From the Guidelines
Combining CBD with SSRIs is not recommended without consulting a healthcare provider due to potential drug interactions that may increase the risk of serotonin syndrome, drowsiness, dizziness, and confusion. The use of CBD with SSRIs requires caution, as both substances are metabolized by the same liver enzymes (cytochrome P450), which may lead to increased SSRI blood levels and adverse effects 1.
Key Considerations
- CBD may increase SSRI blood levels by competing for the cytochrome P450 enzymes, potentially leading to increased side effects such as drowsiness, dizziness, confusion, or serotonin syndrome in severe cases.
- If CBD is used with SSRIs, it is recommended to start with a very low dose (5-10mg) and gradually increase while monitoring for side effects.
- CBD products vary widely in quality and concentration, so it is essential to choose third-party tested products from reputable sources.
- The interaction risk appears dose-dependent, with higher CBD doses (above 100mg daily) more likely to cause significant interactions than lower doses.
Clinical Guidance
When considering the use of CBD with SSRIs, healthcare providers should be aware of the potential drug interactions and monitor patients closely for adverse effects. The clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders recommends caution when starting a second non-MAOI serotonergic drug, including SSRIs, and monitoring for symptoms, especially in the first 24 to 48 hours after dosage changes 1.
Patient Education
Patients should be educated on the potential risks and benefits of combining CBD with SSRIs and should be advised to consult with their healthcare provider before using CBD products. They should also be informed about the importance of choosing high-quality CBD products and starting with low doses to minimize the risk of adverse effects.
From the Research
CBD and SSRIs Interaction
- The interaction between CBD and SSRIs is a complex one, with some studies suggesting that CBD can enhance the effects of SSRIs, while others warn of potential adverse effects 2, 3.
- A study published in 2018 found that the antidepressant-like effect of CBD is dependent on brain serotonin levels, suggesting that CBD may interact with SSRIs in a way that enhances their effects 2.
- Another study published in 2021 found that CBD can inhibit the metabolism of citalopram, a type of SSRI, which can lead to increased plasma concentrations of the drug and potentially increase the risk of adverse effects 3.
- However, a review of case reports found that the combination of tramadol and antidepressants, including SSRIs, can increase the risk of serotonin syndrome, a potentially life-threatening condition 4.
Potential Risks and Benefits
- The use of CBD with SSRIs may be beneficial for some individuals, particularly those with anxiety disorders, as CBD has been shown to have anxiolytic properties 5.
- However, the potential risks of combining CBD with SSRIs, including increased risk of adverse effects and serotonin syndrome, must be carefully considered 4, 3.
- A risk-benefit analysis must be conducted for each individual patient, taking into account their unique medical history and circumstances 6.
Pharmacokinetic Interactions
- CBD has been shown to inhibit the metabolism of certain SSRIs, including citalopram, which can lead to increased plasma concentrations of the drug 3.
- The pharmacokinetic interactions between CBD and SSRIs are complex and not fully understood, highlighting the need for further research in this area 3, 5.