotics.
Antidepressants
The most common types of antidepressants are called reuptake inhibitors, which work by slowing down how fast certain neurotransmitters (brain chemicals) are reabsorbed by the brain. Examples include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and norepinephrine and dopamine reuptake inhibitors (NDRIs).
SSRIs represent the most commonly prescribed type of antidepressant. As the name suggests, these medications help alleviate depression symptoms by working with the body to increase the amount of serotonin in the brain. Serotonin is a neurotransmitter that plays a significant role in regulating mood and experiencing happiness and pleasure.
Anti-anxiety Medications
Benzodiazepines are a popular drug class used to treat a range of conditions, including insomnia and generalized anxiety disorder. Examples of benzodiazepines include Valium, Xanax, Halcion, and Klonopin.
Benzodiazepines act as mood stabilizers by enhancing the action of a neurotransmitter called gamma-aminobutyric acid (GABA). Since GABA has a slowing effect on the central nervous system, enhancing it exerts a calm, sedative effect on the body.
Stimulants
Prescription stimulants are commonly used to treat attention-deficit hyperactivity disorder (ADHD). Stimulants increase alertness, attention, and energy by boosting dopamine and norepinephrine activity.
Atypical antidepressants like bupropion (Wellbutrin) are also sometimes prescribed for ADHD to improve attention span, control impulsivity, and calm hyperactivity.
Antipsychotics
Antipsychotic medications are used to control symptoms associated with psychosis. Examples of psychosis include delusions, hallucinations, mania, and paranoid thinking. These symptoms are often associated with mental health conditions like schizophrenia, bipolar disorder, and personality disorders.
Does Cannabis Interfere With Antidepressants?
Evidence suggests that two major cannabinoids in cannabis, THC and CBD, may slow the metabolism of selective serotonin reuptake inhibitors, such as Prozac, Zoloft, Celexa, and Lexapro — all medications commonly used to treat depression.
Research on adolescents suggests that medicinal marijuana used in conjunction with these types of drugs may increase concentration levels in the body, thereby increasing the risk of side effects.
On the other hand, some people find that cannabis reduces side effects associated with SSRIs and that combining the two offers more relief. Keep in mind that very high doses of cannabis and SSRIs can lead to serotonin syndrome, which is when serotonin levels in the brain rise to toxic levels.
For those already taking SSRIs and marijuana for medical use, be aware that suddenly stopping or decreasing cannabis may also decrease concentrations of the medication you’re taking and exacerbate depression symptoms.
It’s also important to note that there are different risk factors for different depression medications. For example, tricyclic antidepressants target other systems in the body and might react differently when combined with cannabis.
Does Cannabis Interfere With Anti-anxiety Medications?
Anti-anxiety drugs like benzodiazepines depress the central nervous system by slowing down messages between the brain and body. Cannabis can also act as a nervous system depressant, which can lead to feeling relaxed, sedated, and less anxious.
Researchers are still learning about the potential side effects of combining benzodiazepines and weed. Anecdotal evidence suggests that combining the two in low doses may ease anxiety and promote relaxation.
Other research suggests that one of the potential benefits of using medical cannabis with anti-anxiety medications is that there may be a reduced need for benzodiazepines, which have a high risk for addiction. The study found that 45% of patients who used both drugs for six months ended up discontinuing benzodiazepine use at the end.
On the other hand, consuming high doses of these or using THC-rich weed may have the opposite effect and intensify stress, paranoia, and irritability. The effects vary based on the person and the dosage, so it’s advisable to talk to your physician about the benefits and risks.
Does Cannabis Interfere With Stimulants?
Prescription stimulants are used to enhance focus and alertness. They are commonly prescribed to help manage symptoms associated with ADHD. Examples of common prescription stimulants include Adderall, Concerta, Dexedrine, Focalin, and Ritalin.
There’s still much we don’t know about the effects of combining stimulants with cannabis, but preliminary findings suggest it may lead to unpredictable effects. This is partly due to the fact that cannabis can act as a stimulant or a depressant.
Some research suggests that using stimulants and marijuana together may accelerate heart rate due to the additive effects both have on the nervous system.
However, other studies indicate that combining the two may also reduce dependency on ADHD drugs while improving ADHD symptoms. Terpenes like limonene and cannabinoids like cannabinol may be particularly helpful for managing ADHD symptoms.
If you have an increased risk of experiencing adverse effects, talk to a doctor before mixing stimulants and marijuana. For example, people with existing heart conditions may be at higher risk of heart strain.
Does Cannabis Interfere With Antipsychotics?
Dopamine imbalance is believed to play a large role in psychosis and psychotic disorders. That’s why many antipsychotic medications inhibit dopamine receptors in the brain. Cannabis can also influence dopamine because of how it affects certain cannabinoid receptors (CB1 receptors), meaning it could interact with or impact the effectiveness of some antipsychotics.
Animal research has found that medical marijuana can reduce the concentration of antipsychotic medications in the brain and reverse their neurobehavioral effects. Other research in human populations demonstrated that cannabis use reduced the effectiveness of antipsychotics, resulting in treatment failure for patients with schizophrenia.
Combining the two substances also increases the risk of side effects like cognitive impairment, dizziness, drowsiness, and confusion. Cannabis consumers who are also prescribed antipsychotics — such as Risperdal, Seroquel, Zyprexa, or Clozaril — should consult with their physicians before combining the two.
The Bottom Line
Clear information about how cannabis interacts with common psychiatric medications is scarce. However, it’s apparent that weed can intensify or diminish the effects of psychiatric drugs due to similar pathways of action in the brain.
For those who are prone to psychosis or live with conditions like schizophrenia, high-THC products should be avoided.
If you currently take or are planning on taking medication for a mental illness alongside medical cannabis, talk to a physician first. It’s possible that people who consume high-potency cannabis products will have to lower their antidepressant intake to reduce the risk of negative side effects.
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