One of sertraline’s significant side effects is an increased risk of suicide in people under 25 years. This age group requires constant monitoring.
Two drugs, Epidiolex and Sativex, contain CBD and have received approval for use.
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.
3. Liver & Kidney Impairment
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.
Sertraline (Zoloft) is an SSRI and inhibits the reuptake of serotonin in the brain.
Important Points To Consider About CBD
Sertraline hydrochloride was invented and marketed by Pfizer with the brand name Zoloft. It was approved for use by the FDA in 1999.
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.
Cannabinoids and several SSRIs are hepatically metabolized by CYP2C19 and CYP2D6. CYP2D6, and CYP2C19 metabolize many neuropsychiatric medications. CYP2D6 has over 100 known allelic variants and over 20 of these polymorphisms impact function. Broadly, these alleles are classified as normal function, decreased function, and no function . As each individual patient inherits two alleles, phenotypes depend on the combination of inherited alleles. Four metabolic phenotypes have been predicted for CYP2D6: ultrarapid metabolizers inheriting duplications of functional alleles (1–20% of patients), normal (extensive) metabolizers inheriting at least one normal function allele (19–63%), intermediate metabolizers inheriting at least one decreased function or no function allele (14–72%), and poor metabolizers (0–6%) inheriting only no function alleles. Fluoxetine, fluvoxamine, and paroxetine are metabolized by CYP2D6 .
To illustrate the potential clinical impact of concurrent SSRI and cannabinoid use, we present the following.
FAERS analysis of side effects in patients on antidepressants. The heatmap shows differential rates of side effects in patients on CYP2C19-metabolized medications (sertraline, es/citalopram), cannabinoids (CBD and THC) and the patients taking both as reported to FAERS. Rates of 23 side effects that are on the sertraline or es/citalopram label at >5% frequency were compared across three patient groups. Side effects with higher frequencies in the combination compared to the baseline (CYP2C19 medications without cannabinoids) and passing the FDR correction are highlighted using asterisks (* p < 0.05, *** p < 0.005). Frequencies of the side effects in the FAERS data are color coded as gray (0%), blue (5%), and red (10% or greater). Number of patients in each group: CYP2C19 (427,932), CBD (7008), CBD + CYP2C19 (421). Groups were mutually exclusive. Bejamini, Hochberg, and Yekutieli test used for FDR correction, significance threshold 0.05. FDR: false discovery rate.
5 Division of Research in Patient Services, Cincinnati Children’s Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA