Today’s article seeks to answer a simple query. Can you take CBD oil with SNRI antidepressants? In order to successfully answer this query, we need to understand what SNRI antidepressants are. And, we need to understand how they interact within our bodies. This will help us determine how safe it is to take SNRI antidepressants with CBD oil.
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What Is An SNRI Antidepressant?
An SNRI antidepressant is a pharmaceutical drug prescribed to patients with depression and/or chronic nerve pain that leads to depression. SNRI antidepressants work by increasing the levels of Serotonin and Norepinephrine in your brain. They do this by blocking them from being reabsorbed into your nerve cells. The letters SNRI stand for Serotonin Norepinephrine Reuptake Inhibitor.
Serotonin and Norepinephrine are both chemical messengers known as neurotransmitters. They carry signals between the neurons (or nerve cells) in your brain and body. The most common SNRI antidepressants available in the market are Cymbalta (duloxetine), Effexor (venlafaxine), Khedezla (desvenlafaxine ER), Fetzima (levomilnacipran), and Pristiq (desvenlafaxine).
Why Are Serotonin And Norepinephrine Chosen For Treating Depression?
Serotonin and Norepinephrine are 2 out of 7 total identified neurotransmitters. The other chemical messengers are dopamine, histamine, gamma-aminobutyric acid (GABA), glutamate, and acetylcholine. Each one has a unique and important function in our brain and body.
Serotonin helps regulate your mood, social behavior, appetite, digestion, sleep, memory, and sexual function. Norepinephrine helps with your sleep-wake cycle, increasing focus and attention when performing a task, and memory storage capabilities. Norepinephrine also works with adrenaline to increase your heart rate, increase blood pressure, increase blood sugar levels, and break down fat for more energy availability.
The medical community believes that making both Serotonin and Norepinephrine more available in your system will help improve your mood, alertness, and energy levels. In theory, this would fight the effects of depression. However, in reality, SNRI antidepressants come with an extremely negative side effect profile.
What Are The Negative Side Effects Of SNRI Antidepressants?
On paper, SNRI antidepressants seem to be a viable solution for treating depression. Yet, they present more problems than they’re worth. Before we get to the side effects, one problem that exists with SNRIs is that the balance of serotonin and norepinephrine varies greatly with each commercially available SNRI. This means that a patient will go through multiple SNRIs before finding one that would provide optimal results. And, this is not taking into account the negative side effects the patient would experience. The negative side effects a patient would experience include:
- Nausea and vomiting
- Diarrhea or constipation
- Headaches and dizziness
- Dry mouth
- Appetite loss
- Nervousness and tremors
- Excessive sweating
- Insomnia
- Tiredness
- Sexual dysfunction (i.e. erectile, orgasm, libido dysfunction)
If you’re under the age of 25 and you take SNRIs, it’s commonly advised that a very close eye is kept on you. Why? This is because you’re most likely to experience worsening depression and suicidal thoughts. In addition, SNRIs are known to have negative interactions with other drugs.
For example, your risk of bleeding increases when you take SNRIs with Ibuprofen, Aspirin, Warfarin, and other blood thinners. When mixed with other drugs such as pain relievers, St John’s Wort, or other antidepressants, SNRIs can lead to you getting Serotonin Syndrome. This is a condition where too much serotonin becomes present in your body and brain causing you to experience more negative effects such as:
- Agitation and anxiety
- High fever and sweating
- Confusion
- Tremors
- Restlessness
- Lack of coordination
- Rapid heart rate
- Blood pressure changes
The medical community claims that SNRI antidepressants are not addictive. Yet, when you stop taking them or miss repetitions you experience withdrawal symptoms. The most common withdrawal symptoms include dizziness, headaches, flu-like symptoms, irritability, nausea, and diarrhea.
Thus, the combination of unpredictable results coupled with the negative side effects, the negative drug interaction effects, and the negative withdrawal symptoms is making people seek alternative solutions. One of which is cannabis-based treatment. Mostly in the form of CBD oil. This leads us to the question of the day.
Can You Take CBD Oil With SNRI Antidepressants?
From a safety perspective, the answer is no, you cannot. From a mechanical perspective, the answer is yes, you can. You can physically take SNRI antidepressants with CBD oil but the results may not be positive. Doctors are split as to how safe it is for a number of reasons. Regardless, there are specific risks a patient must be aware of beforehand.
How Risky Is It To Take CBD Oil With SNRI Antidepressants?
The main concern people have is whether CBD oil and SNRIs will interact negatively. The medical community is split as to whether it’s safe or not to do so. Anti-cannabis medical professionals argue that SNRIs and cannabis both have psychoactive effects. Hence, it is their belief that taking them together may cause negative psychoactive effects.
On the other hand, pro-cannabis medical professionals state that both CBD and THC are generally safe to take with SNRIs. However, pro-cannabis doctors advise that you must be both strategic and cautionary with your approach. If not, you’re at risk of experiencing the negative drug effects caused by drug interactions.
Taking CBD oil and SSRIs at the same time can increase the amount of SNRI serum available in your system. This happens because both THC and CBD block the metabolism of SNRIs in your body or vice versa. CBD, THC, SNRIs, as well as other medications, are all broken down by an enzyme called Cytochrome P450. Thus, taking SNRIs and CBD oil together will cause metabolic competition causing the blockage of either one being broken down in your body. This leads to an over bio-availability of either SSRIs or cannabinoids in your system.
According to Dr. Cheryl Bugailiskis, in rare cases, the use of SNRIs and cannabis simultaneously can lead to a psychotic event known as mania. Mania is mostly observed in people with bipolar disorder and is usually linked to consuming cannabis edibles. In addition, patients may also experience an increase in the duration and effects of cannabis due to an increased bioavailability in the body.
According to Dr. Richard Kim, because CBD, THC, and SNRIs compete for the same metabolic enzymes you’re also at risk of getting serotonin syndrome. A condition where too much serotonin is present in your body and brain causing negative effects. This happens because you will have too high of a concentration of SNRI serum in your system, which leads to an over-abundance of serotonin in your system causing serotonin syndrome.
How Do You SAFELY Take CBD Oil With SNRI Antidepressants?
Whether your goal is to wean yourself off SNRIs, reduce the impact of withdrawal symptoms, or reduce the impact of negative side effects, there’s a safe way to do it. What most pro-cannabis doctors recommend you do is the following:
- Space out time between your drug administrations
- Microdose your cannabis-based treatment (at the beginning)
- Slowly increase your dose over time
- Track and journal your treatment actions and results
- Consult with a pro-cannabis medical professional (if you have access to one)
This first strategy is to space out the time between your different drug administrations. Due to the fact that SNRIs and CBD oil use the same enzymes to be broken down, pro-cannabis doctors recommend spacing out the time between each drug administration. The general time frame doctors recommend is between 1 – 3 hours. This gives your body enough time to metabolize either drug before taking the next one preventing negative drug interactions.
The second strategy pro-cannabis doctors recommend is a strategy called Micro-dosing. Microdosing is the practice of taking a minimal amount of a given substance to achieve your desired results or effects. With respect to CBD oil, people consume very small amounts throughout the day to achieve results such as reduced anxiety, reduced depression, pain relief, and anti-inflammatory effects. Doses can be as low as 2 – 3 milligrams per serving with the average dose range being around 3 – 10 milligrams per serve. Microdosing enables you to experience the benefits of CBD oil without getting or feeling high.
The third strategy pro-cannabis doctors recommend is to slowly increase your dosage over time. In a practical setting, this means increasing your CBD oil dosage slightly every couple of days while paying close attention to the effects you experience. For example, if you start to feel lethargic or dizzy after a dose increase, then you should reduce your dose slightly to the point that you do not feel dizzy or lethargic anymore. Then stay at the reduced dosage for a few days before attempting to increase your dosage again.
The fourth strategy pro-cannabis doctors recommend is to track and journal your actions and results. Regarding tracking, you want to track everything from the type of CBD oil you take, the concentration levels, dose amounts, dosage frequency in a day, and the effects experienced. This enables you to keep a close eye on how your body responds to your CBD oil treatment relative to the condition you’re treating for. It also enables you to instantly tell when you slip from positive to negative results and what it took to get there.
The fifth and final strategy is to consult with a pro-cannabis medical professional. Be it a doctor or a nurse, you’re always better off working with a professional. This strategy can be challenging for a lot of patients as cannabis laws are still in a legal grey area in most regions of the world. However, because of the Internet, you have access to doctors around the world. Your challenge is to find one who will consult with you and provide guidance along your journey.
For example, here’s an excerpt from Nursing Practitioner, Tatiana Gonzalez consulting with a patient regarding cannabis-based treatment for SNRI withdrawal symptoms:
In addition to the above, another benefit of following the above strategies is that you can prevent yourself from making your depressive symptoms worse with cannabis use. What many patients are unaware of is that heavy cannabis use can lead to worsening symptoms of depression.
In a 2014 clinical study, researchers set out to investigate the effects of heavy marijuana use on substance abusers versus a control group. The researchers found that the brains of marijuana abusers become less sensitive to dopamine over time. Less sensitivity to dopamine makes you detached and apathetic, which are two symptoms of depression. Dopamine is a chemical messenger that sends signals between your nerve cells relating to reward, pleasure, focus, and pain.
In a 2007 rodent model study, researchers set out to investigate the effects of cannabis at low and high doses in rats. The study found that THC boosts serotonin levels at low doses. However, at high doses, THC had the opposite effect. Hence, knowing your optimal dosage levels will enable you to benefit from cannabis-based treatment without falling victim to the negative effects due to misuse or substance abuse.
In Closing…
CBD oil can be taken with an SNRI antidepressant regimen in a strategic and cautious fashion. It is not advised, however, to take CBD oil and SNRIs simultaneously due to metabolic competition. Doing this may cause negative drug interactions such as serotonin syndrome.
Patients are using CBD oil to either reduce the impact of SNRI side effects or to assist with weaning off SNRI due to negative withdrawal symptoms. Moving forward, there should NOT be any doubt in your mind that you will be able to achieve positive treatment results provided you are strategic and cautious with your approach. Specifically, if you use the strategies recommended by doctors earlier in this article. Your two main challenges will be finding a pro-cannabis doctor in your area and finding a suitable CBD oil solution that will assist you in getting results.
Regarding finding a pro-cannabis doctor, you will have to do some considerable leg work because, for every 1 pro-cannabis doctor practicing medicine, there is a multitude of anti-cannabis doctors out there. However, do not let that discourage you. Pro-cannabis doctors do exist and you can find them. You just have to look and be persistent until you find one.
Citations
- Sheffler ZM, Reddy V, Pillarisetty LS. Physiology, Neurotransmitters. [Updated 2020 May 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539894/
- Bibi, Z. Role of cytochrome P450 in drug interactions. Nutr Metab (Lond) 5, 27 (2008). https://doi.org/10.1186/1743-7075-5-27
- Cannabinoids Elicit Antidepressant-Like Behavior and Activate Serotonergic Neurons through the Medial Prefrontal Cortex Francis Rodriguez Bambico, Noam Katz, Guy Debonnel, Gabriella Gobbi Journal of Neuroscience 24 October 2007, 27 (43) 11700-11711; DOI: 10.1523/JNEUROSCI.1636-07.2007
- Decreased brain DA reactivity in marijuana abusers; Nora D. Volkow, Gene-Jack Wang, Frank Telang, Joanna S. Fowler, David Alexoff, Jean Logan, Millard Jayne, Christopher Wong, Dardo Tomasi; Proceedings of the National Academy of Sciences Jul 2014, 111 (30) E3149 E3156; DOI: 10.1073/pnas.1411228111
