Antidepressants can be very helpful for treating depression. But for these drugs to work as intended, it’s important to take them as directed. That includes avoiding any substances — such as foods, drinks, herbs, or other drugs — that could negatively interact with your antidepressant. There’s a wide variety of antidepressants, and each one can interact differently with other substances.
It’s essential to talk with your doctor about any substances you might need to limit or avoid while taking your antidepressant, says Javier Garcia, MD, a psychiatrist and medical director of behavioral health at MetroPlusHealth in New York City.
It’s also very important to tell your doctor about any other medicines or substances you’re taking, because not doing so could have serious health consequences. Sometimes, even common medicines like ibuprofen can be problematic if you’re on antidepressants.
Here are seven common substances you may need to avoid when taking antidepressants.
1. St John’s Wort
“St. John’s Wort acts similarly to several antidepressants, but is less effective,” says Chris Pagnani, MD, the founder and medical director of Rittenhouse Psychiatric Associates in Philadelphia. “If a patient is open to treating their depression with medication, it may not only be counterproductive to take St. John’s wort, as taking it could prevent their provider from increasing the antidepressant that is more likely to be helpful, but it could also be very dangerous.”
That’s because combining St. John’s wort with certain antidepressants that affect the body’s serotonin levels — such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) — can lead to a rare but potentially fatal condition called serotonin syndrome, says Dr. Pagnani. SSRIs include drugs like sertraline (Zoloft) and fluoxetine (Prozac), and SNRIs include drugs like desvenlafaxine (Pristiq) and duloxetine (Cymbalta).
Serotonin syndrome is a medical emergency caused by too much serotonin in the body. It can lead to symptoms like shivering, diarrhea, rigid muscles, fever, seizures, and even death if left untreated.
“It happens more frequently in patients who take several serotonergic medications (drugs that affect serotonin levels in the body) plus recreational drugs such as cocaine, ecstasy, or several other medications that the patient, or in some instances, their providers, do not realize are serotonergic,” says Pagnani.
2. Alcohol
One of the most common questions people have when prescribed antidepressants is whether they can still imbibe from time to time.
Whether you need to limit alcohol or abstain entirely depends on the type of antidepressant you’re taking. If you’ve been prescribed an SSRI, occasional alcohol usage may not be harmful, says Garcia. But if you’re taking an antidepressant belonging to a class of drugs called monoamine oxidase inhibitors (MAOIs), drinking any amount of alcohol can be dangerous, Garcia says. MAOIs include drugs like isocarboxazid (Marplan) and phenelzine (Nardil).
MAOIs work by blocking monoamine oxidase, an enzyme that breaks down excess tyramine in the body. Some alcoholic beverages, like beers, wine, sherry, and other liquor, contain tyramine, which your body is unable to process if you’re on an MAOI. “If you drink with this medication, it can lead to what we call a hypertensive crisis,” says Garcia. A hypertensive crisis is a sudden, dangerous rise in blood pressure.
If you’re not sure whether it’s safe to drink while on your antidepressant, ask your doctor first.
3. NSAIDs
“Patients should always read over-the-counter medication warnings and talk to their provider or pharmacist, if they are unsure if a supplement, over-the-counter medication, or prescribed medication is safe,” says Pagnani.
4. Foods and Drinks High in Tyramine
If you’re taking an MAOI, you’ll need to steer clear of foods that are high in tyramine (think aged cheeses, cured meats, Chianti, fava beans, and some alcoholic beverages). As mentioned, doing so can cause a sudden, dangerous rise in blood pressure called a hypertensive crisis.
This can happen because MAOIs cause a dramatic increase in the availability of the brain chemicals serotonin, norepinephrine, and dopamine in the body, and they block the body’s ability to break these chemicals down, says Pagnani. “In doing so, they also block the body’s ability to break down other chemicals that the body makes with tyramine (such as epinephrine and phenylephrine), which can lead to high blood pressure,” Pagnani says.
5. Some Cough and Cold Medicines
“Some over-the-counter cough and cold medications contain ingredients that can interact with antidepressants, particularly MAOIs,” says Kristi Mae Wragg, MD, an adult psychiatrist and director of outpatient services at HopeWay Psychiatry and Associates in Charlotte, North Carolina.
As mentioned, be sure to read the labels of any over-the-counter medicines and talk to your prescriber before taking them, says Wragg.
6. Lithium
Lithium is a mood-stabilizing medication commonly used to treat bipolar disorder, says Wragg. It’s also sometimes used alongside an SSRI for treatment-resistant depression to help the SSRI work better.
But this is not without risk. “When combined with certain antidepressants, (lithium) can increase the risk of serotonin syndrome or other adverse effects,” Wragg says. “Close monitoring is necessary if these medications are used together.”
7. Some Pain Medications
Certain pain medications, such as tramadol and cyclobenzaprine, affect serotonin levels. “(When) taken with serotonin-enhancing antidepressants like SSRIs or SNRIs, there is an increased risk of developing serotonin syndrome,” says Wragg.
People who are prescribed these medications need to be monitored closely by a healthcare provider to manage any potential drug interactions, she adds.
The Takeaway
If you’re taking antidepressants, be aware that certain foods, drinks, herbs, and other drugs can interact with them. These interactions can sometimes lead to unpleasant or even dangerous side effects. Remember to talk with your doctor about all medications and substances you’re taking while on an antidepressant, as well as any substances you may need to avoid to stay safe.
