CBD Oil And Zoloft

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Many people use CBD as a wellness supplement, and many also take medications. Here’s what to know about how CBD may interact with certain medications. Zoloft (Sertraline) is used to treat depression and other mental conditions. Read here to know the interaction between CBD and Zoloft. In our latest question and answer, the pharmacist discusses whether or not Zoloft (sertraline) interacts with CBD (cannabidiol).

Is It Safe To Take CBD and Zoloft?

CBD has developed a cult following in the wellness community for its holistic benefits. While many people are interested in using CBD, it may not be a valuable option for people who are already using certain medications.

If you’re currently taking Zoloft, there are a few things you need to know about the way CBD and Zoloft may interact with each other. Although CBD’s wellness benefits are helpful to many people, they may not be safe to pursue if you’re currently using an antidepressant drug.

CBD Can Affect the Way Some Medications Work

If you’ve ever taken prescription medication, you’ve likely seen warnings about potential interactions on the label. Some medications, like birth control, can’t be taken with supplements like St. John’s Wort or saw palmetto. While these supplements are fine on their own, they don’t play well with the active constituents of birth control.

Many medications cannot be taken with alcohol. You cannot take benzodiazepine drugs with many kinds of pain relief drugs because of the way their effects stack. It’s always a balancing act, and people who need multiple medications to treat numerous concerns have to work with their doctors to find safe combinations.

Supplements and medications can interact in two different ways, and interactions should be avoided whenever possible.

By Exacerbating Their Side Effects

Many medications have side effects. The majority of people find that the side effects don’t dramatically alter their quality of life. They can work with their doctor to come to a conclusion about the way the benefits stack up against these side effects.

CBD, St. John’s Wort, kava, and melatonin all work to make their users feel more relaxed. When used with medications that cause drowsiness or sedation as a side effect, these supplements may amplify the degree of sleepiness users feel.

It may be dangerous to amplify feelings of fatigue or drowsiness, especially for medications intended for use during the daytime. Falls, automobile accidents, and injuries are more likely to occur when an individual is less alert.

By Modifying Their Absorption

The body metabolizes all medications and supplements through the liver. The liver can only produce so many enzymes necessary to metabolize drugs and supplements at one given time. When you use CBD and another medication at the same time, the two compete for these enzymes.

When this happens, the body can wind up with too much or too little of a particular drug in the bloodstream. Both outcomes can have serious consequences. If you have too little of a necessary medication in your bloodstream, your body can’t effectively use it for its intended purposes. If you have too much of a drug in your bloodstream, it may pose overwhelming or dangerous side effects.

Penn State researchers identified 57 medications that may interact with cannabinoids like CBD. Most doctors would advise against using CBD with these medications.

The only exception would be the use of cannabinoid-based medications like Epidiolex that are medically necessary for treating an underlying disorder. In those cases, doctors monitor patients closely for signs of potential negative interaction.

Can You Take CBD and Zoloft Together?

Zoloft, the brand name for sertraline, is not on the list of 57 medications that cause dangerous interactions. It does, however, cause sleepiness or changes in sleep patterns as a side effect.

Since CBD also works to promote sleep , the two may cause a strong and undesirable sedative effect when used in unison.

Using CBD with Zoloft may cause fatigue, confusion, dizziness, or difficulty with concentration. Side effects are usually more pronounced in seniors. If you’ve already used CBD in conjunction with Zoloft, avoid any activities that involve significant amounts of alertness and concentration, such as driving. Stop using CBD. Its effects will typically wear off within 12 hours.

Most doctors would not advise patients to use CBD in conjunction with Zoloft. There may be exceptions for cannabinoid-based medications used to treat an underlying medical issue, like Epidiolex for the management of seizures. Doctors usually make assessments on a case-by-case basis in these scenarios.

What About Other Antidepressants?

Other antidepressants, like Prozac, Celexa, Paxil, and Lexapro, have similar side effects to Zoloft. These medications are all selective serotonin reuptake inhibitors, or SSRIs. It’s best to regard them all the same way. CBD is just as likely to amplify the side effects of these antidepressant medications.

Tricyclic antidepressants like Tryptizol, Anafranil, Allegron, Tofranil, and Gamanil also shouldn’t be used in conjunction with CBD. CBD can amplify the concentrations of these medications in your blood, leading to extreme versions of their side effects. Side effects of TCAs include high blood pressure, seizures, and accelerated heart rate. This isn’t a chance worth taking.

Do All Forms of CBD Cause Interactions?

CBD is most commonly taken as a sublingual tincture. Drops are placed under the tongue and pass into the bloodstream without first passing through the digestive system. This form of CBD gets to work quickly.

Alternatively, CBD can be taken in the form of a softgel capsule. These capsules are similar to any other supplement that people might use for wellness.

Some people prefer to vaporize CBD concentrate. Inhalation allows users to experience effects rapidly, but it may not be the best delivery method due to its potentially negative impact on cardiovascular health.

CBD in any form can cause interaction with certain medications. The only thing that changes from form to form is how quickly those interactions will take place. Orally ingested CBD will cause a delayed onset interaction, as it takes the body longer to process and utilize CBD in this form.

Interaction with sublingual CBD usually begins to occur within an hour as the CBD starts to take effect. Interactions related to inhaled CBD will begin nearly instantaneously. They’re most noticeable when users are already experiencing side effects from antidepressant medications like drowsiness. CBD can amplify that feeling within minutes, dramatically altering the user’s alertness.

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The concern isn’t so much with the form of CBD as it is with the way CBD works. Because it reaches so many systems in the body and can inspire so many effects, there is no form of CBD users with antidepressants can take while reliably avoiding amplified side effects or compromised absorption.

Is CBD Safe on Its Own?

CBD is generally recognized as safe for most people, as long as it isn’t used in conjunction with prescription medications. Side effects from CBD use are rare and mild, and studies have demonstrated that humans can tolerate doses of up to 1,500 mg of CBD daily.

CBD does not have the potential for abuse or dependency , nor does it cause cognitive impairment. It’s fundamentally different from THC, the active constituent of cannabis that binds to receptors and produces a high.

CBD by itself is not a regulated or controlled substance. As long as the CBD product does not contain any residual traces of THC , it’s legal for use in all 50 states.

If You’re Taking Medications, You Should Always Ask Your Doctor Before Using Supplements

Many medications and supplements create the potential for interaction. If you’re currently taking any prescription medications, you shouldn’t take any supplements (including CBD) without first seeking approval from your doctor.

In some cases, you might be able to ring up your pharmacist. They’re often aware of potential interactions and will be able to give you advice.

Can People With Depression Use CBD?

Not everyone with depression uses antidepressant medications as a part of their treatment plan. If you’re using managed therapeutic or wellness approaches to cope with the symptoms and source of your depression, CBD obviously won’t cause any negative interactions with these forms of treatment.

That said, CBD is not an antidepressant. It’s a wellness supplement that often works to boost mood. It won’t treat or cure depression. People often use CBD simply because they enjoy the support it provides and the way it makes them feel.

Some mental health professionals have found merit in using CBD as part of a care plan for managing symptoms of anxiety or helping to treat those recovering from substance use disorders. CBD is not currently officially recognized for its direct benefits to the source of depression.

If you’re under the care of a mental health professional for depression treatment and you aren’t currently using any medications, speak with your mental healthcare professional about the possibility of incorporating CBD into your wellness plan and follow their advice. If you’re living with anxiety, CBD may be beneficial. It just doesn’t offer any benefits specific to depression.

CBD and Zoloft (Sertraline) – August 2022

According to Mayo Clinic, antidepressants are a popular treatment choice for depression. Although antidepressants may not cure depression, they can reduce the symptoms (4 ) .

Many types of antidepressant medications are available to treat depression, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), atypical antidepressants, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). Zoloft (sertraline) is an antidepressant that belongs to a group of SSRIs.

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

CYP34A enzymes belong to the class of CYP450 or Cytochrome P450 enzymes, which is essential for the metabolism of many medications (5 ) .

An article by CBD Oil Review explains that CBD blocks the cytochrome P450 enzyme system’s ability to metabolize certain drugs, including SSRIs, resulting in an overall increase in processing times (6 ) . Thus, taking CBD supplements while on these medications could interfere with how the body absorbs these medications.

This mechanism mirrors that of the grapefruit as it inhibits the same set of liver enzymes, the CYP34A, that CBD blocks, according to an article published by Harvard Health Publishing (7 ) .

In an article on grapefruit juice and medications, also published by Harvard Health Publishing, 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 (8 ) .

When the CYP450 system’s ability to metabolize certain drugs is affected, a high concentration of drugs remains in the body at one time. This increased level can cause unwanted side effects and, sometimes, an overdose (9 ) .

Taking CBD oil with SSRIs may reduce the efficacy of the antidepressants, or inversely, the efficacy of CBD oil may be reduced by antidepressants (10 ) .

Still, there is no substantial evidence to suggest any definite adverse reaction that may occur when taking CBD oil together with SSRIs.

Stipulations are not definite because of limited research published on CBD and drug interactions.

Another reason for the lack of conclusive evidence is because CBD possesses anti-depressive characteristics of its own .

In a 2014 study published in the CNS & Neurological Disorders – Drug Targets Journal, CBD was shown to possess antidepressant-like and anxiolytic-like effects (11 ) .

Adverse interactions between CBD oil and antidepressants are rare (12 ) . However, seeking the advice of a physician or psychiatrist is recommended before combining the two substances.

Also, when taking medications that interact with CBD, consulting with a doctor is advised to ensure that supplementing a personal therapy with CBD oil is without risk. The doctor may have to adjust the dosage of the medications so that they can be safely used with CBD oil (13 ) .

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

Zoloft (sertraline) is an antidepressant that works by increasing levels of serotonin in the brain.

As a neurotransmitter, serotonin modulates the activity of the nervous system and a wide range of processes linked to brain function and behavior, as indicated in a review published in the Annual Review of Medicine in 2018 (14 ) .

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 depressio n (15 ) :

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil, Pexeva)
  • Sertraline (Zoloft)
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There are fewer side effects and drug interactions with SSRIs than with other types of antidepressants, according to Mayo Clinic.

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.

Can CBD replace Zoloft?

A 2018 study published in the Frontiers in Immunology Journal demonstrated CBD as a potential remedy to depression (16 ) . In the study, researchers examined the experimental and clinical use of CBD and found that it showed anxiolytic (anti-anxiety), antiepileptic, and antipsychotic properties that may help reduce depression linked to stress.

CBD’s potential benefits for depression may be linked to its positive impact on serotonin receptors in the brain.

A 2018 study published in Progress in Neuro-Psychopharmacology & Biological Psychiatry Journal shows how antidepressant-like effects induced by CBD are dependent on brain serotonin levels (17 ) .

Researchers of a study , which was published in World Psychiatry Journal in 2015, found that impairing serotonin function can cause clinical depression in some circumstances (18 ) .

In another study , which was published in Frontiers in Neuroscience in 2018, it was shown that CBD might help treat a variety of psychological conditions, including mental health and post-traumatic stress disorder (PTSD) (19 ) .

Research published in Trends in Pharmacological Sciences in 2009 examined the therapeutic potential of the endocannabinoid system (ECS) (20 ) .

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 , which was published in Neuropharmacology Journal in 2016, arrived at the same conclusion (21 ) .

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

Researchers in 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, a tricyclic antidepressant (TCA) used mainly in the treatment of depression (22 ) .

However, there has been no study that would provide evidence that CBD can be used specifically to replace Zoloft.

Meanwhile, 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, according to the National Alliance On Mental Illness (NAMI) (23 ) .

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

  • Irritability
  • Nausea
  • Vomiting
  • Having nightmares
  • Prickling sensation on the skin

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.

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

What to Look for in a CBD Product

Zoloft interacts with CBD. Thus, consulting with a doctor is advised before supplementing a personal therapy with CBD oil. The doctor may consider adjusting the dosage of the medications so that they can be safely used with CBD oil (24 ) .

Full-spectrum CBD oil contains all phytonutrients from hemp, including trace amounts of THC, terpenes, flavonoids, and essential oils. Meanwhile, CBD isolates carry only pure, isolated cannabidiol.

Regardless of the form of CBD products that one chooses, careful consideration must be employed in selecting the best CBD oil to use, especially when trying to manage depression.

The following factors are essential to ensure the safety and reliability of the CBD products purchased:

  1. Research on the exact legal stipulations applicable to CBD in the area where it would be purchased and used.
  2. Purchase only high-quality CBD products from legitimate and reliable brands. The majority of companies that manufacture the best CBD oil products grow their own hemp from their own farm, or they purchase from licensed hemp producers.
  3. When buying from an online store, research product reviews. When buying from a physical store or dispensary, check whether the store is authorized by the government to sell CBD.
  4. One important thing to look for in CBD products is certification codes. Several certification authorities approve certain products only after some thorough screening tests.
  5. Compare company claims about their products’ potency with that of the third-party lab reports.
  6. Consulting with a trusted medical professional who is experienced in CBD use is ideal before one purchases his or her first bottle of CBD.

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 (25 ) .

ADAA explains that 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.

In a 2914 study published in BMC Psychiatry Journal , researchers suggest that lifestyle changes like increasing social support, improving sleep habits, getting regular exercise, and using stress-reduction techniques may also help manage depression (26 ) .

However, alcohol, smoking, and recreational drugs can make depression and anxiety disorder worse and interfere with treatment, according to the authors of the study.

Having high blood pressure may also contribute to poor management of depression. Results of a 2013 study published in Experimental & Clinical Cardiology Journal suggest that depression is a typical feature in people experiencing uncontrolled high blood pressure (27 ) .

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 published in Clinical Therapeutics Journal examined the role of sertraline in the management of depression (28 ) . Researchers concluded that this SSRI showed promise as a therapeutic alternative in the management of depression.

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However, a study published in Lancet Psychiatry Journal recently has found that, despite being marketed as an antidepressant, sertraline may be unlikely to alleviate depressive symptoms within six weeks. Meanwhile, their data showed improvements in anxiety (29 ) .

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 or tincture is a popular CBD product that one may purchase online like an over-the-counter supplement.

Conclusion

CBD continues to gain popularity as scientists discover more of its potential health benefits.

However, a Harvard Health article by Peter Grinspoon, M.D., author of the memoir Free Refills: A Doctor Confronts His Addiction warns that CBD use may potentially cause side effects, including irritability, nausea, and fatigue (30 ) . Also, CBD may 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.

In its Consumer Update , the U.S. Food and Drug Administration (FDA) also warned against some CBD products that are being marketed with unsubstantiated medical claims and are of inferior or unknown quality (31 ) . Thus, choosing products carefully is essential as getting a safe and potent CBD product from a reliable supplier may prove challenging.

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.

Does CBD Interact With Zoloft (Sertraline)?

In our latest question and answer, the pharmacist discusses whether or not Zoloft (sertraline) interacts with CBD (cannabidiol).

merlinmatt asked

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.

Answer

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:

  • Anxiety
  • Dystonia
  • Pain
  • Seizures
  • Multiple Sclerosis
  • Insomnia
  • 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.

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