FAQ – Antidepressants and Recreational Drugs
(including pharmaceuticals of recreational value)
[Edit: Fixed vB coding in many posts after the upgrade, also deleted some innocuous posts. Awesome work, by the way - Orlando]
DISCLAIMER: This drug interaction table is based on medical literature, anecdotal,
and theoretical data gathered by author and is not necessarily accurate. The author
can not be held responsible about possible inaccurate/incorrect data.
Antidepressants (ADs) can be roughly categorized into four groups: Tricyclics, Heterocyclics, SSRIs, and MAOIs.
Please take a moment to find the antidepressant you are curious about in the list below. Brand names are listed in parentheses after each drug, and the half-lives are listed in brackets. Once you have found what group your antidepressant belongs to, you can proceed to the section about that particular group of antidepressants to learn about recreational drug interactions. It might also be helpful to you the ‘search’ function in your browser to find the name of your medication (make sure to spell it correctly!).
I have also provided some background information about ADs to satiate any general curiosity you might have about your medication.
Some information that might be of use when reading this FAQ:
Serotonin = 5-HT (5-hydroxytryptamine)
Noradrenaline = Norepinephrine = NE
Dopamine = DA
Neurotransmitter = NT
A Reuptake Inhibitor = a drug which prevents the reuptake of a neurotransmitter (such as serotonin, dopamine, etc), resulting in higher levels of the NT in the synapse
Agonist = a drug which STIMULATES the production or the uptake of an NT
Antagonist = a drug which INHIBITS the production or the uptake of an NT
Selectivity = refers to the ability of a drug to target only a certain kind of receptor. For example, Prozac is an SSRI (SELECTIVE serotonin reuptake inhibitor), which means that it ONLY inhibits serotonin reuptake, and does not affect other NTs. Effexor, on the other hand, is a SNRI ( a serotonin/norepinephrine reuptake inhibitor) – it is not ‘selective’ because it affects more than one NT.
GENERAL NOTE: You can smoke weed/MARIJUANA/cannabis on any antidepressant. This is almost always a safe combination. Of course, if you are suffering any bad effects from smoking weed while on your medication, STOP smoking the weed.
Amitripyline (Elavil, Endep, Tryptin(e,) Tryptanol)[31-46 hours]
Amitriptyline and Chlordiazepoxide (Limbitrol)
Amitriptyline + Perphenazine (brand name Etrafon, Triavil -- Perphenazine is an antispychotic)
Clomipramine (Placil, Anafranil)[22-84 hours]
Desipramine (Norpramin, Pertofran)[12-50 hours]
Dothiepin (Prothiaden, Dothep) [11-40 hours]
Doxepin (Adapin, Sinequan, Deptran)[8-24 hours]
Imipramine (Melipramine, Tofranil)[9-24 hours]
Lofepramine (Gamanil, Lomont) [extensively metabolized to Desipramine] [4-6 hours + ~24 hours for the desipramine metabolite]
Nortriptyline (Pamelor, Alledgron, Nortrilen, Sensival) [18-93 hours]
Protriptyline (Vivactil)[54-124 hours]
Trimipramine (Surmontil)[8-30 hours]
Citalopram (Celexa, Cipramil,Seropram) [23-75 hours]
Fluoxetine (Prozac, Flux, Fluxil, Fluxine, Modipran, Oxetin. Prolert, Prozyn, Rize, Seronil, Ufrex,Vonder, Zauxit) [72-360 hours]
Fluvoxamine (Luvox, Faverin, Dumirox) [7-63 hours]
Paroxetine (Paxil, Aropax, Seroxat) [3-65 hours]
Sertraline (Zoloft, Lustral, Besitran) [10-35 hours]
MAOIs (2 subtypes – Irreversible and Reversible)
Irreversible N.B.: half-lives not included because they mean very little in the case of irreversible MAOIs.
Chlorgyline [selective for MAO-A]
Isocarboxazid (Marplan) [nonselective]
Pargyline (Eutonyl) [nonselective]
Phenelzine (Nardil) [nonselective]
Rasagiline [selective for MAO-B]
Selegiline (Deprenyl) [selective for MAO-B]
Tranylcypromine (Parnate) [nonselective]
Reversible [all are selective for MAO-A, thus RIMAs]
Harmaline + Harmine
Moclobemide (Aurorex, Aurorix, Arima, Manerix)
Amoxapine (Asendin, Asendas) [8-14 hours]
Bupropion (Wellbutrin, Zyban, Zyntabac) [8-24 hours]
Maprotiline (Ludiomil, Loxapac) [21-58 hours] see reboxetine also
Mianserin (Bolvidon, Lantanon, Lerivon, Lumin, Norval, Tolvon) [17 (6-40) hours]
Mirtazapine (Remeron, Avanza, Rexer Zipsin) [20-40 hours]
Nefazodone (Serzone) [2-18 hours]
Reboxetine (Edronax, Vestra, Norebox) [8-18 hours] see maprotiline also
Tianeptine (Ardix, Stablon) [2.5 hours]
Trazodone (Desyrel) [4-14 hours]
Venlafaxine (Effexor) [4-10 hours]
Mechanism of Action
TCAs work by blocking the reuptake pumps of various NTs; most TCAs affect primarily the reuptake of serotonin and norepinephrine. By reducing the reuptake of these NTs, TCAs increase the levels of NTs in the synapse. Thus, TCAs are thought to increase the levels of 5-HT/NE/DA in the brain. The main difference in action between TCAs and SSRIs is that that only SSRIs selectively act on serotonin reuptake.
It is possible to become dependent on TCAs – thus is you stop taking TCAs suddenly, you will suffer withdrawal symptoms.
Common Side Effects
Sedation/fatigue, tremor, insomnia, blurred vision, constipation, urinary hesitancy, confusion, orthostatic hypotension, conduction defects, arrhythmias, aggravation of psychosis, seizures, weight gain, sexual dysfunction (inability to orgasm and decreased libido).
TCAs are rapidly absorbed and metabolized. CYP2C19 is the most important enzyme involved in the metabolism of TCAs, but the enzymes CYP 1A2, 3A4, 2C9 and CYP 2D6 are also involved.
Recreational Drug Interactions
Alcohol, Benzos (Xanax, Valium, Klonopin etc), Opiates (Heroin, Codeine, Vicoden, Oxy etc), Barbituates, Ketamine: Because TCAs have strong sedative effects, combining TCAs with central nervous system (CNS) depressants like the drugs listed above can potentiate (make stronger) the effects of those drugs. I.e., if you are taking a TCA, you will be MORE SENSITIVE to these drugs, and you won’t need to take as much to get fucked up. Therefore, please dose carefully; you will probably need a lower dose than a normal person. Otherwise, these drugs are fairly safe to combine with a TCA.
DXM (Dextremethorphan, Robotussin): This can be a very DANGEROUS combination! Do not take DXM and TCAs together! Combining DXM with a TCA can lead to too much serotonin in your brain, which can cause the potentially FATAL serotonin syndrome.
MDMA/Ecstasy (includes MDA, MDEA etc): TCAs will reduce the effects of taking MDMA – i.e. you won’t roll very hard, if at all. Some people do roll on TCAs however, and find that TCAs do not inhibit the effects of MDMA as much as the SSRIs do. Still, you will find that rolling on TCAs is not NEARLY as fun as rolling without being on a TCA. It is not fatally dangerous to take MDMA while one TCA, but as MDMA increases the risk of cardiovascular complications, and TCAs already have some negative effects on the cardiovascular system, it could be unsafe to combine these drugs. I have not heard of a case of cardiovascular problems resulting from MDMA and TCA, but it is still a possibility that you should be aware of. Consider the combination of MDMA and a TCA very carefully – you’ll find that it’s probably not worth it.
Amphetamines (Methamphetamine, Adderall, Dexedrine), Ritalin (methylphenidate), Cocaine
As with MDMA above, many people find that while they are on a TCA, they do not experience the full effects of these stimulants. However, you WILL still be able to get fairly high from these drugs; the impact of the TCA on your high will not be that great. The only danger here is the same as the danger above with MDMA – possible cardiovascular complications. If you combine stimulants and a TCA, watch your dosage and pay attention to your any cardiovascular effects that seem unusual or disturbing.
Hallucinogens (LSD/Acid, psilocybin/Shrooms, Tryptamines – 2-ct-2,DPT, DMT etc, Salvia): TCAs can make the effects of hallucinogens stronger, therefore you should be careful about how much you take of a drug – you probably won’t need as much to get high. Also, because hallucinogens have a number of cardiovascular effects, the same warning that applies to MDMA and stimulants applies here as well. Though fundamentally a safe combination, be careful and use moderation. Start with a LOW dose.
NOTE: Do not take ‘ayahuasca’ while on TCAs. This is a very dangerous combination.