Can You Use Marijuana While on Antidepressants?

As researchers learn more about marijuana, depression, and the relationship between them, some cannabis users may wish to take a closer look at their medicine cabinets.

Cannabis is fully legal in two dozen states and medically legal in over a dozen more. Consumption has been increasing steadily for years, with an estimated 35 million Americans now using marijuana at least once per month.

“The legalization of marijuana in many states seems to have accelerated a more permissive and accepting attitude, especially among adolescents,” explains Larry Young, MD, a board-certified psychiatrist who works primarily with kids and teens. “Unfortunately, this attitude has led to a focus on the drug as a ‘quick fix,’ and many are not aware of potential adverse effects.”

“The legalization of marijuana in many states seems to have accelerated a more permissive and accepting attitude, especially among adolescents.”

Antidepressant use has also seen a steady rise. A 2020 data brief from the National Center for Health Statistics reported that more than one in eight American adults were taking this type of medication during 2015 through 2018. Those numbers are likely even higher now: Prescription rates soared during the COVID pandemic, especially among teenage girls and young women.

Combining marijuana with antidepressants, however, can impact the effective of the pharmaceuticals — or even cause adverse interactions.

A Complex Relationship

That these trends have occurred in tandem may not be coincidental. Researchers are learning more about the link between depression and one of our body’s key neuromodulatory structures, the endocannabinoid system (ECS).

The ECS regulates a wide range of functions including sleep, appetite, and emotional processing. Its built-in cannabinoid receptors control neurotransmitter levels and activity, which affects physiological cues such as hunger, energy, and temperature.

Impaired ECS functioning has been linked to depression in both human and animal subjects. But the picture gets murkier when exogenous cannabinoids (those derived from plants) enter the mix.

Concluding that marijuana worsens depression — let alone that it causes depression — oversimplifies a complicated relationship.

Numerous studies support the notion that heavy marijuana use can exacerbate certain symptoms of depression, namely lack of motivation and disturbances in sleep. Yet concluding that marijuana worsens depression — let alone that it causes depression — oversimplifies a complicated relationship.

Researchers remain unable to determine whether cannabis use increases the likelihood for developing depression, or if depressed individuals are more likely to use cannabis. What’s more, there’s evidence that, in low doses, marijuana can actually alleviate depressive symptoms.

It’s also possible that marijuana doesn’t necessarily worsen depression so much as interfere with its treatment.

When Medicine Can’t Metabolize

Cannabis can, however, interfere with the body’s ability to process certain medications by hindering an enzyme in the liver that’s responsible for metabolizing them. Among the medications impacted are several types of antidepressants.

When they’re not adequately metabolized, higher levels of these medications remain in the bloodstream, which can worsen common side effects like diarrhea, dizziness, and fatigue. And those who experience these side effects are more likely than average to stop taking their medication.

Still, the link between cannabis and antidepressant interference is not a straight line. Outcomes depend not only on the type of antidepressant but the amount of marijuana consumed, as well as individual variables. Metabolism is one of these: People with slower metabolisms are more likely to contend with the medication buildup that exacerbates side effects.

Teen Vulnerability

Could age be another risk factor in the interference between cannabis and antidepressants?

While it’s not yet clear whether adolescents are more biologically vulnerable than adults to negative interactions between cannabis and antidepressants, there are unique risk factors for modern teens — one of which being that they use cannabis more than prior generations did. Rates of marijuana use among teens are the highest they’ve been in 30 years.

Additionally, compared with adult users, teens are less sensitive to the immediate effects of marijuana use and more likely to crave another hit or seek heavier doses. This means they are arguably more vulnerable to becoming addicted.

Some experts believe teens are more psychologically vulnerable, as well.

Researchers can’t say for sure whether teenage marijuana users are more likely than adults to ditch their antidepressants if they experience negative side effects, but neurology isn’t exactly on their side.

Thanks to their still-developing brains (and the sense of invincibility that comes with being young), teenagers are generally less likely than adults to consider the long-term consequences of their actions. It stands to reason, then, that they might dismiss concerns around the detrimental effects of marijuana because smoking offers immediate relief. The relaxed, euphoric feeling gives a false impression that cannabis is helping rather than hindering recovery from depression.

“My patients often seem motivated to reduce substance use only if they are experiencing consistent adverse effects on their body, brain, and in their lives in general,” he says.

Still, knowledge is power and as the body of cannabis research grows — and efforts to reclassify the drug expand opportunities to study it — so too will our understanding of how it impacts mental health.

This article originally appeared as “Marijuana + Antidepressants = A Risky Combination?” in the September/October 2024 issue of Experience Life.

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