As a psychiatrist who specializes in alcoholism and addiction, I treat several depressed college students with antidepressants. This age group tends to experiment with drugs and alcohol. I have observed over the years of my practice that the antidepressants that I prescribe do not seem to be as effective in someone who uses marijuana and / or alcohol, even if the use is infrequent. Here are 2 cases that I have dealt with that illustrate this point.
Case 1: I treated a 19-year-old college student for anxiety and depression. He said he occasionally used marijuana to calm himself down before a social event (weekly or every other week) because he felt more comfortable with people when he was high. He did not respond to two different antidepressants that I prescribed for him over the course of 12 weeks. I told him that his use of marijuana and alcohol on the weekends could be interfering with the effectiveness of the medications. He agreed not to use marijuana or alcohol for a month. Indeed, his social anxiety began to decrease even though he had not changed the dose of his antidepressant or added any new medication. He experienced a significant reduction in anxiety and depression and has not used marijuana or alcohol again. He said he attended social functions, had a lot of fun, and felt more self-confident than when he first came to see me.
Case 2: I treated a 21-year-old college girl for depression who went out with her friends drinking on the weekends. He said he used the drink to anesthetize himself and escape his feelings of depression. He did not drink anything during the week. I prescribed the same antidepressant that had worked for him when he was 14 years old. However, after 6 weeks on a therapeutic dose, she remained depressed. At age 14, he was not drinking alcohol. I explained that alcohol was a central nervous system depressant and probably counteracted the effects of the antidepressant. I asked him to stop drinking and to let the medication do its job. She agreed with this because her depression had progressively worsened over several weeks and she was miserable. Four weeks later, she felt much less depressed. He said that he was looking forward to the day, that it was easier for him to keep up with his work and participate in more activities with his friends.
Both cases provide anecdotal evidence that the antidepressants I prescribe for depression or anxiety do not appear to be as effective when my college patients are actively using alcohol or marijuana. When I prescribe medication to a college student, I explain that it is difficult for me to make positive biochemical changes in the brain with the medications I prescribe when the substances that he is using counteract the positive effects of the medications.
Research on adolescent depression with substance abuse has tended to focus on drug abuse or alcohol use among adolescents at the level of abuse or dependence. Not much attention has been paid to the recreational use of marijuana or alcohol in this population. What are the dangers of marijuana and the dangers of alcohol consumption when used at a low level?
Reduced antidepressant response.
Findings from a very recent study, conducted by Dr. Benjamin Goldstein and others at the University of Pittsburgh, dealing with depressed adolescents who used marijuana and alcohol recreationally, support this. The study was presented on October 26, 2009, at the American Academy of Child and Adolescent Psychiatry and summarized in Medscape Medical News. The study showed that the response to antidepressants was significantly reduced in depressed teens who used marijuana or alcohol recreationally. They studied 334 adolescents with major depressive disorder, of whom 28.1% used marijuana or alcohol recreationally. The researchers also found that those who stopped using marijuana / alcohol during the study showed a good response to antidepressants and those who started using marijuana / alcohol during the study had a reduced response to antidepressants.
I wouldn’t be surprised if the findings outlined in Dr. Goldstein’s study of teen marijuana and alcohol use apply to college students and even older adults.
Here’s the take-home message for depressed teens taking antidepressants:
You use, you lose
In other words, you lose your antidepressant response. Remember, recreational use of alcohol and marijuana interferes with the antidepressant response.
If you want to feel better, let antidepressants do their work in your brain without mixing their effects with other drugs you want to experiment with. According to this study, antidepressants are most effective for your age group if you don’t use drugs or alcohol.