Cannabis vs. antidepressant medications: Which is best?

Both cannabis and antidepressant medications may help ease certain symptoms of depression.

But while antidepressants are approved by the Food and Drug Administration (FDA) for the treatment of depression, cannabis is not.

Still, some people find cannabis to be helpful for depression symptoms, like low mood, sleep problems, and changes in appetite.

When deciding on a depression treatment, it’s important to weigh the potential benefits and risks of each option and consult with a healthcare professional.

Weed vs. antidepressants for depression

Cannabis and antidepressant medications work differently to help with depression.

Cannabis compounds known as cannabinoids, including tetrahydrocannabinol (THC) and cannabidiol (CBD), act on your body’s endocannabinoid system, which helps regulate:

• Mood
• Sleep
• Stress response
• Energy levels
• Cognitive skills like focus and motivation

Some animal studies suggest that certain cannabinoids, including THC, may have antidepressant-like effects. However, high-quality human trials are limited, and cannabis has not been proven or approved as a primary treatment for depression.

There are different classes of antidepressant medications. The most commonly prescribed antidepressants are called selective serotonin reuptake inhibitors (SSRIs).

SSRIs work by increasing the amount of serotonin — the “happy hormone” — in your brain. Common SSRIs include:

• Fluoxetine (Prozac)
• Escitalopram (Lexapro)
• Citalopram (Celexa)
• Sertraline (Zoloft)
• Paroxetine (Paxil)

Another option, called serotonin and norepinephrine reuptake inhibitors (SNRIs), work similarly to SSRIs. In addition to serotonin, they also increase norepinephrine, a hormone that helps balance mood, focus, and alertness.

Common SNRIs include:

• Duloxetine (Cymbalta)
• Venlafaxine (Effexor)

Your doctor may recommend other types of antidepressants, such as:

• Bupropion (Wellbutrin)
• Mirtazapine (Remeron)

These medications work a bit differently from SSRIs or SNRIs to increase mood-enhancing hormones in the brain, and are also considered effective for managing depression.

Research on weed vs. antidepressants for depression

Research shows that both cannabis and common antidepressant medications can help treat depression:

• Antidepressants: Decades of clinical research support the use of antidepressants for depression, especially moderate to severe cases. They are considered first-line therapy in most medical guidelines.
• Cannabis: Animal studies and small human studies suggest cannabis may improve mood, sleep, and appetite in some people. Some patients say using cannabis helps reduce their need for other medications, but these findings are from self-reported surveys, not controlled clinical trials.

If you’re considering changes to your depression treatment, such as lowering a prescription dose or adding cannabis, always consult your healthcare provider or a Leafwell pharmacist first.

Safety of using antidepressants vs. weed for depression

When choosing between cannabis and antidepressants, it’s important to consider their risks.

Cannabis is generally well-tolerated. But it’s linked with some side effects, such as:

• Dry mouth
• Dry eyes
• Dizziness
• Drowsiness
• Confusion
• Impairment
• Headache
• Nausea
• Paranoia

In rare cases, long-term, high-dose cannabis use can lead to a condition called cannabis hyperemesis syndrome. This can cause severe nausea and vomiting.

Smoking cannabis carries respiratory risks, so it may be best to choose another product form, like tinctures or edibles.

Cannabis may also interact with certain medications, including some antidepressants.

Different types of antidepressants carry their own side effect risks, which may include:

• Insomnia
• Drowsiness
• Weakness
• Fatigue
• Headache
• Sexual dysfunction
• Nausea
• Seizures
• Changes in appetite
• Changes in weight
• Suicidal thoughts, especially at the beginning of treatment

Antidepressants can also interact with alcohol, opioids, and other substances, including cannabis.

Regardless of which form of depression treatment you use, ask your doctor to help you establish a safe dosing plan to minimize these risks. Be sure to let your doctor know if you’re taking any other medications or substances.

Risks of using cannabis and antidepressants together

Some people use cannabis and antidepressants together to help manage symptoms of depression.

Combining them may increase certain risks, so it’s important to speak with your doctor or a Leafwell pharmacist before taking them together.

The risks of mixing cannabis and antidepressants can vary depending on the exact medication you’re taking and your dosage. In general, you may be more likely experience:

• Diarrhea
• Drowsiness
• Dizziness

There’s a slight risk that combining cannabis with a serotonin-increasing medication can lead to a rare but potentially fatal condition called serotonin syndrome. Serotonin syndrome occurs when serotonin levels in your brain are too high. Findings from one case report suggest that combining cannabis and SSRIs may increase this risk.

Cannabis can also inhibit liver enzymes that help your body break down and process medications like antidepressants. Taking them together may cause the effects of the antidepressant to feel stronger and last longer than intended.

The bottom line: Consider the pros and cons of cannabis vs. antidepressants

Both cannabis and antidepressants can be used to help manage certain symptoms of depression. That said, each option carries its own risks and benefits to consider.

It’s important to remember that antidepressants have much more supporting clinical evidence and have been FDA-approved for the treatment of depression. Cannabis is not FDA-approved for depression treatment, but it may help with related symptoms, including low moods, insomnia, anxiety, and changes in appetite.

For safe, effective, and personalized depression treatment — and to avoid harmful drug interactions — speak with your doctor or a Leafwell pharmacist.

Always talk with a licensed healthcare provider before starting or stopping any medication or cannabis product.

Resources

• Antidepressant-like effects of Δ9-tetrahydrocannabinol and other cannabinoids isolated from Cannabis sativa L. https://www.sciencedirect.com/science/article/abs/pii/S0091305710000730
• Antidepressants do work after all. https://journals.sagepub.com/doi/full/10.1177/0269881120933127
• Cannabinoid interactions with cytochrome P450 drug metabolism: A full-spectrum characterization. https://pubmed.ncbi.nlm.nih.gov/34181150/
• Efficacy of SSRIs and newer antidepressants in severe depression: Comparison with TCAs. https://www.psychiatrist.com/wp-content/uploads/2021/02/13206_efficacy-ssris-newer-antidepressants-severe-depression.pdf
• Exploring the use of cannabis as a substitute for prescription drugs in a convenience sample. https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-021-00520-5
• Serotonin syndrome and cannabis: A case report. https://pmc.ncbi.nlm.nih.gov/articles/PMC10809727/
• SSRI antidepressant medications: Adverse effects and tolerability. https://pmc.ncbi.nlm.nih.gov/articles/PMC181155/

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