antidepressant
20 interactions related to antidepressant
sertraline + st. john's wort
Sertraline is an SSRI that blocks serotonin reuptake, and St. John's wort independently inhibits serotonin reuptake and contains constituents (hyperforin, hypericin) that elevate central serotonin. Combining them can trigger serotonin syndrome, a potentially life-threatening syndrome of altered mental status, autonomic instability, and neuromuscular hyperactivity. St. John's wort also induces CYP3A4 and CYP2C19, which can lower sertraline plasma levels and undermine treatment.
duloxetine + st. john's wort
Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI), and St. John's wort independently raises central serotonin through reuptake inhibition. Combined use can precipitate serotonin syndrome, and St. John's wort induction of CYP3A4 and P-glycoprotein may also alter duloxetine exposure.
fluoxetine + tryptophan
Fluoxetine blocks serotonin reuptake while tryptophan supplies raw material for serotonin synthesis, and the combination can produce serotonin syndrome. Fluoxetine's very long half-life (active metabolite norfluoxetine persists for weeks) extends the window of risk well beyond the last dose.
sertraline + 5-htp
Sertraline blocks serotonin reuptake and 5-HTP (5-hydroxytryptophan) is the immediate biochemical precursor of serotonin, so it directly increases serotonin synthesis. Combining the two stacks production and reuptake blockade, which can precipitate serotonin syndrome.
paroxetine + st. john's wort
Paroxetine is an SSRI with potent serotonin reuptake inhibition; St. John's wort independently inhibits serotonin reuptake and induces CYP3A4 and P-glycoprotein. The combination can precipitate serotonin syndrome and is among the most frequently reported SSRI plus St. John's wort interactions in published case series.
venlafaxine + st. john's wort
Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI). St. John's wort independently inhibits serotonin (and to a lesser extent norepinephrine and dopamine) reuptake. Combining them can drive a sharp rise in synaptic serotonin and trigger serotonin syndrome, and St. John's wort can also alter venlafaxine pharmacokinetics through CYP3A4 induction.
fluoxetine + st. john's wort
Fluoxetine is an SSRI with a very long half-life (its active metabolite norfluoxetine persists for weeks), and St. John's wort independently raises serotonin via reuptake inhibition. Combined use can precipitate serotonin syndrome and, because of fluoxetine's slow elimination, the risk window extends well beyond the day of last dose.
saffron + antidepressants
Saffron and its constituents crocin and safranal show antidepressant activity by inhibiting serotonin, norepinephrine, and dopamine reuptake and modulating monoamine oxidase, which is additive to SSRIs, SNRIs, and MAOIs and raises the theoretical risk of serotonin syndrome.
alcohol + venlafaxine
Venlafaxine (Effexor) is an SNRI that, like other antidepressants, has additive CNS-depressant effects with alcohol. The FDA-approved label warns patients to avoid alcohol because of worsening drowsiness, dizziness, impaired judgment, and the potential to aggravate the underlying mood or anxiety disorder.
alcohol + duloxetine
Duloxetine (Cymbalta) and heavy alcohol use both can damage the liver. The FDA-approved label explicitly states that Cymbalta should not be prescribed to patients with substantial alcohol use because the combination has been linked to severe, sometimes fatal, hepatotoxicity in clinical trial data.
alcohol + amitriptyline
Amitriptyline is a tricyclic antidepressant with strong sedating, anticholinergic, and antihistaminic effects. Combining it with alcohol — also a CNS depressant — produces marked additive sedation, impaired psychomotor performance, and increased risk of falls, accidents, and respiratory depression in overdose.
alcohol + trazodone
Trazodone and alcohol both depress the central nervous system, producing additive sedation, dizziness, orthostatic hypotension, and impaired psychomotor performance. The combination also increases risk of falls, accidents, and rarely, dangerous arrhythmias related to QT prolongation.
alcohol + mirtazapine
Mirtazapine and alcohol both depress the central nervous system, producing additive sedation, profound drowsiness, impaired psychomotor performance, and increased risk of accidents and falls. Mirtazapine's strong H1-antihistamine activity makes the sedative interaction with alcohol particularly pronounced, especially at lower doses.
caffeine + sertraline
Sertraline and caffeine can each contribute to anxiety, insomnia, tremor and GI upset, and sertraline may modestly slow caffeine clearance via CYP1A2 inhibition. The pharmacokinetic effect is small but the additive symptomatic effect can be uncomfortable.
cbd + sertraline
CBD inhibits CYP2C19, an enzyme that contributes to sertraline metabolism. A published case report describes severe hyponatremia and cognitive dysfunction in a CYP2C19 intermediate metabolizer who added over-the-counter CBD to chronic sertraline, consistent with phenoconversion to a poor-metabolizer phenotype.
coffee + sertraline
Sertraline modestly inhibits CYP1A2-mediated caffeine metabolism, raising caffeine plasma levels and prolonging its half-life. Caffeine can also worsen the anxiety, insomnia, jitteriness, and palpitations that sertraline is often prescribed to treat, blunting the clinical response.
alcohol + sertraline
Sertraline (Zoloft) and alcohol are both central nervous system depressants. Although controlled studies in healthy subjects showed sertraline did not potentiate alcohol's psychomotor impairment, the FDA label still advises against concurrent use because alcohol can worsen depression, anxiety, drowsiness, and judgment in patients being treated for mood disorders.
alcohol + fluoxetine
Fluoxetine (Prozac) and alcohol both depress the central nervous system, increasing drowsiness, dizziness, and impaired judgment. Fluoxetine and its active metabolite norfluoxetine have unusually long half-lives (1 to 4 days and 4 to 16 days), so alcohol effects can be amplified even when the drink and dose are taken hours apart.
sertraline + tryptophan
Sertraline is a selective serotonin reuptake inhibitor (SSRI) that increases synaptic serotonin, and L-tryptophan is the dietary precursor to serotonin. Combining them can excessively elevate serotonergic activity, raising the risk of serotonin syndrome (agitation, tremor, hyperthermia, autonomic instability).
saffron + curcumin
Saffron (Crocus sativus) and curcumin both have antidepressant effects through complementary mechanisms: saffron modulates serotonin reuptake and increases BDNF, while curcumin reduces neuroinflammation and supports monoamine balance via MAO inhibition and HPA-axis modulation. A randomized placebo-controlled trial in major depressive disorder showed the combination was effective in reducing depressive and anxiolytic symptoms.