CBD (Cannabidiol) With Bupropion Interaction
There is a potential interaction but the overall effect is complicated and not well understood.
Is it safe to take CBD oil while on bupropion? I currently take bupropion once a day at night. 100 mg. Thanks!
At a glance
- CBD (cannabidiol) can potentially inhibit or induce (i.e. increase the effects of) the metabolizing enzyme CYP2B6, which is responsible bupropion metabolism. This can have unpredictable effects, either increasing or decreasing the effects of the drug.
There is a potential drug interaction between CBD (cannabidiol) and bupropion, although just how severe or concerning it is isn’t well known.
The concern is that taking CBD (cannabidiol) and bupropion together could significantly alter concentrations of bupropion in the body, resulting in either an increased risk of adverse reactions or decreased effectiveness of the drug.
The description of this concern is vague and unfortunately, there haven’t been any studies that have specifically evaluated the use of bupropion and CBD together.
The interaction is more theoretical based on what we know about the metabolism and pharmacokinetic profile of each.
The potential mechanism behind the interaction is as follows:
- Bupropion is a substrate of the enzyme CYP2B6; meaning that the drug is metabolized by it.
- CBD (cannabidiol) mayinhibit and/or induce CYP2B6.
- If CBD inhibits CYP2B6, bupropion metabolism will be reduced.
- If CBD induces CYP2B6, bupropion metabolism will be increased.
** Enzyme ‘inhibition’ refers to a decrease in enzyme effect. ‘Induction’ refers to an increase in enzyme effect. **
The prescribing information for Wellbutrin, a brand name product containing bupropion, warns about interactions with drugs that affect CYP2B6:
Preliminary studies show that CBD (cannabidiol) can both induce and inhibit CYP2B6.
Although there aren’t many drug interaction studies to draw conclusions from, a prescription CBD product approved in 2018, known as Epidiolex, discusses potential interactions in the prescribing information for the drug and lists bupropion specifically:
- Elsevier ClinicalKey: Cannabidiol Monograph (Accessed 1/10/19)
- Elsevier ClinicalKey: Bupropion Monograph (Accessed 1/10/19)
- A preliminary evaluation of the relationship of cannabinoid blood concentrations with the analgesic response to vaporized cannabis. PubMed (Accessed 1/10/19)
- Differential inhibition of human cytochrome P450 2A6 and 2B6 by major phytocannabinoids. Link (Accessed 1/10/19)
- Epidiolex Prescribing Information (Accessed 1/10/19)
There is a potential interaction between CBD and (cannabidiol) and bupropion. Caution is recommended if using both together.
Can Cannabis Replace Wellbutrin?
Depression can hit at any time of life and brings with it feelings of sorrow, hopelessness, a lack of self-worth, and irritability that can make it all but impossible to live well. One in six Americans regularly fills prescriptions for psychiatric medications, and the majority of those prescriptions are for antidepressants. Wellbutrin is one of the more popular antidepressants today because it produces results for many who take it and doesn’t usually cause sexual side effects like loss of libido and erectile dysfunction. It’s an NDRI (norepinephrine-dopamine reuptake inhibitor) that is sometimes prescribed alone, and sometimes alongside other meds.
But Wellbutrin is not risk-free. Common side effects include drowsiness, headaches, agitation, aggression, nausea, insomnia, or constipation. Allergic reactions, irregular heartbeat, and seizures are three of the less common, but more serious, potential side effects. And like many other antidepressants, Wellbutrin occasionally causes an uptick in suicidal thoughts.
Wellbutrin also doesn’t work for everyone. Google “Wellbutrin reviews” and you’ll find detailed accounts of how the drug sometimes fails those in dire need of relief. And for some who do experience reprieve from their depressive symptoms, the side effects can make it a difficult choice to remain on the medication.
Still, the drug helps people. James, a Wellbutrin user (who prefers to withhold his real name because the stigma associated with his mental health condition could jeopardize his job), told Civilized that comparing his state of mind before and after he started on Wellbutrin was like “night and day.”
A long-time cannabis user, the 42-year-old started smoking a lot more weed when he went through a rough patch in his career and relationship a couple years ago. He was on psychiatric medications other than Wellbutrin at the time, but found that adding large doses of THC into the mix “dramatically” exacerbated his mental health problems. “It degraded reality because there was just too much going on in my head,” he told Civilized . James’s psychiatrist advised him to quit weed for a period of time while his body adjusted to the new regimen of meds that included Wellbutrin.
Today, James takes a combination of three psychiatric medications including Wellbutrin, another antidepressant, and a mood stabilizer. “My meds are what keeps me on a steady track,” he said, though after a break of almost two years, he also enjoys cannabis again to help him relax on weekends and process occasional feelings of being overwhelmed. “I think, in the right amounts, marijuana can help,” he said. “It shifts my outlook, makes me feel lighter and more appreciative for what I have. A little weed while doing something cool can give you a breakthrough. But If you’re clinically depressed, you probably shouldn’t be smoking a ton.”
Depression can be caused by a wide variety of factors, from genetics to stressful life events. Even physical ailments, like chronic pain, can come with “a very strong overtone of depression,” says Dr. Bill Code , an anesthesiologist, integrative medicine specialist, and author of Solving the Brain Puzzle , who has treated more than 2,000 people with chronic pain. He’s seen a number of patients eventually able to come off not only their pain medication, but their antidepressants, too, using medical cannabis. “Many, many people — but not all — can get off antidepressants by tapering,” Dr. Code told Civilized . But in cases of very deep depression, he says pharmaceuticals may be still be the most effective.
Does Cannabis Work as an Antidepressant?
Depression is a serious condition, and this information is not meant to sway anyone toward or against Wellbutrin, nor does this constitute medical advice. But, because there are people who enjoy cannabis and would prefer to live without antidepressants, it’s a question worth asking.
Dr. Code says yes, there is evidence that cannabis can relieve depression, though — as in most things related to the plant — more research is in order. Most of the studies Dr. Code references come from outside North America; Italy and Israel have led the way in clinical research on medical cannabis.
The endocannabinoid system (ECS) appears naturally in the human body and regulates homeostasis, including the functions of mood, sleep, appetite, pain, inflammation, memory, and reproduction. The ECS works through an extensive network of CB1 receptors located in the nervous system and CB2 receptors located in the immune system, major organs, and GI tract. The fact that we have an ECS, according to researchers, helps us understand how and why cannabis acts therapeutically on the human body.
Anandamide — from the Sanskrit word Ananda , or bliss — is an endogenous cannabinoid, meaning that it’s produced naturally by the body and causes a feeling of euphoria. THC, said Dr. Code, has a major effect on the CB1 receptors, and works a lot like anandamide. CBD also works on a number of receptors, including some that affect depression and pain. Additionally, CBD acts secondarily through other mechanisms on the body’s CB2 receptors. Another way to think of it, says Dr. Code, is that, “cannabis has beneficial effects on the body because it’s mimicking the body’s own systems.”
Even beyond cannabinoids, terpenes (aromatic compounds) found in cannabis can have a dramatic impact on inflammation in the body, including in the brain. “‘The brain on fire’ is the short way of talking about depression,” said Dr. Code. Thus, if we can dial down inflammation, we may see an abatement in depression symptoms.
Alpha-pinene, known to reduce inflammation, promote clear thinking, and moderate the effects of too much THC, is potentially one of the most useful terpenes for depression. D-limonene, identified by its citrusy, uplifting, scent, is associated with clean thinking and bright thoughts, said Dr. Code.
“Historically, in depression the imbalance was hypothesized to be from serotonin, dopamine, and norepinephrine deficiency states and medications such as SSRIs, SNRIs and NDRIs are used to reverse this imbalance,” Dr. Zinia Thomas , a psychiatrist in St. Louis who regularly recommends medical marijuana, told Civilized . “CBD and THC are also seen to be able to ‘bind’ or sit in and activate the release of serotonin, dopamine and endorphins which then create a bliss-like state, free of anxiety and pain.”
Dosages, Strains, and Delivery Methods
According to Dr. Code, everything depends on the individual patient’s diagnosis, experience with cannabis, and the sensitivity of their endocannabinoid system. “The secret is to start small and work your way up over a period of days or weeks,” he said. Dr. Code often works with a 1:1 ratio of THC to CBD because he’s had good results with it for mood issues, as well as pain relief. “Many recreational strains will have 10:1 or 20:1 or even 30:1 THC to CBD,” he cautioned, “That’s not going to be therapeutic [for most people with psychiatric diagnoses].”
Dr. Code recommends that patients explore different terpene profiles that may be beneficial to their particular makeup. The good part about experimenting with cannabis medicine, he said, is the low risk of side effects. As long as patients and practitioners stay mindful of the THC to CBD ratios, and avoid an excess of THC (which is individually determined), they’re not likely to run into major complications from cannabis.
Dr. Thomas tends to recommend a cautious ratio of 20 parts CBD to one part THC. Each delivery method has its own pros and cons. Edibles will last longer, but will take 60 to 90 minutes to relieve symptoms. Tinctures and oils can allow for accurate micro-dosing. CBD vape pens, said Dr. Thomas, “can offer instant, yet short lived, effects and are especially useful for panic or severe anxiety symptoms [that can go along with depression].” She also occasionally recommends strains like Sour Diesel, Gorilla Glue #4, GSC, and Tangerine Dream for their potentially antidepressant and anti-anxiety effects.
CBD Can Help People Ease off Wellbutrin
The Stoner Mom , a blogger who has written about her experience getting off antidepressants with the use of CBD, wrote that once she quit the meds, her anxiety skyrocketed and depression loomed. In addition, she experienced “brain zaps”—a well-known withdrawal symptom of certain antidepressant drugs which are often described as sudden and uncomfortable sensations like electric jolts in the brain. She felt confused, disoriented, and overall extremely low. She wrote that CBD was instrumental in getting though that period.
After about eight weeks, her withdrawal symptoms stabilized, and the Stoner Mom now takes a large dose of CBD — 100 mg daily — to support her mental health without pharmaceuticals.
In addition to the mood-stabilizing and mood-boosting benefits of CBD, its anticonvulsant properties can be particularly helpful when weaning off Wellbutrin. Dr. Thomas told Civilized , “just as we can see videos of childhood seizures ceasing in seconds to minutes after CBD oil is administered, that is what happens to the nerves that are withdrawing from Wellbutrin—they’re calmed.”
It should be noted, however, that CBD can affect how the body processes certain pharmaceutical drugs through its action on a liver enzyme and thereby augment the actions of the drug. It’s always best to work with a practitioner well versed in cannabis medicine when mixing CBD or other cannabinoids with pharmaceuticals or considering a reduction in meds.
Don’t Do It Alone
Dr. Thomas observed that many patients, “start to taper off antidepressants on their own and inform the physician after their great success.” But, she doesn’t necessarily recommend that approach. She and Dr. Code both emphasized the importance of seeking qualified help if you believe you’re ready to reduce antidepressants like Wellbutrin. And as with most things health-related, good nutrition, quality sleep, exercise, and stress reduction techniques like yoga , meditation , and time outdoors should all be part of the picture, too.
Cannabis might be a helpful alternative for depression patients looking to wean off pharmaceuticals.