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SSRIs and SNRIs: what to be careful with
These antidepressants raise the availability of serotonin (and for SNRIs also noradrenaline) in the brain, and are used for depression and several anxiety conditions.
General information only, and not exhaustive. This is not medical advice, not a full list of interactions, and not a reason to start, stop or change a medicine. Interactions depend on the exact drug, the dose, your other medicines and your own health — a pharmacist or doctor is the one who decides. Always read the leaflet that came with your medicine, and ask your pharmacist before adding anything, including supplements.
Group, not a brandATC N06AB / N06AX
Examples in this group: sertraline, citalopram, escitalopram, fluoxetine, paroxetine; venlafaxine, duloxetine. Interactions usually belong to the whole group, but your own leaflet is brand-specific — always the final word.
Food and drink to be careful with
- St John's wort. The most important supplement interaction in this group. It has its own serotonergic activity and also induces liver enzymes, so it can both add to the effect and reduce the level of the prescribed medicine. It is specifically warned against in these leaflets.
- Grapefruit juice. Raises levels of some of these medicines, sertraline among them, by the familiar CYP3A4 route. Whether it matters depends on which one you take.
- Take with food if it causes nausea. Nausea in the first days or weeks is the commonest early complaint, and taking the dose with food is the usual first suggestion in the leaflet.
- Caffeine. Not a formal interaction, but these medicines can cause jitteriness and sleep disturbance early on, and caffeine adds to both.
Timing around meals
Once a day is usual. Morning or evening is often chosen by whether the particular medicine makes you sleepy or wakeful. Stopping is not done abruptly — discontinuation symptoms are well described, and the taper is planned by the prescriber.
Alcohol
Leaflets advise caution or avoidance. Alcohol adds to drowsiness and slowed reactions, it worsens sleep quality, and it works against the treatment in depression. This is not a small-print warning.
Other things to watch
- Combining with NSAIDs or aspirin raises the risk of stomach bleeding; a stomach-protecting medicine is sometimes added for that reason.
- Low blood sodium is a recognised effect, particularly in older people, and is a reason a blood test may be requested.
- Combining serotonergic medicines — including some migraine treatments, tramadol and MAOIs — carries serotonin syndrome risk, and MAOIs specifically require a washout gap.
If anything here does not match what you were told, or you notice a new symptom after starting a medicine, contact your pharmacist or doctor — do not just stop taking it. Stopping some medicines suddenly is more dangerous than any food interaction.
Source: The product's own Summary of Product Characteristics and patient information leaflet, published per medicine by the licensing authority. The St John's wort and MAOI warnings are standing entries in SSRI and SNRI product information. · checked 2026-09-02
Frequently asked questions
What should I avoid with ssris and snris?
St John's wort is the one people ask about most: The most important supplement interaction in this group. It has its own serotonergic activity and also induces liver enzymes, so it can both add to the effect and reduce the level of the prescribed medicine. It is specifically warned against in these leaflets. This is general information — your leaflet and pharmacist have the specifics.
Can I drink alcohol with ssris and snris?
Leaflets advise caution or avoidance. Alcohol adds to drowsiness and slowed reactions, it worsens sleep quality, and it works against the treatment in depression. This is not a small-print warning.
Should ssris and snris be taken with food?
Once a day is usual. Morning or evening is often chosen by whether the particular medicine makes you sleepy or wakeful. Stopping is not done abruptly — discontinuation symptoms are well described, and the taper is planned by the prescriber.
Other medicine groups
Statins
Statins lower LDL cholesterol by slowing the liver's own cholesterol production, and are prescribed to reduce the long-term risk of heart attack and stroke.
Metformin
Metformin lowers blood glucose mainly by reducing the amount of glucose the liver releases, and is usually the first medicine used in type 2 diabetes.
Levothyroxine
Levothyroxine replaces the thyroid hormone the body is not making enough of, in an underactive thyroid.
Warfarin
Warfarin thins the blood by blocking the vitamin K-dependent clotting factors, and is used to prevent and treat blood clots.
DOACs (direct oral anticoagulants)
DOACs thin the blood by directly blocking a single clotting factor, and are used to prevent stroke in atrial fibrillation and to treat and prevent venous clots.
NSAIDs
NSAIDs reduce pain, fever and inflammation by blocking prostaglandin production.
All medicine groups · Alcohol units and clearance · Blood test reference ranges
Track meals and symptoms alongside your medicines
TempoLife keeps your food, symptoms and the medicines you take in one place, so a pattern is easy to show your pharmacist or doctor.