Note: The U.S. Food and Drug Administration (FDA) does not approve supplements for safety or effectiveness. Talk to a healthcare professional about whether a supplement is the right fit for your individual health, and about any potential drug interactions or safety concerns.
Sertraline (Zoloft) is a prescription medication that doctors prescribe to manage depression, obsessive-compulsive disorder (OCD), panic attacks, post-traumatic stress disorder (PTSD), and other mental health conditions.
If you take this medication, you may also be looking for other remedies, such as vitamins or herbal supplements, to use alongside it. But some herbs can interact with (or affect) sertraline, either increasing or decreasing its effectiveness and possibly leading to side effects.
How Sertraline (Zoloft) Works
Sertraline belongs to a family of drugs called selective serotonin reuptake inhibitors (SSRIs). That means it helps increase the amount of a crucial chemical messenger in the brain, or neurotransmitter, called serotonin. SSRIs achieve this by preventing brain cells from reabsorbing serotonin after they release it.
One of serotonin’s effects is regulating mood. When the body has more serotonin available for use outside of brain cells, sertraline can continue to stimulate cells and remain active in the brain. Research suggests that this can boost mood and reduce symptoms of depression and other mental illnesses with links to low serotonin levels.
But many compounds — including vitamins and certain dietary supplements — can also affect the levels of serotonin in your brain. That's why taking sertraline at the same time as certain herbs can lead to harmful reactions.
Sertraline (Zoloft) Interactions With Herbs
Always talk with a doctor about the over-the-counter vitamins and supplements you take, especially when you're prescribed a new medication. If sertraline is part of your regimen, you should avoid the following herbal remedies.
St. John's Wort
European herbal and traditional medicine practitioners have used this yellow-flowered plant for centuries. Recent research suggests it may be more effective than a placebo at alleviating mild or moderate depression symptoms in the short term, according to the National Center for Complementary and Integrative Health (NCCIH).
But the NCCIH cautions against taking St. John’s wort if you’re taking certain antidepressants, especially those that affect serotonin, like sertraline. St. John’s wort can cause a dangerous increase in serotonin levels if you take it alongside other serotonin-boosting drugs, leading to a potentially life-threatening series of symptoms known as serotonin syndrome.
These symptoms can include the following:
Fever
Agitation
Rapid heartbeat
Heavy sweating
Increased blood pressure
Twitching or rigid muscles, or loss of muscle coordination
Wide pupils
Headache
Diarrhea
Shivering
Goose bumps
Problems falling or staying asleep
Severe symptoms are a medical emergency and can include:
Tremors
Seizures
High fever
An irregular heartbeat
Becoming unconscious
While taking a single drug that boosts serotonin can cause serotonin syndrome to occur, the condition is most common in people who combine substances.
Tryptophan
Tryptophan is a precursor to serotonin, meaning your body uses tryptophan to make serotonin. Foods like salmon, eggs, cheese, turkey, tofu, and pineapple naturally provide tryptophan. But research hasn’t definitively confirmed that you can boost serotonin levels by eating foods with tryptophan.
However, tryptophan is also available as a supplement. A single study showed that taking L-tryptophan alongside paroxetine, a drug similar to sertraline, caused some symptoms of serotonin syndrome. More research would be needed to confirm the risk of interaction between L-tryptophan and sertraline. Also, studies of L-tryptophan with other drugs similar to sertraline have not reported the same side effects. And foods that contain tryptophan don’t seem to interact with SSRIs in the same way.
Even so, given L-tryptophan’s potential for side effects in combination with SSRIs, do not combine it with sertraline unless a doctor is closely watching your health and symptoms.
Can You Take Ashwagandha With Zoloft?
Some people wonder if ashwagandha, an herbal remedy used in traditional Ayurvedic medicine for thousands of years, can interact with sertraline. Ashwagandha may have some beneficial effects on sleep disturbances and stress, according to the NCCIH. These symptoms can happen along with depression. For this reason, people may wish to try ashwagandha to manage symptoms along with their antidepressant medication.
While more studies are needed to confirm the effectiveness and safety of this evergreen shrub, currently it doesn't appear to have any negative interactions with antidepressant medications. The NCCIH advises that evidence currently only cautions against taking ashwagandha along with medications for high blood pressure and diabetes, as well as sedatives, drugs to reduce immune activity, anti-seizure medications, and thyroid hormone supplements.
What About Rhodiola?
Some people consider rhodiola, a root, to have beneficial effects for those with depression. It's also safe to take with SSRIs, and it even enhanced their effects in a small 2020 study. But much more research is needed to confirm the benefits of taking rhodiola and sertraline together. The NCCIH advises that, at present, not enough strong evidence supports using rhodiola to address or prevent health issues.
Other Interactions With Sertraline (Zoloft)
Herbs aren't the only compounds you may need to avoid or limit. Talk with your doctor about any medications you're taking. You shouldn’t take sertraline with the following medications:
dronedarone (Multaq), a medication for irregular heartbeats
Monoamine oxidase inhibitors (MAOIs), including isocarboxazid (Marplan), phenelzine (Nardil), selegiline, and tranylcypromine (Parnate)
linezolid (Zyvox), an antibiotic that carries out similar activity to MAOIs
Certain antipsychotic medications, including pimozide and thioridazine
An injected medication called methylene blue (ProvayBlue)
Some other medications that may cause problems include:
Amphetamine
Anticoagulants or blood thinners
Anti-seizure medications
Aspirin and other anti-inflammatory drugs
Diuretics, or water pills
Fentanyl, an opioid pain-relief medication
Medications for anxiety
Medications for irregular heartbeat
Migraine medications
Sedatives and sleep-inducing medications
Other antidepressants
If you take any of the above, a doctor may need to adjust your dose or monitor you for side effects. You should also tell them if you drink alcohol, smoke tobacco, or use illicit substances.
The Takeaway
St. John’s wort can interact with sertraline (Zoloft), potentially causing serotonin syndrome by increasing serotonin to dangerous levels.
L-tryptophan supplements may also increase serotonin levels and cause symptoms. But not all research has shown harmful interactions between the two. Speak with a doctor if you want to take L-tryptophan along with your sertraline prescription.
Ashwagandha and rhodiola may be safe to take with sertraline, but not enough evidence supports using these supplements with the medication at the same time.
Mention any other medications or supplements that you take to your prescribing doctor if they suggest that sertraline might help you manage a mental health condition.
EDITORIAL SOURCES
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.
Gao L et al. Antidepressants Effects of Rhodiola Capsule Combined With Sertraline for Major Depressive Disorder: A Randomized Double-Blind Placebo-Controlled Clinical Trial. Journal of Affective Disorders. January 15, 2020.
Kristina D. Carter, PharmD, is a clinical pharmacist and freelance health writer who currently works in a managed care setting, performing quality audits on utilization management case reviews for the pharmacy team. She has over 20 years of experience and has worked in several pharmacy practice settings, including at a community pharmacy as well as in ambulatory care, senior care, and pharmacy operations.
She received her doctor of pharmacy degree from Xavier University of Louisiana College of Pharmacy and her master's of business administration and health administration from Georgia State University Robinson College of Business. She is an American Council on Exercise–certified health coach, group fitness instructor, senior fitness specialist, and weight management specialist. She is also a registered pharmacist, licensed in Georgia, Indiana, and Tennessee.
Dr. Carter enjoys exploring new restaurants with family and friends, walking along city trails, and watching action movies and college sports.
Sarah Klein is a Boston-based health journalist with over 15 years experience in lifestyle media. She has held staff positions at Livestrong.com, Health.com, Prevention, and Huffington Post. She is a graduate of the Arthur L. Carter Journalism Institute at New York University, and a National Academy of Sports Medicine–certified personal trainer. She moderated a panel on accessibility in fitness at SXSW in 2022, completed the National Press Foundation's 2020 Vaccine Boot Camp, and attended the Mayo Clinic's Journalist Residency in 2019.
