What Vitamins Not To Take With Antidepressants: Understanding Interactions

October 5, 2025 •

4 min read

According to the Mayo Clinic, combining certain supplements with medications can lead to dangerous interactions. Understanding what vitamins not to take with antidepressants is crucial for individuals managing their mental health to avoid complications like serotonin syndrome or reduced medication effectiveness.

Quick Summary

This guide examines specific supplements that may interact with antidepressants, such as St. John's Wort and 5-HTP. It highlights potential risks like serotonin syndrome and emphasizes the importance of consulting a healthcare professional.

Key Points

Avoid Specific Supplements: Supplements like St. John's Wort, 5-HTP, and SAMe should generally be avoided when taking antidepressants due to the risk of serotonin syndrome.
Manage Mineral Intake: Iron supplements can interfere with antidepressant absorption; take them at a different time of day than your medication.
Follow MAOI Guidelines Strictly: If taking MAOIs, adhere closely to your doctor's instructions regarding dietary and supplement restrictions to avoid dangerous reactions.
Always Consult Your Doctor: Before starting any new supplement, discuss it with your healthcare provider to check for potential interactions with your specific antidepressant.
Consider Nutrient Levels: Certain nutrients like folate, vitamin D, and magnesium may be relevant to mood and overall health; discuss potential supplementation with your doctor.
Timing Matters for Some Vitamins: If taking high doses of fat-soluble vitamins like Vitamin E, consult your doctor about appropriate timing to avoid potential issues.

Supplements and Antidepressants: Potential Risks

While many standard multivitamins are generally considered safe when taking antidepressants, certain supplements, particularly concentrated herbal products and amino acid precursors, can pose significant risks. These supplements can interact with the way antidepressants work in the brain and how they are processed by the body.

Many medications and supplements are metabolized by the same liver enzymes. When taken together, they can compete for these enzymes, potentially leading to increased levels of the antidepressant in the body or decreased effectiveness.

High-Risk Supplements to Discuss with Your Doctor

Several supplements are known to have potential interactions with antidepressants. A major concern is the risk of serotonin syndrome, a serious condition caused by excessive serotonin activity in the brain.

St. John's Wort

This herbal supplement is often used for mood support, but it can significantly increase serotonin levels. Combining St. John's Wort with antidepressants, especially SSRIs, can lead to dangerously high levels of serotonin and increase the risk of serotonin syndrome. Symptoms of serotonin syndrome can include agitation, confusion, rapid heart rate, and tremors.

5-HTP (5-hydroxytryptophan)

5-HTP is converted into serotonin in the body. Taking 5-HTP with an antidepressant can result in excessively high serotonin levels, raising the risk of serotonin syndrome. This interaction is a concern with various types of antidepressants.

SAMe (S-adenosyl-methionine)

SAMe is another supplement that may affect serotonin levels. Combining SAMe with an antidepressant could potentially lead to an unsafe buildup of serotonin and increase the risk of serotonin syndrome. While SAMe is sometimes used alongside antidepressants under strict medical guidance, it should not be combined without a doctor's explicit approval and monitoring.

Other Supplements and Considerations

Vitamin E: High doses of vitamin E can have a blood-thinning effect. This could be a concern for individuals taking antidepressants that also increase bleeding risk, such as SSRIs or SNRIs. High-dose Vitamin E may also affect the absorption of some older antidepressants.
Iron Supplements: Oral iron supplements can interfere with the absorption of certain oral medications, including some antidepressants. To minimize potential interference, it is often recommended to take these supplements and medications at different times of the day, typically one to two hours apart.

Specific Considerations for MAO Inhibitors

Monoamine oxidase inhibitors (MAOIs) are a class of antidepressants known for significant interactions with certain foods and supplements. Individuals taking MAOIs need to follow strict guidelines to avoid potentially dangerous reactions, such as a hypertensive crisis. This includes avoiding supplements that increase serotonin, like St. John's Wort, 5-HTP, and SAMe, due to the high risk of severe serotonin syndrome.

Overview of Potential Supplement Interactions with Antidepressants


Supplement	Potential Risk	Reason	Important Note
St. John's Wort	High (Serotonin Syndrome)	May increase serotonin levels, leading to a potential excess when combined with antidepressants.	Avoid this supplement if taking antidepressants.
5-HTP	High (Serotonin Syndrome)	Is converted to serotonin in the body, potentially causing dangerously high levels when combined with antidepressants.	Avoid this supplement if taking antidepressants.
SAMe	High (Serotonin Syndrome)	May impact serotonin production, increasing the risk of serotonin syndrome when combined with antidepressants.	Use only under the direct supervision of a doctor.
Iron Supplements	Moderate (Absorption Interference)	Can interfere with the absorption of some antidepressants if taken simultaneously.	Take at least 1-2 hours apart from antidepressant medication.
Vitamin E (high dose)	Moderate (Increased Bleeding Risk)	Can have a blood-thinning effect, which may be a concern with certain antidepressants.	Consult your doctor before taking high doses.
Omega-3 Fish Oil	Generally Low Risk	Some research suggests potential benefits, but results are not conclusive.	Discuss with your doctor before supplementing.
Folate (Folic Acid/L-Methylfolate)	Generally Low Risk (Potential Benefit)	Low levels are sometimes associated with depression; supplementation may enhance antidepressant effectiveness.	Discuss with your doctor before supplementing.
Vitamin D	Generally Low Risk (Potential Benefit)	Low vitamin D levels have been linked to depression.	Discuss with your doctor before supplementing.
Magnesium	Generally Low Risk (Potential Benefit)	Plays a role in mood regulation.	Discuss with your doctor before supplementing.

The Importance of Consulting Your Healthcare Provider

Before adding any new vitamin, mineral, or herbal supplement to your routine, it is crucial to consult with your doctor or pharmacist. They can review your current medications and health status to determine if a potential interaction exists with your specific antidepressant. Always inform them about all supplements you are taking, regardless of how safe they may seem. Your healthcare provider can offer guidance on safe options, appropriate timing, or potential adjustments to your medication plan if needed. This communication is especially vital for individuals taking MAOIs due to their broad interaction profile. It is important to emphasize: Never change or stop taking any medication or supplement without first discussing it with your doctor.

Conclusion

While many standard multivitamins are typically safe to take with antidepressants, certain supplements, particularly herbal remedies and amino acid precursors, can pose significant and potentially dangerous risks. Supplements such as St. John's Wort, 5-HTP, and SAMe are considered high-risk due to the potential for serotonin syndrome and should be avoided. Other supplements, like iron and high-dose Vitamin E, require careful consideration and timing to prevent interactions. Open and transparent communication with your healthcare team is essential for safely managing your mental health medication and overall well-being. By working closely with your doctor and pharmacist, you can make informed decisions about supplements to ensure they do not interfere with the effectiveness or safety of your antidepressant treatment. For additional information on the safe use of medications and supplements, resources like the U.S. Food and Drug Administration provide valuable guidelines.

Frequently Asked Questions

Generally, a standard multivitamin is considered safe with most antidepressants. However, it's always recommended to discuss any supplements with your doctor or pharmacist to confirm it's appropriate for your specific situation and medication.

Serotonin syndrome is a serious, potentially life-threatening condition resulting from too much serotonin activity in the brain. Symptoms can range from mild (agitation, tremors) to severe (high fever, seizures). It can occur when certain medications and supplements that increase serotonin are combined.

St. John's Wort can increase serotonin levels. Taking it with an antidepressant, especially an SSRI, can lead to a dangerous excess of serotonin, potentially causing serotonin syndrome.

No, 5-HTP is a precursor to serotonin, and combining it with an antidepressant can lead to dangerously high serotonin levels and the risk of serotonin syndrome. It should be avoided.

Iron supplements can interfere with the absorption of some antidepressants. To help ensure proper absorption, it's often advised to take them at least one to two hours apart from your antidepressant medication.

Individuals taking MAOIs need to avoid foods high in tyramine, such as aged cheeses and cured meats, to prevent a hypertensive crisis. This dietary restriction is typically not required for other classes of antidepressants.

Some research suggests that certain antidepressants may potentially affect the levels of certain nutrients, such as B vitamins, magnesium, and zinc. Discussing this with your doctor can help identify and manage any potential deficiencies.