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Can I take ashwagandha with SSRIs like Lexapro or Zoloft?

Maybe, but only with your prescriber's OK. The evidence is case reports only: Polish drug-safety doctors found 6 people on sertraline, escitalopram or paroxetine who had side effects, such as severe diarrhea or muscle pain, after adding ashwagandha. No study has measured SSRI levels with it. In one small 6-week trial, 15 people on SSRIs took ashwagandha with no side effects reported. Check with your prescriber or pharmacist.

How well documented: Case reports only. Individual patients have been described, but no study has measured it.

Last reviewed

How we grade evidenceEditorial policy

What's known

  • Case reports. A Polish drug-safety centre reviewed 1,816 reports of side effects and found 30 where an herbal "adaptogen" plus an antidepressant was the likely cause. Ashwagandha was in 7. Six involved SSRIs: severe diarrhea needing a hospital stay (sertraline); muscle pain, stomach pain with vomiting, restless legs, or a severe cough (four people on escitalopram); and muscle and eye pain with raised eye pressure (paroxetine). (Siwek 2023)
  • What isn't known. Nobody measured drug levels in those people. The authors suggest ashwagandha may slow the enzymes and pumps that clear these drugs, or simply add similar side effects, but no study in people has tested either idea. No case of serotonin syndrome with ashwagandha and an SSRI was found, and the sertraline label doesn't name ashwagandha. (Siwek 2023; Zoloft label)
  • A small trial. In 30 people with OCD who were all taking SSRIs, 15 added 120 mg a day of ashwagandha root extract and 15 a placebo for 6 weeks. No side effects were reported. That is too small and short to rule out rare problems. (Jahanbakhsh 2016)
  • Other cautions. NIH's NCCIH says ashwagandha might interact with sedatives, thyroid hormone, and diabetes and blood pressure medicines, and isn't recommended for people with thyroid or autoimmune disorders or before surgery. Rarely, it has caused liver injury, usually 2 to 12 weeks after starting. (NCCIH; LiverTox)

What to do

  • Talk to your prescriber or pharmacist before adding ashwagandha to an antidepressant, and mention any sedatives, sleep aids or thyroid medicine you take.
  • If new or worse side effects start after you add it, tell your prescriber. Yellow skin or eyes (jaundice) or itching can be signs of liver injury and need prompt medical care. (LiverTox)
  • If you're pregnant, planning a pregnancy or breastfeeding, ask your doctor or midwife: NCCIH says to avoid ashwagandha in pregnancy and while breastfeeding. (NCCIH)
  • Don't stop or change a prescribed medicine on your own. The sertraline label tells prescribers to lower the dose gradually rather than stop it suddenly.

Sources

  1. Siwek M, et al. Harder, better, faster, stronger? Retrospective chart review of adverse events of interactions between adaptogens and antidepressant drugs. Front Pharmacol. 2023. PubMed 37829299 · doi:10.3389/fphar.2023.1271776
  2. Jahanbakhsh SP, et al. Evaluation of the efficacy of Withania somnifera (Ashwagandha) root extract in patients with obsessive-compulsive disorder: A randomized double-blind placebo-controlled trial. Complement Ther Med. 2016. PubMed 27515872 · doi:10.1016/j.ctim.2016.03.018
  3. National Center for Complementary and Integrative Health. Ashwagandha. Last updated March 2023. NCCIH
  4. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Ashwagandha. National Institute of Diabetes and Digestive and Kidney Diseases, updated December 2024. NCBI Bookshelf
  5. US National Library of Medicine. Zoloft (sertraline) tablets and oral solution: prescribing information. DailyMed, revised August 2023. DailyMed