Can You Take Ashwagandha With Sertraline or Antidepressants?

No study has measured what ashwagandha does to blood levels of sertraline or any other antidepressant. Two small 6-week trials added it to an SSRI, in 40 people with anxiety and 30 with obsessive-compulsive disorder, and reported no adverse effects; adverse-event reports name it with sertraline and three other antidepressants. Tell your prescriber or pharmacist first, and never stop an antidepressant to take it.^{1, 2, 3} Part of the Wellgard ashwagandha guide.

Evidence at a glance

• Trials: two randomised placebo-controlled trials added ashwagandha to an SSRI, in 40 adults with generalised anxiety disorder and 30 with obsessive-compulsive disorder, 6 weeks each.^{1, 2}
• Largest single study: a Polish review of 1,816 adverse-event reports, four of which named ashwagandha with an antidepressant.³
• Strongest measured outcome: anxiety scores fell 14 points against 8 on placebo in the 40-person trial.¹
• Not tested: blood levels of any antidepressant taken with ashwagandha, or the risk of serotonin syndrome in people.

Sources checked on 13 October 2026.

Can you take ashwagandha with sertraline?

Only after your prescriber or pharmacist has heard about it, because no study has measured whether ashwagandha changes how much sertraline reaches the blood. The two SSRI trials did not name the medicine. In 40 adults with generalised anxiety disorder, 22 took root extract and 18 placebo for 6 weeks, with no adverse effect observed; in 30 adults with obsessive-compulsive disorder, 15 in each group, no adverse event was reported.^{1, 2} Both come from one research group in Mashhad, Iran, and their funding statements could not be checked.

Against that, a review of 1,816 adverse-event reports sent to a Polish drug-safety centre between January 2021 and November 2022 judged 30 to be probably caused by an adaptogen taken with an antidepressant. One was severe diarrhoea needing hospital care in a 36-year-old man taking ashwagandha with sertraline and doxylamine, an antihistamine.³ Reports like this cannot show cause, and nobody counts the people who took the pair without trouble.

The NHS sertraline page says not to use St John's wort and to tell your doctor about "any other medicines, herbal remedies, vitamins or supplements".⁴ The caution is about combining a supplement with a medicine, not about ashwagandha on its own.

What about citalopram, escitalopram, fluoxetine and mirtazapine?

The NHS pages for all four carry the sertraline instruction: no St John's wort, and tell your doctor about herbal remedies and supplements before you start.^{5, 6, 7, 8} None names ashwagandha. In the Polish reports it appeared with escitalopram (muscle pain, stomach pain, nausea, vomiting, restless legs and a severe cough), with paroxetine (muscle and eye pain, raised eye pressure) and with reboxetine (testicular pain).³ No report in that review and no trial names citalopram, fluoxetine or mirtazapine with ashwagandha.

Mirtazapine is usually taken at bedtime because "it can make you sleepy".⁸ The Polish review lists drowsiness among ashwagandha's reported side effects,³ and the French food-safety agency, ANSES, advised in April 2024 that people on medicines that depress the central nervous system should not take it. With a sedating antidepressant, ask the pharmacist about the two together; sleep supplements with antidepressants works through the same question for valerian, theanine and the other sleep ingredients.

Does ashwagandha affect serotonin?

In blood, on average, yes; in the human brain, nobody has measured it. Pooled across 23 placebo-controlled trials in 1,706 adults, circulating serotonin was 31.75 ng/mL higher with ashwagandha than with placebo, with heterogeneity the authors flag.⁹ In one supplier-run trial of 70 adults with mild to moderate depression and anxiety, serum serotonin rose over 90 days on root extract with piperine and fell on placebo.¹⁰ SSRIs also act on serotonin, which is why the overlap is a question for the prescriber.

In the laboratory, four root and leaf extracts did not inhibit any of seven liver enzymes that regulators recommend testing for drug interactions; that is reassuring but is not a study in people.¹¹ A 2026 review, citing older work, says extracts may inhibit two of them, and lists serotonin syndrome among the risks of herbal products for mood and sleep in general.¹² A PubMed search on 13 October 2026 found no published case of serotonin syndrome attributed to ashwagandha. Mood, memory and how it feels: what ashwagandha does for the brain.

Can ashwagandha replace an antidepressant?

No. It is not an alternative to a prescribed antidepressant, and no trial has tested it as one. A 2025 pooling of 14 trials in 713 people with diagnosed mental disorders found lower depression scores than with comparators across five trials, but the result did not hold in the review's second, Bayesian analysis, and the authors graded it very low certainty; the anxiety result held, at low certainty.¹³ The NHS is plain: "Do not stop taking an antidepressant suddenly or without talking to your doctor first."¹⁴ Low mood that lasts goes to a GP, and in England you can refer yourself to NHS talking therapies for anxiety and depression without seeing a GP.¹⁵

What should you tell your prescriber or pharmacist?

Three things. The product, with the milligrams of extract on its label. Every other supplement you take: the NHS herbal-medicines page lists antidepressants among the medicines that do not mix well with herbal medicines, and says to check with a pharmacist first.¹⁶ And any change after starting, such as new flatness, agitation, diarrhoea, drowsiness or a change in sleep; the side effects of ashwagandha lists what trials recorded.

The NHS sertraline page lists serotonin syndrome as a rare but serious side effect, with a fast heartbeat, sweating, shaking, twitching muscles and feeling confused or agitated. For a serious side effect it says to call NHS 111, and 999 for a swollen throat or tongue or difficulty breathing; side effects can be reported to the Yellow Card scheme.⁴ Thyroid medicine is a separate question: ashwagandha with levothyroxine.

Can you take magnesium, vitamin D or other supplements with sertraline?

The NHS sertraline page names one supplement not to use, St John's wort; for everything else, magnesium, vitamin D and turmeric included, it asks you to tell your doctor before you start.⁴ This page adds no verdict of its own on those. Ashwagandha with magnesium and other supplements, with no medicine involved, is covered in what you can take with ashwagandha.

What we don't know

• No study has measured blood levels of sertraline or any other antidepressant taken with ashwagandha.
• No trial has given ashwagandha to people with depression who take an antidepressant; the two SSRI trials enrolled people with anxiety or obsessive-compulsive disorder.
• No trial has tested ashwagandha with mirtazapine, an SNRI or a tricyclic antidepressant.
• No adverse-event study has counted how often a problem occurs among people who take the pair.

Frequently asked questions

Does ashwagandha have antidepressant effects?

Depression scores fell more than with comparators across five trials in the 2025 review, but the finding did not survive its second analysis and was graded very low certainty.¹³ One supplier-run trial of 70 adults reported lower depression and anxiety scores over 90 days.¹⁰ Ashwagandha has no authorised health claim in Great Britain.

Should people with depression take ashwagandha?

Speak to the GP first. If you take an antidepressant, the prescriber hears about it before the first dose; if you do not, low mood that lasts is a reason to see a GP, and NHS talking therapies accept self-referrals in England.¹⁵ No trial has tested ashwagandha in people with depression who take an antidepressant.

Can ashwagandha cause serotonin syndrome?

No study has measured the risk, and a PubMed search on 13 October 2026 found no published case; its one hit, a 2026 review, lists serotonin syndrome as a general risk of herbal products for mood and sleep.¹² The NHS lists it as a rare but serious side effect of SSRIs themselves, and says to call 111 if you think you have a serious side effect.⁴

What medication should not be taken with ashwagandha?

The NHS has no page on ashwagandha. Its herbal-medicines page lists statins, antidepressants, diabetes and blood-pressure medicines, blood thinners and hormonal contraception among medicines that do not mix well with herbal medicines.¹⁶ Sedatives and thyroid medicine are the other two to raise; who should not take ashwagandha has the full table.

Sources

1. Fuladi et al., 2021. Randomised trial, 40 adults with generalised anxiety disorder on SSRIs, 6 weeks; no industry authors listed, funding not checked. PubMed 32282308.
2. Jahanbakhsh et al., 2016. Randomised trial, 30 adults with obsessive-compulsive disorder on SSRIs, 6 weeks; no industry authors listed, funding not checked. PubMed 27515872.
3. Siwek et al., 2023. Retrospective review of 1,816 adverse-event reports, Poland, 2021 to 2022; case details from the full text; one author at a drug-safety consultancy. PubMed 37829299.
4. NHS. Sertraline. Page last reviewed 8 September 2025. nhs.uk.
5. NHS. Citalopram. Page last reviewed 26 June 2026. nhs.uk.
6. NHS. Escitalopram. Page last reviewed 18 June 2026. nhs.uk.
7. NHS. Fluoxetine. Page last reviewed 1 June 2026. nhs.uk.
8. NHS. Mirtazapine. Page last reviewed 18 August 2026. nhs.uk.
9. Fornalik et al., 2026. Pooled analysis, 23 randomised trials, 1,706 adults; no conflicts declared. PubMed 41740946.
10. Majeed et al., 2024. Randomised trial, 70 adults, 90 days; supplier-run. PubMed 37878284.
11. Raichura et al., 2025. Laboratory enzyme study, four root and leaf extracts; no conflicts declared. PubMed 40023576.
12. Căuș et al., 2026. Narrative review of herbal products for anxiety, depression and sleep; no conflicts declared. PubMed 41901246.
13. Marchi et al., 2025. Pooled analysis, 14 randomised trials, 713 people with mental disorders; outcome trial counts from the full text; no funding or conflicts declared. PubMed 41140145.
14. NHS. Antidepressants. Page last reviewed 12 June 2025. nhs.uk.
15. NHS. Talking therapies. Page last reviewed 5 November 2025. nhs.uk.
16. NHS. Herbal medicines and complementary therapies. Page last reviewed 1 May 2026. nhs.uk.

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