What Supplements Not to Mix with Lexapro?

October 14, 2025 •

4 min read

According to the CDC, millions of Americans experience symptoms of anxiety and depression, making medications like Lexapro (escitalopram) widely prescribed. However, combining antidepressants with certain dietary or herbal supplements can lead to serious health complications. It is critical to understand what supplements not to mix with Lexapro to ensure your safety and treatment efficacy.

Quick Summary

This article outlines dangerous interactions between Lexapro and common supplements, detailing specific substances like St. John's Wort and 5-HTP that increase serotonin syndrome risk. It also explains interactions involving sedatives, stimulants, and other herbs, emphasizing the importance of consulting a healthcare provider before combining any supplements with Lexapro.

Key Points

Serotonin Syndrome Risk: Supplements that increase serotonin, such as St. John's Wort, 5-HTP, and L-Tryptophan, should be strictly avoided while taking Lexapro due to the risk of a life-threatening condition called serotonin syndrome.
Avoid Herbal Remedies: Many herbal remedies and complementary medicines are not sufficiently tested for interactions with prescription drugs like Lexapro and should be avoided.
Increased Sedation: Supplements with sedative effects, like valerian root and melatonin, can cause excessive drowsiness and fatigue when combined with Lexapro.
Other High-Risk Herbs: Be cautious with other herbs like Panax Ginseng and Nutmeg, which have known or potential serotonergic effects that could be dangerous with Lexapro.
Always Consult Your Doctor: Before starting any new supplement—including those that seem benign like vitamins or Omega-3s—inform your doctor to prevent unintended and potentially serious interactions.

The Dangers of Combining Supplements and Prescription Medication

Lexapro, the brand name for escitalopram, is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI). SSRIs work by increasing the level of serotonin in the brain, a neurotransmitter that helps regulate mood. While this is beneficial for treating conditions like depression and anxiety, mixing Lexapro with other substances that also increase serotonin can lead to a dangerous condition called serotonin syndrome. Furthermore, certain supplements can interact with Lexapro in other ways, causing excessive drowsiness or other adverse effects.

Serotonin-Increasing Supplements to Strictly Avoid

Combining Lexapro with any supplement that boosts serotonin is a high-risk activity that can cause serious or even fatal side effects. The following supplements must be avoided:

St. John’s Wort (Hypericum perforatum): A popular herbal remedy often used for depression, St. John's Wort functions similarly to an SSRI by increasing serotonin levels. When taken with Lexapro, the combined effect can cause serotonin levels to rise to toxic levels, leading to serotonin syndrome. This is one of the most well-known and dangerous herbal-medication interactions.
5-HTP (5-hydroxytryptophan): As a direct precursor to serotonin, 5-HTP is converted into serotonin in the body. Taking 5-HTP with Lexapro can cause a significant overload of serotonin, making serotonin syndrome a serious risk. Combining these is generally not recommended by healthcare providers.
L-Tryptophan: This essential amino acid is also a precursor to serotonin. While foods rich in tryptophan are safe, concentrated L-tryptophan supplements should not be taken with Lexapro due to the risk of inducing serotonin syndrome.

The Critical Risk of Serotonin Syndrome

Serotonin syndrome is a potentially life-threatening drug reaction caused by excessive serotonin activity in the central nervous system. It can manifest with a range of symptoms, from mild to severe, and typically appears within hours of an overdose or drug combination.

Symptoms of Serotonin Syndrome include:

Mild: Shivering, diarrhea, heavy sweating, and dilated pupils.
Moderate: Agitation, restlessness, confusion, rapid heart rate, high blood pressure, and muscle twitching.
Severe (requiring immediate medical attention): High fever, seizures, severe muscle rigidity, irregular heartbeat, and unconsciousness.

Supplements with Sedative or Depressant Effects

Certain supplements can increase the sedative side effects of Lexapro, leading to excessive drowsiness, fatigue, and impaired cognitive function.

Valerian Root: Used to aid sleep, valerian can amplify the sedative effects of Lexapro, increasing feelings of drowsiness and fatigue. While not as dangerous as a serotonin-boosting interaction, it can still significantly impair daily activities.
Melatonin: A hormone that regulates sleep-wake cycles, melatonin can be used as a sleep aid. When combined with Lexapro, it may increase drowsiness, confusion, and dizziness. Healthcare providers may approve this combination under close supervision, but starting with a low dose is crucial.

Other Notable Interactions

Beyond the primary risks, other substances warrant caution or avoidance while taking Lexapro.

Stimulants (e.g., Amphetamine-based supplements): Combining Lexapro with stimulants can increase the risk of serotonin syndrome, as well as heightened anxiety, jitteriness, and elevated heart rate.
Panax Ginseng: This herbal supplement has multiple effects and is best avoided while taking Lexapro due to potential for serotonin-related side effects.
Nutmeg: In large doses, nutmeg can have hallucinogenic effects and is known to interfere with serotonergic pathways, making it a risk for serotonin syndrome.

Supplement Interactions with Lexapro: A Quick Comparison


Supplement	Primary Interaction Risk	Potential Side Effects	Recommendation
St. John's Wort	Serotonin Syndrome	Agitation, confusion, rapid heart rate, fever	Strictly Avoid
5-HTP & Tryptophan	Serotonin Syndrome	Agitation, confusion, muscle twitching, tremors	Strictly Avoid
Valerian Root	Increased Sedation	Drowsiness, fatigue, impaired coordination	Avoid or Use with Caution
Melatonin	Increased Sedation	Drowsiness, confusion, dizziness	Consult Doctor Before Use
Panax Ginseng	Serotonergic Effects	Variable; potential for serotonin syndrome	Avoid
Stimulant Herbs	Serotonin Syndrome, Anxiety	Heightened anxiety, jitteriness, racing thoughts	Avoid

Safe Supplementation: The Path Forward

While many supplements pose risks, certain vitamins and minerals are generally considered safe and may even be beneficial with a doctor's approval. For instance, Omega-3 fatty acids, particularly EPA, have been studied as an adjunct treatment for depression and generally do not interact negatively. Standard daily vitamins, such as multivitamins, are not known to interact with Lexapro, though it's always best to inform your doctor of everything you are taking. The key is transparency and communication with your healthcare team to ensure the best and safest treatment plan.

Conclusion: Always Consult a Healthcare Professional

The potential for adverse drug interactions between Lexapro and supplements is a serious and complex issue. The risks range from mild side effects like excessive drowsiness to life-threatening conditions such as serotonin syndrome. The most dangerous interactions involve supplements that increase serotonin levels, such as St. John's Wort, 5-HTP, and L-tryptophan. It is imperative that patients do not begin or discontinue any supplement without first discussing it with a doctor or pharmacist. Given the variability in individual responses, professional medical advice is the only reliable way to navigate supplement use safely while on Lexapro. For further information and drug interaction checkers, reliable resources like Drugs.com or Healthline can be consulted after speaking with a medical professional.

Frequently Asked Questions

No, you should never combine St. John's Wort with Lexapro. Both increase serotonin levels, and taking them together can cause a dangerous and potentially fatal condition known as serotonin syndrome.

No, it is not safe. 5-HTP and L-Tryptophan are precursors to serotonin. Combining them with Lexapro can lead to an excess of serotonin and trigger serotonin syndrome.

Serotonin syndrome is a potentially life-threatening reaction caused by too much serotonin in the body. Symptoms can range from mild (sweating, shivering, diarrhea) to severe (high fever, seizures, irregular heartbeat, unconsciousness).

You should avoid using valerian root with Lexapro. It can increase side effects like drowsiness and fatigue, potentially impairing your motor skills and judgment.

Combining melatonin and Lexapro may increase drowsiness, dizziness, and confusion. While a doctor might approve this under supervision, you should always consult them before mixing them and start with a low melatonin dose.

Omega-3 fatty acids and standard daily vitamins are generally considered low-risk for interaction. However, you should still inform your doctor of any supplements you are taking to ensure they are safe for your specific health needs.

If you experience any symptoms of serotonin syndrome, especially severe ones like high fever or confusion, seek immediate medical attention. Do not wait for symptoms to subside.