Foods to avoid when taking Sertraline? (5+ drug-food interactions)

In this article, we will discuss foods that should not be taken while being treated with Sertraline, a selective serotonin reuptake inhibitor (SSRI). We will also discuss some tips to ensure the safe and effective use of Sertraline.

What foods to avoid when taking Sertraline?

Some foods and beverages to avoid when taking Sertraline include:

• Grapefruit or grapefruit juice
• Tyramine rich foods
• Caffeinated beverages
• Alcoholic beverages
• Cannabis
• Certain supplements and herbs

Grapefruit or grapefruit juice

Grapefruit or grapefruit juice should be avoided when taking Sertraline, as it can affect how your body handles the medication. Research indicates that grapefruit juice can slow down the breakdown of Sertraline (1). 

One research study indicated that grapefruit juice makes it harder for Sertraline to convert into desmethylsertraline, which is an important step in the metabolism (breakdown) of this antidepressant before it gets eliminated from the body (1). 

This makes Sertraline (the active drug) stay longer in your body, which basically prolongs the mechanism of action for this SSRI. 

This can significantly increase the risk of side effects and the excessive serotonergic activity in the brain can also increase the risk of a rare, but life-threatening condition called serotonin syndrome. So, the use of grapefruit with Sertraline should be avoided (2).

Tyramine-rich foods

It is important to avoid excessive intake of Tyramine-rich foods while taking Sertraline. Tyramine is an amino acid which can trigger the release of serotonin, an excitatory monoamine neurotransmitter. 

Sertraline, being an SSRI, works by increasing the amount of serotonin in the brain. Consuming excessive Tyramine-rich foods while taking Sertraline can result in high serotonergic activity in the brain, which can lead to disturbing complications. Some Tyramine-rich foods include (3):

• Aged cheeses (like cheddar, gouda, parmesan)
• Cured meats (such as salami, pepperoni, and certain sausages)
• Fermented foods (like sauerkraut, kimchi, and soy sauce)
• Smoked or pickled fish (such as smoked salmon or pickled herring)
• Certain beans (like broad beans and fava beans)
• Alcoholic beverages, especially red wine and beer
• Some condiments (like miso paste and shrimp paste)
• Certain overripe or spoiled fruits (like avocados, bananas, and figs)
• Some nuts (such as peanuts and Brazil nuts)
• Yeast extracts (like Marmite or Vegemite)

Caffeinated beverages

It is important to avoid too much caffeine intake while taking Sertraline. Although you can enjoy a cup or two of your favourite coffee, taking excessive amounts can lead to disturbing side effects. 

This can be more challenging for people who are new to Sertraline, as this antidepressant can cause anxiety during the first few weeks of your treatment. Once your body settles in, it gets better. 

Taking excessive caffeine while your body is adjusting to the medication can cause increased anxiety, restlessness, confusion, irritability, and insomnia (4). This is why it’s important to limit your caffeine intake.

Alcoholic beverages

Avoid alcoholic beverages while taking Sertraline. Alcohol and antidepressants have never been a good pair and they will hardly ever be. 

The excessive intake of alcohol with Sertraline can lead to nerve-racking side effects and can significantly affect your battle with depression. 

Alcohol is a CNS depressant and Sertraline works to counteract the effects that alcohol can end up aggravating (1,5). That can not only ruin the effects of Sertraline but can also worsen depression and suicidal behaviour (5).

Cannabis sativa

Cannabis should not be paired with Sertraline. Cannabis is a recreational substance which is associated with side effects of its own (6). Using Cannabis and Sertraline together can be dangerous and can lead to unpredictable effects on your mental health. 

This combination may make you feel more anxious, and paranoid, or even trigger panic attacks (6). It can also affect your coordination and decision-making ability. 

It is also important to note that using both at the same time can increase the risk of additive side effects, as both Sertraline and cannabis can cause dizziness, drowsiness, and problems with memory and concentration (1,6). 

Certain supplements 

Certain supplements, like St. John’s wort, should never be used along with Sertraline. St. John’s wort is also used for its mood-enhancing properties, as it can also affect your brain and excitatory chemicals, including serotonin. 

It is also used for the management of major depressive disorder (MDD) (7). The concomitant use of these two can lead to disturbing consequences and can also increase the risk of serotonin syndrome. 

How to ensure the safe and effective use of Sertraline?

The following points are important to ensure the safe and effective use of Sertraline:

• Always take Sertraline as prescribed by your healthcare provider. Do not change the dose, frequency, or timing without discussing it with your doctor first.
• Avoid foods that can interact with Sertraline.
• Limit the use of alcohol
• If you’re planning any major diet changes or starting a new supplement, discuss it with your healthcare provider.
• Do not start taking any medication with Sertraline without consulting your doctor first.
• It is also important to monitor your side effects properly. If anything concerns you, talk to your provider.
• Sertraline often takes a few weeks to show its full effects. If you don’t see immediate changes, don’t worry. Stick with it, and talk to your doctor if you have concerns.

Conclusion

In this article, we have discussed foods that should not be taken with Sertraline, either at all or excessively. We have also discussed some important points to ensure the safe and effective use of this antidepressant. 

References

1. Singh HK, Saadabadi A. Sertraline. 2023 Feb 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31613469. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547689 

2. Lee AJ, Chan WK, Harralson AF, Buffum J, Bui BC. The effects of grapefruit juice on sertraline metabolism: an in vitro and in vivo study. Clin Ther. 1999 Nov;21(11):1890-9. doi: 10.1016/S0149-2918(00)86737-5. PMID: 10890261. https://pubmed.ncbi.nlm.nih.gov/10890261/

3. Kiani J, Imam SZ. Medicinal importance of grapefruit juice and its interaction with various drugs. Nutr J. 2007 Oct 30;6:33. doi: 10.1186/1475-2891-6-33. PMID: 17971226; PMCID: PMC2147024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2147024/ 

4. Broderick P, Benjamin AB. Caffeine and psychiatric symptoms: a review. J Okla State Med Assoc. 2004 Dec;97(12):538-42. PMID: 15732884. https://pubmed.ncbi.nlm.nih.gov/15732884/ 

5. Boden JM, Fergusson DM. Alcohol and depression. Addiction. 2011 May;106(5):906-14. doi: 10.1111/j.1360-0443.2010.03351.x. Epub 2011 Mar 7. PMID: 21382111. https://pubmed.ncbi.nlm.nih.gov/21382111/ 

6. Karila L, Roux P, Rolland B, Benyamina A, Reynaud M, Aubin HJ, Lançon C. Acute and long-term effects of cannabis use: a review. Curr Pharm Des. 2014;20(25):4112-8. doi: 10.2174/13816128113199990620. PMID: 24001294. https://pubmed.ncbi.nlm.nih.gov/24001294/ 

7. Hypericum Depression Trial Study Group; Davidson JR, Gadde KM, Fairbank JA, Krishnan KRR, Califf RM, Binanay C, Parker CB, Pugh N, Hartwell TD, Vitiello B, Ritz L, Severe J, Cole JO, de Battista C, Doraiswamy PM, Feighner JP, Keck P, Kelsey J, Lin KM, Londborg PD, Nemeroff CB, Schatzberg AF, Sheehan DV, Srivastava RK, Taylor L, Trivedi MH, Weisler RH. Effect of Hypericum perforatum (St John’s wort) in major depressive disorder: a randomized controlled trial. JAMA. 2002 Apr 10;287(14):1807-14. doi: 10.1001/jama.287.14.1807. PMID: 11939866. https://pubmed.ncbi.nlm.nih.gov/11939866/