Can You Combine Ashwagandha and Lexapro?

Ashwagandha has become a herbal supplement hit in recent years, its indications expanding beyond enhancing wellness to treating mental health problems. However, not much is known about how ashwagandha works throughout the body. In this article, we will cover the research on how ashwagandha interacts with Lexapro, also known as escitalopram, a common SSRI antidepressant. What are the common indications of ashwagandha and lexapro and is combining ashwagandha and Lexapro safe? Could ashwagandha replace lexapro prescriptions? Read on to find out.
Klara Hatinova

Klara Hatinova

Klara is postgraduate researcher in experimental psychology at the
University of Oxford.

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Do Ashwagandha and Lexapro interact?

There isn’t yet sufficient evidence to determine exactly whether Ashwagandha and Zoloft pharmacologically interact. However, based on the available information - Ashwagandha can interact with antidepressant drugs, including Lexapro. In particular, there is a slight risk of a condition called serotonin syndrome.

How Does Ashwagandha Work?

Ashwagandha is a popular herb containing Withaferin A with benefits across a spectrum of health conditions and biological functions [1]. Scientifically known as Withania somnifera, ashwagandha can modulate the body's stress response through its adaptogenic properties. These effects attract the attention of the health-conscious community as a supplement to help balance stress hormone levels and reduce anxiety [2, 3].

Ashwagandha can modulate neurotransmitters, such as serotonin and GABA, contributing to improved mood and relaxation. This modulation of neurotransmitters can have a positive impact on mental health symptoms such as anxiety, low mood, stress, sleep and Obsessive-compulsive disorder (OCD) [4, 5, 6].

Ashwagandha reduces inflammation, modulates the immune system and has antioxidant properties that improve health across a spectrum of systems. For example, anti-inflammatory and antioxidant properties can protect against neurodegenerative conditions, cancer and Polycystic ovarian syndrome [5].

Ashwagandha extracts can contain up to 35 unique chemicals, including steroidal alkaloids and lactones, which contribute to its therapeutic and adaptogenic effects [6]. The specific way that Ashwagandha achieves its broad-spectrum benefits is still under investigation, and we currently only have a small number of studies [5].

How Does Lexapro Work?

Lexapro specifically belongs to a group of antidepressants called selective serotonin reuptake inhibitors (SSRIs). This means that Lexapro improves mood by increasing serotonin levels, a critical regulator of mood, appetite, and alertness, in your brain. SSRIs achieve this by blocking serotonin's reuptake (re-absorption) and increasing the amount of free serotonin in the brain. Due to the role of serotonin in the brain, increasing serotonin can improve mood and reduce anxiety [7].

It's worth noting that Lexapro doesn't cure depression, but it can help manage the symptoms.

On top of other antidepressants, Lexapro can act as an allosteric modulator of serotonin reuptake, which makes it better tolerated than other SSRIs [7].

Lexapro

Lexapro is a Selective Serotonin Reuptake Inhibitor antidepressant

What are Ashwagandha and Lexapro Used for?

Lexapro is a synthetic prescription SSRI that is approved by the FDA for the treatment of depression and anxiety. Off-label, Lexapro is also used for OCD, panic disorder, premenstrual dysphoria and vasomotor symptoms of menopause [8, 9, 10].

Ashwagandha has been an essential herb in Ayurveda, a form of traditional Indian medicine, for thousands of years. Ashwagandha has primarily been used to reduce stress and anxiety, improve energy, reduce fatigue, ease pain, and decrease inflammation [5].

Nonetheless, as an herbal supplement, Ashwagandha is not regulated by the FDA, and its therapeutic profile and side effects have not been studied in a controlled and systematic way [11].

Despite not being FDA-approved, Ashwagandha can improve mood and moderate anxiety, similar to the effects of Lexapro [12].

Ashwagandha reduces inflammation, which may have antidepressant properties, as well as helps to calm the nervous system and relieve stress and anxiety. Moreover, ashwagandha improves sleep and brain function, which are common symptoms of depression.

Both Lexapro and ashwagandha have been investigated as treatments for OCD, but neither has demonstrated significant improvements.

Can Ashwagandha Replace Lexapro?

Ashwagandha is unlikely to be as effective as Lexapro in improving mood and treating depression. Therefore, you should consult a healthcare professional if you feel like you may have depression and not self-medicate with ashwagandha.

Do Ashwagandha and Zoloft Interact?

There isn’t yet sufficient evidence to determine exactly whether Ashwagandha and Zoloft pharmacologically interact [13]. However, based on the available information - Ashwagandha can interact with antidepressant drugs, including Lexapro.

The most significant risk when combining Lexapro with other drugs, especially those that affect serotonin, is Serotonin syndrome. Serotonin syndrome occurs when there is too much serotonin in the brain. This is why doctors avoid prescribing more than one SSRI unless your depression is severe.

As the therapeutic actions of Ashwagandha are not fully clear, there is a small risk that ashwagandha and Lexapro taken concurrently increase the risks of serotonin syndrome.

Empirically, only one study looked at the tolerability of ashwagandha and SSRIs, such as Lexapro. Specifically, this study from 2023 compared taking adaptogens like ashwagandha with SSRI to taking over-the-counter medications, for example, aspirin, with SSRIs. The team found that there was a small risk of gastrointestinal side effects such as nausea, vomiting and epigastric pain, as well as increased coughing and restless leg syndrome (a type of dyskinesia) [14, 15].

This highlights how important it is to carefully consider taking herbal supplements when also taking prescription drugs. Ensure you report all supplements and medications you are taking or intend to take to your medical professional.

Summary: Weighing the Pros and Cons of Ashwagandha and Lexapro Together

To summarise, there is good evidence to support the stress-relieving benefits of ashwagandha and even preliminary evidence to indicate it can be used for depression and anxiety.

As an herbal supplement, Ashwagandha is not an FDA-approved treatment for these conditions and may not provide sufficient symptom relief. There is not sufficient evidence to advise for or against combining ashwagandha and Lexapro – in general, there is an increased risk of gastrointestinal side effects and even serotonin syndrome.

Given the potential for interactions, it's always a good idea to consult a healthcare professional before combining Ashwagandha with Zoloft or any other medication. Likewise, if you experience symptoms of anxiety or depression, see a healthcare professional and do not self-medicate with ashwagandha.

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Klara Hatinova

Klara Hatinova

Klara is a postgraduate researcher in experimental psychology at the University of Oxford. She has worked across a spectrum of hot topics in neuroscience, including her current project measuring reinforcement learning strategies in Parkinson’s disease. Previously, she studied the efficacy of psilocybin as a therapy for critical mental health conditions and examined molecular circadian rhythms of migraine disorders. She completed her undergraduate degree in Neuroscience at the University of Glasgow and participated in a year abroad at the University of California, where she worked on a clinical trial for spinal cord injury.