In our latest question, our cannabis pharmacist discusses whether using CBD alongside the antidepressant medication sertraline is safe. Considering taking CBD and sertraline? Or looking to replace sertraline with CBD? Here's the guide on what you need to do, potential outcomes, and studies.
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
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?
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.
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.
Zoloft [package insert]. New York, NY: Pfizer, Inc. 2016.
Epidiolex [ package insert ]. Carlsbad, CA: Greenwich Biosciences, Inc. 2020.
CBD and Sertraline, Read This Before Taking Both – Interactions and Side Effects
Considering taking both CBD and sertraline? If so, then you will need to understand the interactions and potential implications this might cause.
In this article, we’ll be guiding you through what happens if you take both CBD and sertraline, starting with a quick sum-up answer.
CBD and Sertraline? CBD and sertraline taken together are believed to interact adversely, increasing the side effects of sertraline. This includes increased dizziness, drowsiness, confusion, and difficulty concentrating. But the clinical significance of this is vague. CBD also reflects some sertraline properties.
The outcome for CBD and sertraline is not that promising, so do not stop taking your medication at this point. Proceed with caution and consult your doctor before taking these elements together.
What are CBD and sertraline?
Before beginning with this topic, it’s important to get a breakdown of what these two components are.
What is CBD
CBD is short for cannabidiol and is a known chemical compound of the cannabis sativa plant. This compound is naturally occurring and is added to products such as oils and other edibles.
Unlike some other components of the cannabis sativa plant – CBD is not psychoactive. Meaning it will exhibit its benefits without the feeling of becoming high.
CBD is a supplement used mainly to provide the user with a feeling of calmness and relaxation, including promoting positive sleep patterns.
CBD is also used for treating conditions such as anxiety, insomnia, and a variety of chronic pain. But it can cause side effects such as headaches.
What is sertraline
Sertraline is an antidepressant sold under the brand name Zoloft.
Sertraline is known as a “selective serotonin reuptake inhibitor” or (SSRI) and works by restoring the balance of serotonin in the brain.
It is used for treating a variety of conditions starting from, but not limited to:
- Obsessive-compulsive disorder
- Panic attacks
- Stress disorder
- Social anxiety disorder (social phobia)
- Severe forms of premenstrual syndrome (premenstrual dysphoric disorder)
Aside from its benefits, drugs like sertraline do have their side effects. Still, sertraline helps improve your overall mood, supports quality of sleep, and boosts appetite and energy levels to restore your interest in daily living. It also reduces fear, anxiety, and other unwanted thoughts.
Moreover, it can reduce your urge to perform repeated tasks that disturb your daily routine.
When comparing CBD with sertraline, they both exhibit general characteristics in terms of treating anxiety and promoting a sense of calmness and relaxation.
However, the use of both in combination has a different perspective as to its safety and effectiveness.
Can you take CBD with sertraline?
Firstly, it’s important to mention that CBD has gained much popularity recently. This popularity is what helped CBD reveal its medicinal nature. Consumers then began mixing CBD with prescription medications in the hope of maximizing effectiveness.
Because of this recent trend of using CBD for medicinal purposes, there is a distinct lack of studies to validate drug interactions for many drugs, including CBD and sertraline.
The studies we know of that we can fall back on help us answer whether you can take CBD with sertraline.
It’s believed that using CBD with sertraline is likely to worsen the side effects of sertraline.
Specifically, using sertraline with CBD can increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. To add to this, the elderly may experience impairment in thinking, judgment, and motor coordination when sertraline is taken alongside CBD.
In general, it’s believed that CBD does have some theoretical drug interactions. However, many believe that the interactions are only mild or rare and would not bring about any severe reactions. However, there is not enough clinical evidence to say for sure.
A solid answer to whether you can take CBD with sertraline is still largely unknown because of unstudied potential interactions.
So with that in mind, it’s best to understand more about how CBD could interact with sertraline. Let’s tackle that next.
How can CBD interact with sertraline?
Sertraline is an SSRI (Selective Serotonin Re-uptake Inhibitor) that requires extensive metabolization by various CYP enzymes, including ones like CYP2B6, CYP2C19, CYP2C9, CYP3A4, and CYP2D6.
The metabolization of any medications is essential to get rid of the pharmaceutical compounds from the body.
The slower the drug metabolization process is, the more the drug stays in the system, causing potential toxicity and other dangerous outcomes.
In contrast to this process, research indicates that CBD inhibits many of the metabolizing enzymes listed above. This increases the risk of adverse effects as a result of increasing sertraline concentration in the body.
Meaning, the longer sertraline stays in the body because CBD inhibits its metabolizing enzymes, the greater the concentration of sertraline remains in the system, which can be toxic and cause adverse effects.
Can CBD and sertraline interaction severe?
Although theoretical reasoning says that CBD and sertraline interactions can pose adverse effects, some data and studies say otherwise.
Firstly, additional data on CBD interaction states that the risk of CBD interacting with sertraline is specifically is low.
Secondly, many studies project that even if CBD inhibits certain specific enzymes necessary for metabolizing sertraline, it is not significant. The blood concentration required to affect and inhibit these enzymes significantly exceeds regular CBD dosages.
Third and finally, another study states that because sertraline is metabolized with the help of several enzymes, it would be complex for a single agent like CBD to cause a severe or clinically important interaction.
However, while clinical reasonings opposed the conclusions of theoretical reasoning, we can only make general educated guesses until studies are completed that provide a more substantial data set and a solid conclusion.
So, be advised, it is crucial that you consult your doctor if you want to combine CBD with sertraline and follow any guidance they provide.
Can CBD replace sertraline?
With such interaction-based confusions, it’s common to wonder whether CBD can replace sertraline, given the fact that they have similar properties.
Starting with a study undertaken in 2018, published in the Frontiers in Immunology, CBD was demonstrated as a potential remedy for depression, similar to how sertraline is taken for depression.
The study found that CBD exhibits anxiolytic (anti-anxiety), antiepileptic, and antipsychotic properties, which can reduce depression linked to stress. This benefit of CBD for depression tends to be linked to its positive impact on serotonin receptors in the brain.
In another study published in Frontiers in Neuroscience, also in 2018, it was stated that CBD might help treat a variety of psychological conditions. Such conditions include mental health and post-traumatic stress disorder (PTSD) – the same conditions for which sertraline is commonly prescribed.
CBD also appears to work faster than most antidepressant medications, including sertraline, which in most cases takes weeks to start performing.
To back this up, 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. Imipramine is a tricyclic antidepressant (TCA) used mainly for the treatment of depression.
Dependent on brain serotonin
However, deviating from these positive statements, a further study published in Progress in Neuro-Psychopharmacology & Biological Psychiatry Journal shows that these antidepressant-like effects induced by CBD are dependent on brain serotonin levels.
Moreover, as of now, no study has provided evidence that CBD can be used specifically to replace sertraline.
So, to conclude on this point, replacing sertraline with CBD is not recommended, and as always, we would recommend that you consult with your doctor if you plan to do so.
We hope this has helped you to understand the interactions, risks, and benefits around CBD and sertraline.
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