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Medication · ssri

Supplements and Escitalopram.

Every documented pair, every citation. Below: 6 documented pairs grouped by mechanism.

Escitalopram, sold under the brand name Cipralex, is a selective serotonin reuptake inhibitor (SSRI): it raises synaptic serotonin by blocking its reuptake.

Escitalopram is a selective serotonin reuptake inhibitor (SSRI). The class raises synaptic serotonin by blocking the serotonin reuptake transporter, with relatively low affinity for other monoamine systems. The most clinically important supplement concerns are serotonergic and additive. St John's Wort is a hard exclude per the BNF and MHRA. 5-HTP is a hard exclude on theoretical and case-report grounds. Tryptophan, and at higher doses saffron extract and SAMe, sit on the same pathway. Serotonin syndrome is rare but recognisable. Tremor, hyperthermia, clonus, agitation. Metabolic profiles vary across the class. Sertraline runs on CYP2B6 and CYP2C19. Fluoxetine and paroxetine are CYP2D6 inhibitors. Citalopram and escitalopram run on CYP2C19. Individual SSRI pages give a sharper picture. Discontinuation needs taper, not stop. SSRI withdrawal symptoms are real and documented in NICE NG222, and any planned change should run through the prescribing GP.

Below are the 6 documented pairs we have explicitly assessed against Escitalopram in the Distil database: 2 red and 4 amber. The pairs cluster around 1 mechanism: Additive serotonergic activity. Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not on this list is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by supplement, and the missing-item form at the bottom of the page routes any uncatalogued supplement into our next curation pass.

Documented interactions

Additive serotonergic activity

Red 5-HTP

5-HTP raises serotonin levels. Combined with an SSRI like escitalopram, it can cause serotonin syndrome. Do not combine.

BNF: Escitalopram
Red St John's Wort

St John's Wort and escitalopram both raise serotonin levels. Combined, they can cause serotonin syndrome. Do not combine.

BNF: Escitalopram
Amber L-Tryptophan

Tryptophan is the building block your body uses to make serotonin, so adding it to escitalopram raises serotonin from both directions. The combination can cause agitation, sweating, tremor, shivering, muscle twitching, or a racing heart. Do not stack them without your GP's involvement.

PMID 3488767 · PMID 2035713 · PMID 15784664 · BNF: Escitalopram

Reviewer-flagged: awaiting clinical-reviewer sign-off.

Amber Rhodiola Rosea

Rhodiola has mild effects on serotonin pathways that can add to escitalopram's. Most people tolerate the combination, but watch for restlessness, sweating, tremor, or a racing heart, and talk to your GP before stacking them, especially if your dose has recently changed.

PMID 19168123 · PMID 25413939 · PMID 30659561 · BNF: Escitalopram

Reviewer-flagged: awaiting clinical-reviewer sign-off.

Amber SAMe

SAMe has its own antidepressant, serotonin-related activity, which may add to escitalopram's. Most people tolerate the combination, but watch for restlessness, sweating, tremor, shivering, or a racing heart, and tell your GP before stacking them, especially if your escitalopram dose has recently changed.

PMID 7854515 · PMID 30115553 · PMID 2035713 · BNF: Escitalopram

Reviewer-flagged: awaiting clinical-reviewer sign-off.

Amber Saffron Extract

Saffron has its own antidepressant effect that may stack with escitalopram's. Most people tolerate the combination but discuss it with your GP, especially if your dose has recently changed.

PMID 15852492 · BNF: Escitalopram

What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope (food-supplement interactions only; for drug-drug interactions, the BNF is authoritative). Use the checker below to surface any supplement, and submit a missing item if you take something we have not catalogued.

Related guides

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For adults over 18. This tool gives evidence-graded information, not medical advice. Always discuss changes with your GP, especially if you take any medication, are pregnant, breastfeeding, or have a serious health condition.
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How we decide

How we grade severity, choose what's in scope, and what we exclude.

Every call on this page is reasoned. We publish the full rubric for severity tiers, the medication inclusion logic, the evidence grades we accept, and what we deliberately leave out. About three thousand words. Worth reading once if you use this tool more than occasionally.

Read the full methodology
Your whole stack

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This page checks the pairs you enter. The personalised Distil report goes further:

  • the same graded, cited interaction check across your whole stack, not just the pairs you thought to type in
  • where your current routine may be leaving you short of your goals
  • the evidence-backed compounds worth adding, and the ones worth dropping

It's a paid report: £79, or £49 for the first 25 customers. The interactions check is one section of it, and you can read a real one in full before you buy.

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Distil's interactions database is reviewed and updated every quarter. We grade evidence transparently and publish our methodology, including every database change, at /about/methodology. This tool is information, not a substitute for clinical judgement. If you take medication and supplements together, your GP or pharmacist can review your full regimen against your medical history. If you want a full personalised stack reasoned against this same database, the Distil report is the next step up.