CBD and Zoloft (Sertraline)

Does CBD interact with Zoloft and other antidepressants, and if so, how? What are the risks of taking CBD with Zoloft or other antidepressants?

  • A 2018 study demonstrated CBD’s anti-anxiety, antiepileptic, and antipsychotic properties. The authors suggest that these properties may help reduce depression linked to stress.
  • However, the results of a study indicated that CBD most potently inhibited the activity of liver enzymes, which help metabolize antidepressants like Zoloft. 
  •  Taking CBD may potentially block these enzymes and lead to higher drug concentrations in the bloodstream.
  • Given that the studies on CBD use and depression are limited, the best course of action is still to consult with a doctor before starting a CBD regimen.

Can CBD Be Taken With Zoloft?

Anecdotal reports show that many people are already trying CBD for depression, and many of them have found it useful. However, there has never been a study that specifically examined the interaction between CBD and Zoloft.

Peter Grinspoon, M.D., author of the memoir Free Refills: A Doctor Confronts His Addiction, and an instructor in medicine at Harvard Medical School, said that CBD supplements are generally safe to use in conjunction with antidepressants. Still, some issues cannot be overlooked.

The primary concern, according to Grinspoon, is that CBD is not regulated by the U.S. Food and Drug Administration (FDA). In its Consumer Update, the FDA also warned against some CBD products that are being marketed with unsubstantiated medical claims and are of inferior or unknown quality. Thus, getting a safe and potent CBD product from a reliable supplier may prove challenging.

Grinspoon added that CBD has possible drug interactions, but the question is whether these are clinically important or not.

CBD can potentially cause the body to have high doses of certain antipsychotic medications or anti-anxiety medications like benzodiazepines, Grinspoon explained. This action is due to how CBD inhibits two primary enzyme systems in the body.

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

CBD inhibits the system that breaks down serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and antipsychotics, which means taking CBD supplements while on these medications could interfere with how the body absorbs these medications, Grinspoon said.

This mechanism mirrors that of the grapefruit, Harvard Medical School reported, as grapefruit inhibits the same set of liver enzymes, called CYP34A, that CBD blocks.

CYP34A enzymes belong to the class of CYP450 or Cytochrome P450 enzymes. CYP450 is essential for the metabolism of many medications.

In an article on grapefruit juice and medications, 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.

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

 Grinspoon advised that before trying CBD, talk with a doctor first to make sure that taking CBD would not affect other medications that are also taken together with it.

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

Zoloft (sertraline) is an antidepressant belonging to a group of drugs called selective serotonin reuptake inhibitors (SSRIs), which treat depression by increasing levels of serotonin in the brain.

Serotonin works as a neurotransmitter that modulates the activity of the nervous system and a wide range of processes linked to brain function and behavior.

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 depression:

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

Anecdotal reports suggest fewer side effects and drug interactions with SSRIs than many other types of antidepressants.

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.

CBD also inhibits the enzyme system that breaks down tricyclic antidepressants and antipsychotics, as Dr. Grinspoon of Harvard Medical School stated. 

Can CBD Replace Zoloft?

While the studies demonstrated CBD as a potential remedy to depression, there has been no study that would provide evidence that CBD can be used to replace Zoloft. 

Experts believe that CBD’s potential benefits for depression may be linked to its positive impact on serotonin receptors in the brain. Low serotonin levels are associated with depression.

CBD does not directly boost serotonin levels. However, researchers of a 2018 study examined the experimental and clinical use of CBD and found that it showed anxiolytic (anti-anxiety), antiepileptic, and antipsychotic properties. The authors suggest that these properties may help reduce depression linked to stress.

In a study, researchers found that CBD may help treat a variety of psychological conditions, including mental health and post-traumatic stress disorder (PTSD).

One research on CBD and antidepressants in humans focused on the role of the endocannabinoid system (ECS) in depression. 

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 arrived at the same conclusion.

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

However, 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.

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

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.

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

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

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. Lifestyle changes like increasing social support, improving sleep habits, getting regular exercise, and using stress-reduction techniques may also help. 

Alcohol, smoking, and recreational drugs can make depression and anxiety disorder worse and interfere with treatment.

Results of a study suggest that depression is a typical feature in people experiencing uncontrolled high blood pressure, which may contribute to poor control of the condition. 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 examined the role of sertraline in the management of depression, and researchers concluded that this SSRI showed promise as a therapeutic alternative in the management of depression.

However, a new study has found that, despite being marketed as an antidepressant, sertraline, may be unlikely to alleviate depressive symptoms within six weeks. However, data showed improvements in anxiety.

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 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 acceptance and approval as scientists discover more of its potential health benefits. 

However, an article published by Harvard Health warns that CBD use may potentially cause side effects, including irritability, nausea, and fatigue. CBD may also 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.

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.

Susan Lindeman

Susan is a young mother and writer, passionate about cooking and blogging. She makes CBD-infused foods, like cookies and candies, to help her cope with anxiety and perform her daily tasks better.
Susan Lindeman

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More Information on Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective Serotonin Reuptake Inhibitors (SSRIs) are used in the treatment of depression. They are also used in panic disorder, obsessive compulsive disorder and bulimia nervosa. Selective Serotonin Reuptake Inhibitors (SSRIs) are potent inhibitors of serotonin re-uptake by central nervous system neurons and may interact with other drugs or circumstances which cause serotonin release. The enhancement of serotonergic effects may produce a life-threatening serotonin syndrome.

Selective Serotonin Reuptake Inhibitors (SSRIs) can inhibit in vitro and in vivo the hepatic isoenzyme 2D6 of the cytochrome P450 system (CYP2D6), which is involved in the oxidative metabolism of numerous drugs. Caution should be used when combining an SSRI with CYP2D6 substrates (desipramine, nortriptyline, haloperidol, thioridazine, flecainide, codeine, propranolol, metoprolol), as the SSRI can cause a significant increase in serum concentrations of these drugs.

Selective Serotonin Reuptake Inhibitors (SSRIs) specifically inhibit central nervous system neuronal reuptake of serotonin, thus increasing the concentration of serotonin at the synapse and enhancing of serotonergic neuronal transmission. A deficiency of serotonin is thought to play a major role in depression, therefore increasing the availability of serotonin would be expected to improve the clinical signs of depression.

Main Risks

When taken alone, Selective Serotonin Reuptake Inhibitors (SSRIs) appear safer in overdose than most other classes of antidepressants. They are potent inhibitors of serotonin reuptake by central nervous system neurons and may interact with other drugs or circumstances which cause serotonin release. The enhancement of serotonergic effects may produce a life-threatening serotonin syndrome. Drugs which can increase the serotonin level when taken in combination with SSRIs include tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), carbamazepine, lithium or serotonergic substances.

Symptoms

Drowsiness, tremor in upper extremities, lightheadedness, nausea, vomiting are the most common symptoms. Other symptoms include tachycardia (occasionally bradycardia), hypo/hypertension, dilated pupils, agitation, dry mouth and sweating. Coma and convulsions may occur in large overdoses. They are much less cardiotoxic than the conventional antidepressants, though citalopram has caused nodal rhythm, QT and QRS prolongation. The combination of Selective Serotonin Reuptake Inhibitors (SSRIs) with agents that increase serotonin availability in the central nervous system can cause the serotonin syndrome which is characterized by the presence of at least 3 of the following symptoms: mental status changes (confusion, hypomania), agitation, myoclonus, hyperreflexia, sweating, shivering, tremor, diarrhea, motor incoordination, muscle rigidity and fever. Severe complications may occur, including severe hyperthermia, rhabdomyolysis, disseminated intravascular coagulation (DIC), convulsions, respiratory arrest and death.

Management

The primary management of SSRI overdose consists of the institution of careful observation of vital signs and neurological status and supportive care until signs and symptoms resolve. In more severe intoxications or where there is a co-ingestion, more aggressive measures such as establishment of an airway, ventilation, administration of intravenous fluids, control of seizures, and control of hyperthermia may be necessary.

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