Don't Mix These 7 Foods, Drinks, or Drugs With Antidepressants

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 is a plant often sold in the form of supplements. It's been promoted as a natural remedy for various health conditions, including depression.

"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.

Although some may feel that alcohol improves their mood in the short term, it's actually a depressant, says Dr. Garcia. It can make some antidepressants less effective and could worsen certain side effects. Some antidepressants - such as SSRIs or mirtazapine (Remeron) - may have a sedating effect, especially when you first start taking them.

Drinking alcohol could make that side effect worse.

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

If you're taking an SSRI, you need to stay away from nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen, which are sold over-the-counter. That's because using SSRIs with NSAIDs is associated with a rare but increased risk of gastrointestinal bleeding, research suggests.

"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.

"These ingredients, such as dextromethorphan, can lead to serotonin syndrome when combined with MAOIs," says Dr. Wragg. The same applies for people taking SSRIs such as escitalopram (Lexapro) .

Dextromethorphan is found in common cough medicines like Robitussin , Garcia notes.

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."

Combining lithium with some antidepressants, such as tricyclic antidepressants, can also raise the risk for lithium neurotoxicity, especially in high doses. Lithium neurotoxicity is a complication caused by too much lithium in the body. It can cause symptoms like vomiting, diarrhea, and neurological symptoms like confusion and uncontrolled shaking. Without prompt medical treatment, lithium neurotoxicity can be fatal.

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.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy . We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

1. St. John's Wort. National Center for Complementary and Integrative Health . October 2020.
2. Antidepressant Medications. Centre for Addiction and Mental Health .
3. Yuet WC. Selective Serotonin Reuptake Inhibitor Use and Risk of Gastrointestinal and Intracranial Bleeding. Journal of Osteopathic Medicine . February 1, 2019.
4. Dy P et al. Serotonin syndrome caused by drug to drug interaction between escitalopram and dextromethorphan. BMJ Case Reports . August 7, 2017.
5. Ferensztajn-Rochowiak E et al. Long-Term Lithium Therapy: Side Effects and Interactions . Pharmaceuticals . January 3, 2023.

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Angela D. Harper, MD

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Angela D. Harper, MD, is in private practice at Columbia Psychiatric Associates in South Carolina, where she provides evaluations, medication management, and psychotherapy for adults.

A distinguished fellow of the American Psychiatric Association, Dr. Harper has worked as a psychiatrist throughout her career, serving a large number of patients in various settings, including a psychiatric hospital on the inpatient psychiatric and addiction units, a community mental health center, and a 350-bed nursing home and rehab facility. She has provided legal case consultation for a number of attorneys.

Harper graduated magna cum laude from Furman University with a bachelor's degree and cum laude from the University of South Carolina School of Medicine, where she also completed her residency in adult psychiatry. During residency, she won numerous awards, including the Laughlin Fellowship from the American College of Psychiatrists, the Ginsberg Fellowship from the American Association of Directors of Psychiatric Residency Training, and resident of the year and resident medical student teacher of the year. She was also the member-in-training trustee to the American Psychiatric Association board of trustees during her last two years of residency training.

Harper volunteered for a five-year term on her medical school's admission committee, has given numerous presentations, and has taught medical students and residents. She currently supervises a nurse practitioner. She is passionate about volunteering for the state medical board's medical disciplinary commission, on which she has served since 2015.

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Nayanika Guha is a freelance writer who writes about social justice, identity, and community. She has a background in psychology and social work, which informs her writing and worldview. Her work has appeared in The Guardian, The Lily, Refinery29, and more. See full bio See Our Editorial Policy Meet Our Health Expert Network