CBD is a popular alternative treatment for anxiety and depression, but will it help or worsen the side effects of sertraline (Zoloft) if used together? 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. In our latest question and answer, the pharmacist discusses whether or not Zoloft (sertraline) interacts with CBD (cannabidiol).
Does CBD Interact With Sertraline (Zoloft)?
Information on risks & possible interactions between CBD & sertraline.
Zoloft, or sertraline, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It’s used in treating depression, panic attacks, obsessive-compulsive disorder, post-traumatic stress disorder, and premenstrual dysphoric disorder.
Cannabidiol or CBD has been gaining attention for its positive effects on anxiety, insomnia, inflammation, and depression.
Studies are still underway, though, and not much is known about the many other effects it could cause. CBD decreases particular enzymes’ abilities to metabolize Zoloft, so using them together could worsen the latter’s effects; however, the research is limited.
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Does CBD Interact With Sertraline?
CBD may act as a competitive inhibitor for the same enzymes that metabolize sertraline (Zoloft). It can prevent the actions of cytochrome P450 enzymes, the same enzymes that metabolize sertraline; theoretically, using them together could decrease sertraline’s metabolization and, thus, increase its effects.
Because of this, sertraline might remain in the body for longer and could cause some side effects, ranging from simple ones to serious ones, such as serotonin syndrome.
However, there are not enough studies to determine exactly how much of an effect there will be by using sertraline and CBD together.
Other Names For Sertraline
Sertraline is sold under many different names. All share the same risk and potential interactions.
Other names for sertraline include:
Similar Medications: CBD & SSRIs
Sertraline is classified as an SSRI (selective serotonin reuptake inhibitor). CBD and SSRIs all share similar risks for interaction and side effects.
Here’s a list of similar medications that share a similar level of risk when combined with CBD:
- Citalopram (Cipramil & Celexa)
- Dapoxetine (Priligy)
- Escitalopram (Cipralex & Lexapro)
- Fluoxetine (Prozac, Rapiflux, Sarafem, Selfemra & Oxactin)
- Fluvoxamine (Faverin)
- Paroxetine (Seroxat)
- Vortioxetine (Brintellix)
Is It Safe to Take CBD & Sertraline Together?
Because of CBD’s effects on the enzymes that metabolize sertraline (Zoloft), the latter drug is likely to be more potent than usual. This could lead to side effects and, at worst, may cause excessive serotonin levels, leading to symptoms similar to serotonin syndrome.
There’s not much information on the side effects of mixing these two drugs, but be on the safe side and exercise extreme caution.
If you want to mix CBD with sertraline (Zoloft), talk to your doctor first.
Is CBD a Viable Alternative to Sertraline?
Because CBD lacks extensive studies on its effectiveness, it cannot be considered a good alternative to sertraline (Zoloft). For now, it’s best to continue your regular dosage of Zoloft and talk to your doctor.
Under the advice of your medical practitioner, you may take both medications, but if you experience any abnormal symptoms, immediately stop CBD and contact your doctor.
What Is Sertraline (Zoloft)?
Sertraline hydrochloride was invented and marketed by Pfizer with the brand name Zoloft. It was approved for use by the FDA in 1999.
Sertraline is metabolized in the liver by several cytochrome enzymes, including CYP2B6, CYP2C19, CYP2C9, CYP3A4, and CYP2D6.
|Other Names (other generics)||Lustral, Setrona, Zosert, Certrafine, Psyline, Sertima|
|CYP Metabolism||CYP2B6, CYP2C19, CYP2C9, CYP3A4, and CYP2D6|
|Interaction With CBD||Metabolic Competitor|
|Risk of Interaction||Moderate; patient needs careful monitoring|
What Does Sertraline (Zoloft) Do?
Sertraline (Zoloft) is an SSRI and inhibits the reuptake of serotonin in the brain.
Zoloft is used in treating depression, panic attacks, obsessive-compulsive disorder, post-traumatic stress disorder, social anxiety disorder, and premenstrual dysphoric disorder. Zoloft can also improve mood and sleep and make the patient feel a better sense of well-being.
Depression is a mental disorder characterized by persistent low mood and lack of interest in activities that the person had previously enjoyed. In most patients with depression, serotonin levels are deficient.
Serotonin is the hormone that stabilizes mood, feelings of happiness, and well-being. Its level decreases in conditions such as depression.
Sertraline binds to the serotonin transporter (SERT) and inhibits the CNS neuronal retaking of serotonin (5HT). It prevents the fast metabolism of serotonin, thus allowing it to last longer in the brain, long enough for the person to function well again.
Side Effects of Sertraline
Like most other medications, sertraline (Zoloft) also has side effects. It affects the body as a whole and not just one system. These side effects usually happen on overdosing or incorrect dosing of the medication.
Side Effects In More Than 10% of Patients:
- Ejaculation disorder
- Dry mouth
Side Effects In Less Than 10% of Patients:
Rare Side Effects:
- Back pain
- Chest pain
- Increased appetite
- Weight gain
Possible Complications With Sertraline
There are some things about sertraline (Zoloft) that one should know before taking it. In some instances, Zoloft can be more dangerous. Here are a few situations:
1. Monoamine Oxidase Inhibitors (MAOI)
It can interact with MAOIs causing a decrease in serotonin metabolism, leading to an increased serotonin level, called Serotonin Syndrome. Its symptoms are high blood pressure, rapid heart rate, nausea, vomiting, and anxiety, and can be dangerous.
The oral solution of sertraline contains alcohol, so using them together can cause flushing, headaches, nausea, and vomiting.
3. Liver & Kidney Impairment
Patients with liver and kidney problems cannot properly remove sertraline from the body; low doses under supervision are required.
Using sertraline during pregnancy can cause congenital heart defects in the newborn.
Breastfeeding mothers with depression can use sertraline since its appearance in breast milk is minimal.
6. Patients Under 25
One of sertraline’s significant side effects is an increased risk of suicide in people under 25 years. This age group requires constant monitoring.
What Is CBD?
CBD, or cannabidiol, is a compound extracted from cannabis, usually hemp, to comply with federal law. It’s the second most common cannabinoid in cannabis, making up almost 40% of it.
There are many ways to take CBD, including inhalation, orally, or topically — topical application only works on the area it’s applied to. It does not cause alterations in mood or intoxication like another popular cannabinoid, delta-9 tetrahydrocannabinol (THC).
CBD has been the topic of many studies over the past few decades. It’s useful in treating anxiety, cognition, movement disorders, and pain.
In 2018, a cannabidiol drug, Epidiolex, was approved by the FDA. Epidiolex is used for the treatment of two rare epilepsy conditions. In some parts of the world, CBD combined with THC in a 1:1 combination is approved for use in symptomatic relief for adults with Multiple Sclerosis.
What Does CBD Do?
CBD interacts with the endocannabinoid system (ECS); this complex system is found throughout the body and is composed of endocannabinoids, enzymes, and cannabinoid receptors.
There are two receptors of most importance in the ECS, called CB1 and CB2. CB1 is associated with the nervous system, while CB2 is found mainly in the immune system.
THC binds directly to the CB1 and CB2 receptors. CBD, however, alters the behavior of the receptors, causing a reaction.
CBD can activate 5-HT1A/2A/3A serotonergic receptors. While it doesn’t necessarily increase serotonin levels in the brain, it may affect the chemical receptors’ response to the already available serotonin .
CBD is metabolized in the liver by several cytochrome P450 enzymes and acts as a competitive inhibitor for these same enzymes. It occupies sites of enzymatic activity and displaces its chemical competitors. Due to this, these enzymes of cytochrome P450 are unable to metabolize other compounds.
CBD may have a benefit over other medications used in depression. While antidepressants take a few weeks to start working, CBD can show antidepressant-like effects much sooner.
CBD does not have side effects like most antidepressants do. There are no side effects like insomnia, sexual dysfunction, or mood swings with CBD .
Side Effects of CBD
- Potential liver damage
- Decrease in blood pressure
Important Points To Consider About CBD
You need to know a few things about CBD that may impact how you buy and use it.
The FDA Does Not Regulate CBD
Two drugs, Epidiolex and Sativex, contain CBD and have received approval for use.
CBD and CBD products are largely unregulated and are not FDA-approved. Unfortunately, this leaves a large gap, and the quality and safety of these products are often called into question. There are many good companies, but you have to watch out for the bad ones.
Often, companies lie about the amount of CBD in the products or add chemicals to make them seem more potent.
Even though many studies find CBD to be beneficial, the research is still lacking. We don’t know the full extent of its abilities and side effects yet, especially long-term.
Types of Drug Interactions With CBD
There are three different ways that CBD can interact with other drugs.
1. Agonistic Interaction (Increased Effect)
This happens when two substances have the same effects in the body due to both of them acting on the same receptors to push in the same direction.
These include drugs like:
- Antihypertensive medications — ACE inhibitors, alpha-blockers, angiotensin II receptor blockers, beta-blockers, calcium channel blockers, central agonists, and diuretics.
- Anti-anxiety medications — Benzodiazepines and barbiturates.
- Antidiabetic medications — Alpha-glucosidase inhibitors, biguanides, DPP-4 inhibitors, GLP-1 receptor agonists, meglitinides, SGLT-2 inhibitors, sulfonylureas, and insulin.
Antagonistic Interaction (Decreased Effect)
This decreases the effects of the medication.
These include medications like:
- Stimulants — Amphetamine, modafinil
- Immunomodulators — Antihistamines like carbinoxamine, desloratadine, levocetirizine
- Immunosuppressants — Azathioprine, mycophenolate cyclosporine, methotrexate
These medications need similar enzymes to break down the drug molecules, causing both types of medications to compete against each other, leading to a slow metabolism rate for both of them. They may increase the effects or decrease the effects.
These include medications like:
- Blood Thinners — Enoxaparin, heparins, and others
- NSAIDs — Ibuprofen, naproxen, high-dose asprin
- Opiate analgesics — Morphine, codeine, hydrocodone
- Antidepressants — Trazodone, mirtazapine, vortioxetine, and vilazodone
Key Takeaways: Is it Safe to Take Sertraline (Zoloft) With CBD?
While theoretically, taking sertraline with CBD could cause some serious side effects, the studies are still limited. It’s better to exercise caution and talk with your doctor before you use CBD with sertraline. If you feel any side effects on using these drugs together, seek medical attention immediately.
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.
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.
Does CBD Interact With Zoloft (Sertraline)?
In our latest question and answer, the pharmacist discusses whether or not Zoloft (sertraline) interacts with CBD (cannabidiol).
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.
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:
- Multiple Sclerosis
- 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.