As a psychiatrist that specializes in alcoholism and addiction, I treat a number of 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 I prescribe do not seem to be as effective in someone who is using marijuana and/or alcohol even if the use is infrequent. Here are 2 cases I have treated that illustrate this point.
Case 1: I treated a 19 year old college boy for anxiety and depression. He said he occasionally used marijuana to calm himself before a social event (weekly or every other week) because he felt more comfortable around people when he was high. He did not respond to two different antidepressants I prescribed over the course of 12 weeks. I told him that his marijuana and alcohol use on the week-ends might be interfering with the medications effectiveness. He agreed to go without marijuana or alcohol for a month. Sure enough, his social anxiety started to diminish even though I had not changed the dose of his antidepressant or added any new medications. He experienced significantly reduced anxiety and depression and has not returned to marijuana or alcohol. He reported going to social functions, having a great time, and feeling more self confident than when he first came to see me.
Case 2: I treated a 21 year old college girl for depression that would go out with her friends drinking on week-ends. She said she used drinking to anesthetize herself and escape her feelings of depression. She did not drink at all during the week. I prescribed the same antidepressant she had done well on when she was 14 years old. However, after 6 weeks on a therapeutic dose she remained depressed. At 14, she was not drinking alcohol. I explained to her that alcohol was a central nervous system depressant and was probably counteracting the effects of the antidepressant. I asked her to quit drinking and let the medication do its job. She agreed to this because her depression had gotten progressively worse over several weeks and she felt miserable. Four weeks later, she felt much less depressed. She reported looking forward to the day, finding it easier to keep up with her work, and participating in more activities with her friends.
Both these 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 put a college student on medication, I explain to him/her that it is tough for me to make positive biochemical changes in the brain with the medications I prescribe when the substances he/she is using counteract the positive effects of the medications.
Research on teenage depression with substance abuse, has tended to focus on teen drug abuse or teenage drinking at the level of abuse or dependence. There has not been much focus on recreational use of marijuana or alcohol in this population. What are the dangers of marijuana and the dangers of alcohol use when used at a low level?
Reduced antidepressant response.
The findings of a very recent study, conducted by Dr. Benjamin Goldstein et al at the University Of Pittsburgh dealing with depressed adolescents who were using marijuana and alcohol at a recreational level support this. The study was presented on October 26th, 2009 at the American Academy of Child and Adolescent Psychiatry and was summarized in the Medscape medical news. The study showed that the antidepressant response was significantly reduced in depressed teenagers using marijuana or alcohol on a recreational basis. They studied 334 adolescents with major depressive disorder of which 28.1% used marijuana or alcohol on a recreational basis. The researchers also found that those that quit marijuana/alcohol during the study showed a good response to antidepressants and those that started using marijuana/alcohol during the study had a reduced response to antidepressants.
I would not be surprised if the findings outlined in Dr.Goldstein’s study regarding teenage marijuana and alcohol use apply to college kids and even older adults.
Here is the take home message for depressed teenagers on antidepressants:
You Use, You Lose
In other words, you lose antidepressant response. Remember, recreational use of alcohol and marijuana interferes wIth the antidepressant response.
If you want to feel better, let the antidepressants do their job in your brain without mixing its effects with other drugs you may want to experiment with. According to this study, antidepressants are most effective for your age group if you are not using drugs or alcohol.