Depressed and anxious people are more likely to do drugs, but many are already popping SSRIs on the daily. Is it ever OK to mix something from your doctor with something from your dealer?
Doing lots of different drugs at the same time without too much thought feels like a very British thing. Channel hop to, say, Paris, Berlin or Amsterdam and you’re more likely to see local clubbers chicly pop a single, pre-tested pill with no more than a few klein beers or do some proper 99 Flake without even considering a sprinkling of K or a drizzle of GHB.
Sure, people mix drugs on nights out outside of the UK (and stay up way later than us) but there’s usually more prep involved. There’s something very us about nonchalantly doing whatever is lurking in dusty wallets or on other people’s keys, buffeting on a serotonergic smorgasbord of substances. These combos can be legendary if done right – Calvin Klein: wink wink, sniff sniff – but doing a Molotov cocktail of unknown chems is also playing with fire.
But what happens if you’re already taking a drug that fucks with your serotonin every single day? For those on SSRIs – Selective Serotonin Reuptake Indicators – their brain’s transmitters, receptors and transporters are already being affected. A mind-blowing 8 million people in the UK are on SSRIs, the most common class of antidepressants and usually prescribed for depression and anxiety but also used to treat OCD, eating disorders and chronic pain.
With depressed and anxious people more likely to take drugs than those with sound mental health, and many of these people in turn being on SSRIs, self-medicating while already on medication is a major issue. Especially considering that, as anyone who has started or stopped an SSRI will testify, they are really strong. Citalopram: it’s a hell of a drug!
Of course, the best thing to do is not do any drugs while you’re on SSRIs. “People taking SSRIs for a clinically significant mental health condition should not take any recreational drugs,” says Phillip Cowen, Professor of Psychopharmacology at the University of Oxford, adding that alcohol in moderation can be safe. “The safest option is that if you are taking an SSRI in the long-term is to avoid taking anything else that hasn’t been prescribed,” agrees Harry Sumnall, Professor of Substance Use at Liverpool John Moores University.
This, obviously, is easier said than done. After all, ‘tis the season of partying and peer pressure, where we’re especially keen to have a heavy night after a very heavy year. “We tend to see a seasonal increase in substance-related harms across the party season,” Professor Sumnall says. “Excess is normalised, and usual social constraints on behaviour are relaxed, increasing general risk taking.”
Professor Cowen gives us a light bit of advice that might help when a craving hits while carving your turkey. “The holiday period should be fun enough without the need for recreational drugs,” he says. “SSRIs make people more sociable and pleasant to be with, so if you are taking them, make the most of that!”
Whatever you choose to do, don’t go cold turkey. “Stopping SSRIs to improve a drug high is not a good idea,” says Professor Sumnall. “Rapid cessation can lead to discontinuation syndrome which is characterised by unpleasant symptoms,” he adds. Plus, you would need to stop for several weeks to get it out of your system, and none of us are that prepared.
Still think you might end up mixing drugs and SSRIs? In the spirit of harm reduction, here’s a rundown of the risks, rewards and regrets of combining antidepressants and highs.
“The safest option is that if you are taking a SSRI in the long-term is to avoid taking anything else that hasn’t been prescribed” – Professor Harry Sumnall
CANNABIS
For many people with anxiety, bud is a friend when it comes to chilling out and clearing your head. For others, smoking loud doesn’t lead to peace and quiet but, instead, sheer panic. But can you get stoned while you’re on SSRIs? For the most part, it seems pretty safe.
That said, Professor Sumnall points to research that suggests that weed could heighten the effects of antidepressants. “There is some evidence that whole-plant cannabis and cannabinoids like CBD may affect the metabolism of SSRIs, leading to increased concentrations of the latter,” he says. “This could affect clinical response, and risk of serotonin toxicity. More common, and milder are reports of increases in coughs, diarrhoea, dizziness, and fatigue,” he adds.
Even taking CBD should be done with caution. “Recent guidance from the Food Standards Agency in the UK has also recommended that people taking any prescription medicine, including SSRIs should avoid CBD, and should advise their doctor if they intend to do so,” Professor Sumnall says. So, before you start lubricating your tongue with flavoured hemp oil, maybe have a word with your GP.
KETAMINE
Millions of us spend a pony on a packet of pony powder every weekend. But is doing K and SSRIs a yay or a neigh? “There are not known to be any particularly harmful interactions between ketamine and SSRIs, and these have been used safely together in the clinical treatment of depression,” Professor Sumnall says.
Recent research has shown that ketamine could be used to treat depression thanks to it increasing neuroplasticity and neurogenesis. Plus, since ketamine mainly acts on glutamate-binding sites, it won’t give you a textbook comedown. Professor Cowen concurs: “As an antidepressant treatment, ketamine is often combined with SSRIs, and this seems safe.”
There is a catch. “However, both drugs can increase heart rate and blood pressure, particularly at the start of a course of SSRIs, and so this is something that should be monitored,” he adds. Remember, though, drinking loads and slamming K can be really risky, so go easy (or preferably zero) on the alc.
COCAINE
On a common sense level, enduring those crushing coke comedowns while being depressed or anxious obviously isn’t the brightest idea. But mixing coke and SSRIs can put your physical health at risk, too. “There is potential toxicity if you take cocaine with an SSRI,” Professor Cowen says. It’s because while cocaine mainly acts on dopamine, it also floods your brain with serotonin, meaning there’s a small risk of serotonin toxicity if you’re on SSRIs.
Doctors are now being encouraged to be more cautious when prescribing SSRIs to potential coke users due to the risk of brain bleeds. “The UK government even issued an alert back in 2016 advising doctors to ask about use of cocaine in people prescribed SSRIs after the death of a man who had been prescribed citalopram and suffered bleeding on the brain after taking cocaine,” Professor Sumnall says.
“We tend to see a seasonal increase in substance-related harms across the party season. Excess is normalised, and usual social constraints on behaviour are relaxed, increasing general risk taking” – Professor Harry Sumnall
PSYCHEDELICS
Many of us are now microdosing acid or turning to trips to try to reset our brains. Research into psychedelics is mushrooming right now too, with many academics and charities pushing for psilocybin to be made a legal treatment for depression and anxiety. But is it OK if you’re already taking SSRIs?
“From a toxicological perspective, serotonergic psychedelics such as LSD and psilocybin mushrooms are relatively safe,” Professor Sumnall says, explaining that they don’t cause a big increase in the release of serotonin in the brain, making serotonin toxicity lower risk.
The main issue stems from SSRIs diluting the experience. “They produce many of their effects by acting at serotonin receptor sites in the brain. This means that longer-term use (over two weeks) of SSRIs will diminish psychedelic effects,” he explains. This can lead to doing too much and having a sketchy trip. “Whilst it might be tempting to increase the dose of psychedelics, if this is not done carefully, this could lead to a more intense and unpleasant drug experience.”
MDMA
Being on MD is pretty much the clinical opposite of feeling depressed. What’s more euphoric than pumping your brain full of lovely, warm, sensual serotonin. After all, it’s called ecstasy! There is, though, the morning after (and, these days, the morning after that) to contend with. Plus, here’s the mad thing – it doesn’t even really work if you’re on SSRIs.
“Recent exposure to SSRIs reduces many of the desired psychological and subjective effects of MDMA,” Professor Sumnall says, explaining this cancelling out of the high has been seen in clinical studies too. Basically, you’re not going to feel like you’re rolling.
What’s worse, though, is that you can still get a higher heart rate and blood pressure without feeling any of the nice bits. “There are also concerns about so-called serotonin toxicity. This is a rare, but potentially life-threatening condition resulting from serotonergic overactivity, and can lead to a range of mild to severe outcomes, from tremors and nausea to severe hypothermia, muscle rigidity, seizures and organ failure,” he says. SSRIs also affect the metabolism of MDMA, leading to higher blood concentrations in the blood. “There are several case reports of people dying after this combination,” he warns.
ALCOHOL
Time for the big one – booze. Can you still enjoy a drink while on SSRIs? “While the occasional drink probably won’t cause problems, there are anecdotes and case reports of people who report feeling more intoxicated than normal after drinking their normal dose of alcohol whilst on a course of SSRIs,” Professor Sumnall says, caveating that there hasn’t been much specific research. “Again, as with other drugs, if you’re taking SSRIs because you’re experiencing depression or anxiety, then it’s wise to avoid alcohol as this can make your mood worse.” Other opinions are more moderate. “You can drink alcohol, but only in moderation and not more than the government safe limits,” Professor Cowen says.
FINAL THOUGHTS
Not to be killjoys, but clearly doing any drug while on SSRIs can be dodgy. Everyone Dazed spoke to is clear that you should not do anything. You should never stop your SSRIs abruptly too, just to get on it.
Harm reduction, though, is all about evaluating the best way to minimise these risks. So, with that in mind, ketamine, cannabis and alcohol (but not together!) seem safest in moderation and trips are likely OK too, but you’ll probably feel less of what you’re wanting to.
Anything that floods the brain with a load of serotonin, though – think cocaine and ecstasy – can be dangerous. And to give you a proper bit of literal WebMD advice, don’t even bother doing MD this Christmas. You’ll genuinely feel more euphoria taking half a mince pie instead.
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