![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by parent on May 23, 1999, at 5:21:56
From a concerned parent: Just found out
From concerned parents: Just found out that
16-yr-old who has been successfully treated
for depression (diagnosed 6 months ago) has
been smoking marijuana for past two months.Concerned about possible co-morbid
addiction condition, interaction of
marijuana with zoloft (100 mg), exacerbation
of depression and anxiety, etc. Gifted and
talented kid who needs real info. not
propaganda to convince him of dangers.
HELP!
Posted by JD on May 23, 1999, at 10:59:49
In reply to Zoloft & Marijuana Interactions?, posted by parent on May 23, 1999, at 5:21:56
Dear "parents",
While you have every right to be concerned
about your son's marijuana use, I wouldn't
get overly worried about the drug interaction
aspect: except for a few anecdotal reports
of problems with simultaneous use of SSRIs
like Zoloft, the medical literature hasn't
sounded too many alarms over what I'm sure is
a fairly popular combination among young
people. (I do, however, see one report of
Prozac and marijuana causing a manic response
in a patient, if you feel like going the fear
route in a tete-a-tete! It's never wise to
mix such medications in any event, even if
many people have no big problems.)The deeper issue may be whether people who
are depressed tend to "self-medicate" with
marijuana: one recent study showed that Prozac actually
helped to decrease its use, which alas
doesn't seem to be the case with your son on
Zoloft, which is a largely similar medicine.
From my point of view, the best solution may
be to address the marijuana essentially
as it's own issue, insofar as it relates to
your son's physical and emotional well-being
over the last few months. See some of the
abstracts I've included below...Good luck to you all,
JDDepression 1996;4(2):77-80
Do patients use marijuana as an antidepressant?
Gruber AJ, Pope HG Jr, Brown ME
Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts 02178, USA.
Several lines of evidence suggest that cannabis may have antidepressant effects. However, methodologic limitations in available
studies make the results difficult to interpret. We review this literature and present five cases in which the evidence seems
particularly clear that marijuana produced a direct antidepressant effect. If true, these observations argue that many patients
may use marijuana to "self-treat" depressive symptoms.---------------
J Clin Psychiatry 1991 Jun;52(6):280-1
A case of mania as a result of fluoxetine-marijuana interaction.
Stoll AL, Cole JO, Lukas SE
Publication Types:
Letter (no abstract)
----------------------
Fluoxetine versus placebo for the marijuana use of depressed alcoholics.
Cornelius JR, Salloum IM, Haskett RF, Ehler JG, Jarrett PJ, Thase ME, Perel JM
Department of Psychiatry, University of Pittsburgh School of Medicine, PA 15213, USA.
[Medline record in process]
The aim of this analysis was to evaluate the efficacy of the SSRI antidepressant fluoxetine versus placebo for the marijuana use
of depressed alcoholics. There are no previous reports involving and SSRI antidepressant for marijuana abuse. This analysis
involved a subsample of 22 depressed alcoholic marijuana users out of a total of 51 depressed alcoholics. The entire sample
was involved in a 12-week double-blind, placebo-controlled study evaluating the efficacy of fluoxetine versus placebo in
depressed alcoholics. During the course of the trial, the cumulative number of marijuana cigarettes used was almost 20 times as
high in the placebo group as in the fluoxetine group. Also, the number of days of marijuana use during the study was five times
higher in the placebo group than in the fluoxetine group. These data suggest efficacy for fluoxetine in decreasing marijuana use
of depressed alcoholics.> From a concerned parent: Just found out
>
>
> From concerned parents: Just found out that
> 16-yr-old who has been successfully treated
> for depression (diagnosed 6 months ago) has
> been smoking marijuana for past two months.
>
> Concerned about possible co-morbid
> addiction condition, interaction of
> marijuana with zoloft (100 mg), exacerbation
> of depression and anxiety, etc. Gifted and
> talented kid who needs real info. not
> propaganda to convince him of dangers.
> HELP!
Posted by PattyG on May 23, 1999, at 18:48:25
In reply to Zoloft & Marijuana Interactions?, posted by parent on May 23, 1999, at 5:21:56
How about checking with the doc and see if he'll consider switching to Wellbutrin (which is used for those who wish to quit smoking.) I'm told it also help curb desire for pot. Another idea might be to add Naltrexone - just learned at a convention that this drug (in addition to SSRI) supposedly helps folks stop smoking pot. (He noted, however, that this is for the "dependent" pot smoker, not a social user.) I know this has to be a worry for you, but I can sure tell you that many, many people sure seem to feel that marijuana helps ease their depression......sigh........
Posted by parent on May 23, 1999, at 21:53:06
In reply to Re: Zoloft & Marijuana Interactions?, posted by PattyG on May 23, 1999, at 18:48:25
> How about checking with the doc and see if he'll consider switching to Wellbutrin (which is used for those who wish to quit smoking.) I'm told it also help curb desire for pot. Another idea might be to add Naltrexone - just learned at a convention that this drug (in addition to SSRI) supposedly helps folks stop smoking pot. (He noted, however, that this is for the "dependent" pot smoker, not a social user.) I know this has to be a worry for you, but I can sure tell you that many, many people sure seem to feel that marijuana helps ease their depression......sigh........
Thanks for the info. We "think" it is still in
stage of "social" use rather than "addiction"
at this point. Wondering whether we should
consult another counselor who works more
with drugs since cognitive behavioral
counselor has been working with him on
depression -- which has abated but now we
have this formerly overly perfectionist kid
who is rebellious and smoking pot! Don't know
how to help him get to a healthy balance and
therapists seem to all be "segmented" into
specific areas--It helps to reach out through
this site. Thanks. Open to other suggestionss.
Suggestions????
Posted by Parents on May 23, 1999, at 22:10:45
In reply to Re: Zoloft & Marijuana Interactions?, posted by JD on May 23, 1999, at 10:59:49
"From my point of view, the best solution may
be to address the marijuana essentially
as it's own issue, insofar as it relates to
your son's physical and emotional well-being
over the last few months."Thanks for the abstracts--we are trying to
deal with this with him in a "logical"
rather than "scare" tactic process. How do
you suggest we do the above though--do we
need to get a substance abuse therapists
in addition to cognitive behavioral therapist
who has helped him with his depression? Do
we need to consider changing medications? Zoloft
seems to have quelled the anxiety but maybe
too much so that he's now more apathetic. How do we
help him find a balance?
He's gone from extreme perfectionism and
depression to more risky behavior and
no depression but marijuana use. Says its
just experimentation...but?????> Dear "parents",
>
> While you have every right to be concerned
> about your son's marijuana use, I wouldn't
> get overly worried about the drug interaction
> aspect: except for a few anecdotal reports
> of problems with simultaneous use of SSRIs
> like Zoloft, the medical literature hasn't
> sounded too many alarms over what I'm sure is
> a fairly popular combination among young
> people. (I do, however, see one report of
> Prozac and marijuana causing a manic response
> in a patient, if you feel like going the fear
> route in a tete-a-tete! It's never wise to
> mix such medications in any event, even if
> many people have no big problems.)
>
> The deeper issue may be whether people who
> are depressed tend to "self-medicate" with
> marijuana: one recent study showed that Prozac actually
> helped to decrease its use, which alas
> doesn't seem to be the case with your son on
> Zoloft, which is a largely similar medicine.
> From my point of view, the best solution may
> be to address the marijuana essentially
> as it's own issue, insofar as it relates to
> your son's physical and emotional well-being
> over the last few months. See some of the
> abstracts I've included below...
>
> Good luck to you all,
> JD
>
>
>
> Depression 1996;4(2):77-80
>
> Do patients use marijuana as an antidepressant?
>
> Gruber AJ, Pope HG Jr, Brown ME
>
> Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts 02178, USA.
>
> Several lines of evidence suggest that cannabis may have antidepressant effects. However, methodologic limitations in available
> studies make the results difficult to interpret. We review this literature and present five cases in which the evidence seems
> particularly clear that marijuana produced a direct antidepressant effect. If true, these observations argue that many patients
> may use marijuana to "self-treat" depressive symptoms.
>
> ---------------
>
> J Clin Psychiatry 1991 Jun;52(6):280-1
>
> A case of mania as a result of fluoxetine-marijuana interaction.
>
> Stoll AL, Cole JO, Lukas SE
>
> Publication Types:
>
> Letter (no abstract)
>
> ----------------------
>
> Fluoxetine versus placebo for the marijuana use of depressed alcoholics.
>
> Cornelius JR, Salloum IM, Haskett RF, Ehler JG, Jarrett PJ, Thase ME, Perel JM
>
> Department of Psychiatry, University of Pittsburgh School of Medicine, PA 15213, USA.
>
> [Medline record in process]
>
> The aim of this analysis was to evaluate the efficacy of the SSRI antidepressant fluoxetine versus placebo for the marijuana use
> of depressed alcoholics. There are no previous reports involving and SSRI antidepressant for marijuana abuse. This analysis
> involved a subsample of 22 depressed alcoholic marijuana users out of a total of 51 depressed alcoholics. The entire sample
> was involved in a 12-week double-blind, placebo-controlled study evaluating the efficacy of fluoxetine versus placebo in
> depressed alcoholics. During the course of the trial, the cumulative number of marijuana cigarettes used was almost 20 times as
> high in the placebo group as in the fluoxetine group. Also, the number of days of marijuana use during the study was five times
> higher in the placebo group than in the fluoxetine group. These data suggest efficacy for fluoxetine in decreasing marijuana use
> of depressed alcoholics.
>
>
>
> > From a concerned parent: Just found out
> >
> >
> > From concerned parents: Just found out that
> > 16-yr-old who has been successfully treated
> > for depression (diagnosed 6 months ago) has
> > been smoking marijuana for past two months.
> >
> > Concerned about possible co-morbid
> > addiction condition, interaction of
> > marijuana with zoloft (100 mg), exacerbation
> > of depression and anxiety, etc. Gifted and
> > talented kid who needs real info. not
> > propaganda to convince him of dangers.
> > HELP!
Posted by PattyG on May 24, 1999, at 8:02:00
In reply to Re: "Depression" to "Pothead"?, posted by Parents on May 23, 1999, at 22:10:45
(parents wrote)
He's gone from extreme perfectionism and
depression to more risky behavior and
no depression but marijuana use. Says its
just experimentation...but?????///Are you positive of the diagnosis? Have you done any reading of the diagnostic criteria for Borderline Personality Disorder? Just a thought..........Also, I'm sort of surprised that the current therapist hasn't suggested some substance abuse counseling (assuming he/she knows about the usage.) However, it could be that the current therp is already addressing those issues?
Posted by JD on May 24, 1999, at 8:46:54
In reply to Re: "Depression" to "Pothead"?, posted by PattyG on May 24, 1999, at 8:02:00
As a former "perfectionist sixteen-year-old"
who went through many of the same issues you
mention in your son (depression, social drug
use, increased risk-taking), I wouldn't go
too off the deep end about things like
borderline personality disorder unless there
are truly marked personality changes,
dangerous and/or aggressive behaviors, etc.
Not to make light of the matter, but certain
behaviors can occur along a spectrum of
standard adolescent "growing pains". My hunch
(and it's just a hunch) is that that while
the Zoloft has lifted his depression, there
remain some deeper issues in him that are now
more free to be "acted out" through social
drug use, rebellion, etc. A substance-abuse
counselor might be a good idea if
not for the fact that, paradoxically, it
might only alienate him further and make
matters seem adverserial -- He needs to
understand that you are truly on his side,
though I realize what a challenge this can
be. When I look back to what would have
helped me most as a sixteen year-old
perfectionist-cum-risk-taker, it is probably
simply a talk therapy environment in which
I felt comfortable enough to explore the
very conflicted feelings leading me to act
in ways that weren't always very productive
in scheme of things!Hope this helps in some way... Being supportive
of your son without jeopardizing his fledgling
sense of independence (important but very
fragile at 16!)is probably what he needs most, in my humble
opinion. As his parents, you are the best
judge...Best,
JD
> (parents wrote)
> He's gone from extreme perfectionism and
> depression to more risky behavior and
> no depression but marijuana use. Says its
> just experimentation...but?????
>
> ///Are you positive of the diagnosis? Have you done any reading of the diagnostic criteria for Borderline Personality Disorder? Just a thought..........Also, I'm sort of surprised that the current therapist hasn't suggested some substance abuse counseling (assuming he/she knows about the usage.) However, it could be that the current therp is already addressing those issues?
Posted by Sean on May 24, 1999, at 14:26:11
In reply to Zoloft & Marijuana Interactions?, posted by parent on May 23, 1999, at 5:21:56
> From a concerned parent: Just found out
>
>
> From concerned parents: Just found out that
> 16-yr-old who has been successfully treated
> for depression (diagnosed 6 months ago) has
> been smoking marijuana for past two months.
>
> Concerned about possible co-morbid
> addiction condition, interaction of
> marijuana with zoloft (100 mg), exacerbation
> of depression and anxiety, etc. Gifted and
> talented kid who needs real info. not
> propaganda to convince him of dangers.
> HELP!This is an interesting issue because it gets into
the personality changes SSRI's are capable of
inducing. From personal experience, Zoloft made me
(a) more risk seeking (b) did not give a hoot about
other people opinions (c) smoked more pot and drank
(d) did not care about my health.Basically, smoking pot on zoloft is wonderful. It
is really more enjoyable than without because the
anxiety and paranoia that often come along with
pot smoking in inhibited people is totally gone;
you can really enjoy the effect and in many ways,
it helps with the *total internal boredom* that
comes with SSRI's. In a way, I think people on
SSRI's should smoke pot because these drugs can
linearize your head something terrible...There is no evidence that SSRI's and pot have any
kind of negative interaction; they effect different
neurotransmitter systems and if anything, go well
together.If you can't tell already, I am not anti-drug use.
I think drug use in responsible people has much to
offer both in terms of personal insight and looking
deeply at the society we live in, which by the way,
is so spiritually off-base and material, it is no
wonder that the search for meaning, which I must say
is part of any recovery, is so difficult...Sean.
Posted by Still Concerned Parent on May 24, 1999, at 21:35:07
In reply to Re: Zoloft & Marijuana Interactions?, posted by Sean on May 24, 1999, at 14:26:11
> > "This is an interesting issue because it gets into
the personality changes SSRI's are capable of
inducing. From personal experience, Zoloft
made me
(a) more risk seeking (b) did not give a hoot
about
other people opinions (c) smoked more pot
and drank
(d) did not care about my health."
I thought that this was an interesting comment
although, as a concerned parent, I do not
agree with your other comments about the beneficial
effects of drugs -- especially for minors!!!
But, my question is, can SSRIs (especially
zoloft) induce more risk-taking behavior and/or
apathy and/or loss of inhibitions? It seems
that I've seen something in the literature
about this? Still Concerned Parent
P.S. I appreciate everyone who has responded.
Thanks--It has helped us, as parents, keep
a more logical perspective as we go through this.
From a concerned parent: Just found out
> >
> >
> > From concerned parents: Just found out that
> > 16-yr-old who has been successfully treated
> > for depression (diagnosed 6 months ago) has
> > been smoking marijuana for past two months.
> >
> > Concerned about possible co-morbid
> > addiction condition, interaction of
> > marijuana with zoloft (100 mg), exacerbation
> > of depression and anxiety, etc. Gifted and
> > talented kid who needs real info. not
> > propaganda to convince him of dangers.
> > HELP!
>
> This is an interesting issue because it gets into
> the personality changes SSRI's are capable of
> inducing. From personal experience, Zoloft made me
> (a) more risk seeking (b) did not give a hoot about
> other people opinions (c) smoked more pot and drank
> (d) did not care about my health.
>
> Basically, smoking pot on zoloft is wonderful. It
> is really more enjoyable than without because the
> anxiety and paranoia that often come along with
> pot smoking in inhibited people is totally gone;
> you can really enjoy the effect and in many ways,
> it helps with the *total internal boredom* that
> comes with SSRI's. In a way, I think people on
> SSRI's should smoke pot because these drugs can
> linearize your head something terrible...
>
> There is no evidence that SSRI's and pot have any
> kind of negative interaction; they effect different
> neurotransmitter systems and if anything, go well
> together.
>
> If you can't tell already, I am not anti-drug use.
> I think drug use in responsible people has much to
> offer both in terms of personal insight and looking
> deeply at the society we live in, which by the way,
> is so spiritually off-base and material, it is no
> wonder that the search for meaning, which I must say
> is part of any recovery, is so difficult...
>
> Sean.
Posted by Parent With ? on May 24, 1999, at 21:48:26
In reply to Re: Zoloft & Loss of Inhibitions?, posted by Still Concerned Parent on May 24, 1999, at 21:35:07
> > > If you have time, can you reply to the
possibility of zoloft inducing a state where
a formerly "perfectionistic" depressed teenagers
becomes more of a risk-taker and has loss
of inhibitions. See the former questions
and responses to this --thanks--parents"This is an interesting issue because it gets into
> the personality changes SSRI's are capable of
> inducing. From personal experience, Zoloft
> made me
> (a) more risk seeking (b) did not give a hoot
> about
> other people opinions (c) smoked more pot
> and drank
> (d) did not care about my health."
> I thought that this was an interesting comment
> although, as a concerned parent, I do not
> agree with your other comments about the beneficial
> effects of drugs -- especially for minors!!!
> But, my question is, can SSRIs (especially
> zoloft) induce more risk-taking behavior and/or
> apathy and/or loss of inhibitions? It seems
> that I've seen something in the literature
> about this? Still Concerned Parent
> P.S. I appreciate everyone who has responded.
> Thanks--It has helped us, as parents, keep
> a more logical perspective as we go through this.
>
>
> From a concerned parent: Just found out
> > >
> > >
> > > From concerned parents: Just found out that
> > > 16-yr-old who has been successfully treated
> > > for depression (diagnosed 6 months ago) has
> > > been smoking marijuana for past two months.
> > >
> > > Concerned about possible co-morbid
> > > addiction condition, interaction of
> > > marijuana with zoloft (100 mg), exacerbation
> > > of depression and anxiety, etc. Gifted and
> > > talented kid who needs real info. not
> > > propaganda to convince him of dangers.
> > > HELP!
> >
> > This is an interesting issue because it gets into
> > the personality changes SSRI's are capable of
> > inducing. From personal experience, Zoloft made me
> > (a) more risk seeking (b) did not give a hoot about
> > other people opinions (c) smoked more pot and drank
> > (d) did not care about my health.
> >
> > Basically, smoking pot on zoloft is wonderful. It
> > is really more enjoyable than without because the
> > anxiety and paranoia that often come along with
> > pot smoking in inhibited people is totally gone;
> > you can really enjoy the effect and in many ways,
> > it helps with the *total internal boredom* that
> > comes with SSRI's. In a way, I think people on
> > SSRI's should smoke pot because these drugs can
> > linearize your head something terrible...
> >
> > There is no evidence that SSRI's and pot have any
> > kind of negative interaction; they effect different
> > neurotransmitter systems and if anything, go well
> > together.
> >
> > If you can't tell already, I am not anti-drug use.
> > I think drug use in responsible people has much to
> > offer both in terms of personal insight and looking
> > deeply at the society we live in, which by the way,
> > is so spiritually off-base and material, it is no
> > wonder that the search for meaning, which I must say
> > is part of any recovery, is so difficult...
> >
> > Sean.
Posted by JD on May 25, 1999, at 6:44:00
In reply to Re: "Depression" to "Pothead"?, posted by JD on May 24, 1999, at 8:46:54
I'll throw in my last 2 cents on this matter before ceding to anyone else who has things to add. I'm not very aware of Zoloft or other SSRI's causing a disinhibitional syndrome in people, but Sean has brought up some interesting points even if I'm not sure I agree with him across the board. He's certainly right to note that a certain proportion of people find SSRIs to be rather "affect-flattening" medications--i.e., they relieve depression but can leave a person feeling a bit like they're flying on automatic pilot. One can understand how such people (Sean himself giving a good example) might actually seek out marijuana while on SSRIs to try to bring some emotional color back into their lives! (Though I know lots of people who haven't had this problem at all...) So perhaps there is at least some reason to wonder whether the Zoloft itself is playing a role in your son's behavior--again, probably something best guaged by talking with him up front and personal about it.
Best,
JD
Posted by PattyG on May 25, 1999, at 8:50:56
In reply to Re: Zoloft & Marijuana -- final thoughts, posted by JD on May 25, 1999, at 6:44:00
(JD wrote)
One can understand how such people (Sean himself
giving a good example) might actually seek out marijuana while on SSRIs to try to bring some emotional color
back into their lives! (Though I know lots of people who haven't had this problem at all...)///My problem with this theory would be all the kids out there who are experimenting with alcohol, pot, etc. in an effort to "self medicate" - that usually seems to be the order of things. Could it, perhaps, be more of a case of the individual continuing their quest for something, anything to make them feel better? (Parents - are you positive your son hadn't already experimented with pot before taking prescribed meds?)
Posted by paul on May 25, 1999, at 12:08:22
In reply to Re: Dr. Bob or Toby: Zoloft & Loss of Inhibitions?, posted by Parent With ? on May 24, 1999, at 21:48:26
I want to start a debate about the concept of "self-medication."
Since moderate alcohol consumption is socially acceptable and legal, it is not considered to be "self-medication," and my guess is that most psychiatric professionals would not call it that. Is the degree of social acceptability of a substance's use a criterion for determining whether it is "medicine" (self-administered or otherwise)?
Posted by PattyG on May 25, 1999, at 20:28:06
In reply to "self-medication", posted by paul on May 25, 1999, at 12:08:22
I want to start a debate about the concept of "self-medication."
Since moderate alcohol consumption is socially acceptable and legal, it is not considered to be "self-medication,"
and my guess is that most psychiatric professionals would not call it that. Is the degree of social acceptability of a
substance's use a criterion for determining whether it is "medicine" (self-administered or otherwise)?//Chuckle, chuckle.........start a debate;)
Okay, my thought is that regardless of the acceptance (or the legality), it's more an issue of when, where, and how. I'm not talking about "rites of passage" - I'm talking about kids who discover during that process that drinking/drugging feels good and gives them "relief." It's then taken a step farther and isn't used in a social fashion, rather when they're alone (what fun is it to get drunk/stoned/strung out all by yourself?) The "how" would be with regard to the extent of usage. My thought is that the folks who are "self medicating" will over-use. Okay.....debate on:)
Posted by Jeff on May 26, 1999, at 9:00:45
In reply to "self-medication", posted by paul on May 25, 1999, at 12:08:22
> I want to start a debate about the concept of "self-medication."
>
> Since moderate alcohol consumption is socially acceptable and legal, it is not considered to be "self-medication," and my guess is that most psychiatric professionals would not call it that. Is the degree of social acceptability of a substance's use a criterion for determining whether it is "medicine" (self-administered or otherwise)?
As somebody who self medicated ADD with nicotine for years, I can attest that the legality and/or public availability of a of a substance in many cases has no bearing on whether it is used as "medication". I managed without any prescription medication until I was forced to give up nicotine, and my life had improved greatly when I began using it at 16. There is no doubt in my mind that I would not have achieved the things I have(college degree, good start to career, etc.) without it. This is why I am not totally opposed to the extent of use of Ritalin in children...if it stops some of them from becoming addicted to nicotine it has been a benefit.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
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