Navigating treatment for anxiety often involves prescription medication, a process that requires strict adherence to a doctor's instructions. A critical part of this is understanding the potential for interactions with other substances, including alcohol, over-the-counter drugs, herbal supplements, and even certain foods. These interactions can range from increasing side effects to causing dangerous, and in some cases, life-threatening, reactions. It is essential to discuss all medications and supplements with a healthcare provider to ensure safe and effective treatment.
The most dangerous combinations: Central Nervous System Depressants
Central nervous system (CNS) depressants are substances that slow down brain activity. When combined with anxiety medication, especially benzodiazepines, their effects are intensified, leading to dangerous and potentially fatal consequences.
Alcohol
Alcohol is a powerful CNS depressant and should be avoided when taking most anxiety medications, including benzodiazepines like Xanax (alprazolam) or Ativan (lorazepam), as well as SSRIs and buspirone.
- Excessive Sedation: Both alcohol and anxiety pills can cause drowsiness. Mixing them multiplies this effect, leading to extreme sleepiness, impaired judgment, and poor coordination.
- Increased Overdose Risk: The combination of benzodiazepines and alcohol can severely depress the respiratory system, slowing or stopping breathing and increasing the risk of coma or death.
- Worsened Anxiety: While alcohol may provide temporary relief, its long-term effect is to worsen anxiety symptoms and disrupt sleep cycles.
Opioids
The combination of benzodiazepines and opioid pain medication is so dangerous that the FDA has issued a Boxed Warning against it.
- Fatal Respiratory Depression: Both drug classes slow down breathing. Taking them together significantly increases the risk of respiratory arrest and death.
- Compounded Sedation: The synergistic effect leads to profound sedation, confusion, and impaired motor skills, heightening the risk of falls and accidents.
Other Sedatives
This category includes any medication designed to cause drowsiness or promote sleep, such as prescription sleeping pills (e.g., zolpidem), muscle relaxers (e.g., cyclobenzaprine), and even older-generation, sedating antihistamines (e.g., diphenhydramine).
- Intensified Side Effects: Combining these with anxiety medications dramatically increases the risk of excessive sleepiness, dizziness, confusion, and impaired coordination.
Hidden dangers: Foods and herbal supplements
Drug interactions are not limited to other medications. Certain foods and herbal supplements can interfere with how anxiety medication is metabolized in the body.
Grapefruit and its juice
Grapefruit contains compounds called furanocoumarins that can block the CYP3A4 enzyme in the intestinal tract. This enzyme is crucial for breaking down many medications, including certain benzodiazepines (like Valium and Xanax) and buspirone.
- Increased Drug Levels: By inhibiting the enzyme, grapefruit allows higher levels of the medication to enter the bloodstream, potentially leading to side effects similar to an overdose.
- Prolonged Effects: The effects of the interaction can last for over a day, meaning even if you don't take them together, you may still be at risk.
St. John's Wort and other herbs
Herbal supplements are unregulated by the FDA and can have potent effects that interact with prescription medication.
- Serotonin Syndrome: St. John's Wort, an herbal supplement used for depression, should never be combined with SSRIs, as it can cause a dangerous buildup of serotonin, a condition known as serotonin syndrome. Symptoms include agitation, rapid heartbeat, and high fever.
- Additive Sedation: Sedative herbs like kava and valerian can increase drowsiness and confusion when taken with anxiety medications.
Medications and substances with specific interactions
MAOIs and tyramine-rich foods
Monoamine oxidase inhibitors (MAOIs) are an older class of antidepressants sometimes used for anxiety. They require strict dietary restrictions.
- Dangerous Blood Pressure Spikes: MAOIs interact with tyramine, an amino acid found in aged meats, cheeses, and fermented foods. This can cause a severe, life-threatening spike in blood pressure.
Other psychiatric medications
Using multiple antidepressants or combining them with other psychiatric drugs can increase the risk of serotonin syndrome or other adverse effects. Close medical supervision is required for such combinations.
Antibiotics and antifungals
Some medications, like certain antibiotics (e.g., clarithromycin) and antifungals (e.g., ketoconazole), can interfere with the metabolism of anxiety medication, potentially increasing drug levels and the risk of side effects.
| Substance | Interaction with Benzodiazepines | Interaction with SSRIs | Risk Severity |
|---|---|---|---|
| Alcohol | Enhanced sedation, respiratory depression, overdose | Worsened anxiety, increased side effects | High |
| Opioids | Fatal respiratory depression, profound sedation | Serotonin toxicity (with some opioids) | High |
| Grapefruit | Increased drug concentration, heightened side effects | Increased drug concentration (e.g., sertraline) | Moderate to High |
| St. John's Wort | Possible increased sedation | High risk of serotonin syndrome | High |
| Sedating Antihistamines | Excessive drowsiness, impaired coordination | Increased sedation, additive side effects | Moderate |
| Kava / Valerian | Increased sedation, confusion | Increased sedation, dizziness | Moderate |
| MAOIs | Possible sedation and blood pressure issues | High risk of serotonin syndrome, hypertensive crisis | Very High |
| Antibiotics / Antifungals | Increased drug levels (e.g., clarithromycin, ketoconazole) | Varied interactions, potential for increased levels | Moderate |
How to avoid harmful interactions
Preventing dangerous drug interactions requires vigilance and open communication with your healthcare team. Always follow these guidelines to ensure your safety:
- Maintain an up-to-date medication list: Keep a record of all prescription drugs, over-the-counter medications, vitamins, and supplements you take. Share this list with every doctor, pharmacist, and healthcare provider you see.
- Read warning labels: Check the labels on your prescription bottles, as well as OTC medications, for warnings about interactions, especially those regarding alcohol and grapefruit.
- Ask your pharmacist: Pharmacists are trained to screen for drug interactions. When you fill a new prescription, ask about potential risks and what you should avoid.
- Avoid abrupt changes: Never stop or change the dosage of your anxiety medication without consulting your doctor. Abruptly stopping can cause withdrawal symptoms and rebound anxiety.
- Be cautious with new supplements: Inform your doctor before starting any new herbal supplement or dietary change. Supplements are not risk-free and can significantly impact your treatment.
Conclusion
Understanding what not to take with anxiety pills is fundamental to a safe and effective treatment plan. While anxiety medication can be life-changing, combining it with certain substances can have severe, even fatal, consequences. The most significant risks are associated with other CNS depressants, particularly alcohol and opioids, due to the danger of respiratory depression. However, less obvious interactions with common items like grapefruit and herbal supplements can also lead to adverse effects, including dangerously high drug levels or serotonin syndrome. By maintaining open communication with healthcare professionals, diligently checking warning labels, and avoiding contraindicated substances, individuals can navigate their anxiety treatment safely and maximize its therapeutic benefits.
