Prescription medication can be essential for some people living with depression, anxiety or another mental health condition. But can you mix sources of caffeine — like coffee or energy drinks — and antidepressants or anti-anxiety meds?
"With modest doses of caffeine, most people don't experience any difficulty with their antidepressants," says Timothy B. Sullivan, MD, psychiatrist and chair of Psychiatry and Behavioral Sciences at Northwell Health's Staten Island University Hospital in New York City. "So if you're on antidepressants and drinking one or two cups of coffee a day, I don't typically recommend cutting back."
This holds true for people taking the most commonly prescribed class of mental health medication, called selective serotonin reuptake inhibitors, or SSRIs, Dr. Sullivan says.
It's important to note, however, that energy drinks or caffeine can increase the risk of experiencing anxiety, and even panic episodes. Plus, a high caffeine intake — more than a couple of cups of coffee a day — when taking any antidepressant or anti-anxiety med can increase your risk of a problem in general.
High Caffeine Intake and SSRIs
Research shows that people living with mental health conditions tend to consume more caffeine to begin with, and having depression or anxiety can make you more sensitive to its jittery effects. Other research shows that excessive coffee consumption can trigger serotonin syndrome.
Serotonin syndrome is when too much serotonin floods your brain at once, according to the National Library of Medicine (NLM). It can also happen if you take an SSRI and a triptan, a migraine medication, at the same time. And this serotonin and caffeine interaction can prompt anxiety, confusion, insomnia, restlessness, tremors, and muscle problems.
To avoid this and any other potential side effects, here's an overview how caffeine and antidepressants or anti-anxiety meds mix, broken down by the type of medication.
The potential for serotonin syndrome is heightened when mixing energy drinks and antidepressants or anti-anxiety meds. "People down them as if they're water, and they contain a lot of caffeine," Sullivan says.
Luvox (Fluvoxamine)
Caffeine does affect some antidepressants — there's concern about one SSRI in particular, Luvox (fluvoxamine), which is primarily used to treat an anxiety disorder called obsessive-compulsive disorder, or OCD.
According to Laura J. Fochtmann, MD, professor in the departments of Psychiatry, Pharmacological Sciences and Biomedical Informatics with the School of Medicine at Stony Brook University in Stony Brook, New York, and a medical editor with the American Psychiatric Association, Luvox cuts caffeine metabolism, so more caffeine stays in your system.
That can send both medication and caffeine levels out of whack, Dr. Fochtmann says.
The result is "a significant risk for jitteriness, wakefulness, a rapid heartbeat, insomnia and high blood pressure," Sullivan says.
Zoloft (Sertraline)
Zoloft (sertraline) is an SSRI used to treat depression, along with OCD, panic disorder, premenstrual dysphoric disorder, post-traumatic stress disorder and anxiety disorders, according to Mayo Clinic.
But can you drink coffee with Zoloft, and are there any risks to taking sertraline and caffeine at the same time? Sullivan says that when it comes to Zoloft and caffeine, modest doses of the stimulant shouldn't cause any side effects.
However, if you're drinking large doses of caffeine with Zoloft, it's possible you may experience a Zoloft and coffee interaction like the serotonin syndrome described above.
As a result, your best bet for combining Zoloft and coffee is to stay under the 400 milligram limit of caffeine a day, recommended by the U.S. Food and Drug Administration (FDA), to avoid any sertraline and coffee issues.
Lexapro (Escitalopram)
Lexapro (escitalopram) is another SSRI used to treat depression. But can you drink coffee or anything else with caffeine while on Lexapro?
Like many other SSRIs, it's typically fine to combine Lexapro and caffeine, as long as you stick to lower doses, Sullivan says.
You may notice, though, that Lexapro helps you feel more energized, not unlike the jolt you can get from caffeine.
This Lexapro energy boost, however, is likely due to the medication's effects against depression — depression can cause lethargy, so you may notice improved energy levels a week or two after starting Lexapro, according to the National Alliance on Mental Illness (NAMI).
Although having a cup of coffee and Lexapro shouldn't be cause for concern, other sources of caffeine can contain higher doses of the stimulant. For instance, mixing Lexapro and energy drinks (rather than Lexapro and coffee) may overload you with caffeine and could lead to complications like serotonin syndrome.
Celexa (Citalopram)
Celexa (citalopram) is another common SSRI used to treat symptoms of depression. There are no reported interactions between Celexa and caffeine, meaning you can likely safely take citalopram and caffeine together as long as you stick to appropriate doses of each.
Citalopram can, however, potentially affect heart rhythm, which is something to keep in mind before consuming caffeine.
Just make sure to avoid alcoholic beverages — you can't drink on citalopram, as the combination of medication and alcohol may cause unexpected side effects, according to Mayo Clinic.
Like Lexapro, you may notice that you have extra energy after starting Celexa. According to the NAMI, this is likely because the medication is taking effect against symptoms of depression like fatigue and lethargy.
Prozac (Fluoxetine)
Another common SSRI antidepressant is Prozac (fluoxetine), which is used to treat depression, OCD, eating disorders, premenstrual dysphoric disorder, and panic attacks, according to the NLM.
Like most other SSRIs, taking fluoxetine and caffeine together shouldn't pose any issues — if you want to enjoy a cup of coffee with Prozac, that should be fine, Sullivan says, as there isn't evidence of any significant Prozac and coffee or caffeine interactions.
If you're combining Prozac and coffee or caffeine, sticking to modest doses of the stimulant will help you avoid complications like serotonin syndrome.
Effexor (Venlafaxine)
Serotonin and norepinephrine reuptake inhibitors, or SNRIs, are another common class of antidepressants. And there are also some SNRI and caffeine considerations to keep in mind.
The SNRI Effexor (venlafaxine), used to treat major depressive disorder and generalized anxiety disorder, can have side effects such as insomnia, nervousness, and restlessness, according to NAMI.
Mixing Effexor and caffeine may worsen these issues, NAMI notes.
You can drink small amounts of coffee while taking venlafaxine, Sullivan says — she just recommends being aware of the potential complications so that you can cut back on caffeine if any side effects occur.
Wellbutrin (Bupropion)
Similarly, side effects like insomnia, anxiety, excitement, and uncontrollable shaking are linked to Wellbutrin (bupropion), which is in a unique class of antidepressants, according to the NLM.
This doesn't mean you have to rule out caffeine with these antidepressants, though. You can take steps to minimize side effects that may occur when combining Wellbutrin and caffeine.
"When I'm activating antidepressants like Effexor or Wellbutrin, I talk about sleep issues, about the need to generally take these meds in the morning and concerns about possible interactions with caffeine," Sullivan says.
Because a person’s reaction to a drug is unpredictable, Sullivan generally doesn’t tell her patients in advance to cut back on caffeine. She advises it when side effects occur.
But it's important to be on the alert for them and to note how you feel when you drink or eat caffeine-rich beverages and foods, and remember that modest amounts of caffeine should be fine, Sullivan says.
Cymbalta (Duloxetine)
Cymbalta (duloxetine) belongs to a class of medicines called selective serotonin and norepinephrine reuptake inhibitors (SSNRIs), according to Mayo Clinic. It's used to treat depression and anxiety, along with other conditions like fibromyalgia and diabetes-related nerve damage.
Though this type of medication can increase the activity of brain chemicals like serotonin and norepinephrine, Cymbalta is not a stimulant that produces a jolt of energy in the same way caffeine does.
Typically, you can drink coffee while taking Cymbalta without any side effects, as there are no reported interactions between duloxetine and caffeine.
But if you do combine Cymbalta and caffeine or coffee, just make sure to stick to lower doses of the stimulant in order to avoid Cymbalta interactions like serotonin syndrome, Sullivan says.
Caffeine and SSRI Withdrawal
Some people experience symptoms when they stop taking antidepressants, a condition called antidepressant discontinuation syndrome, according to Harvard Health Publishing. It can cause symptoms like:
- Anxiety
- Depression
- Dizziness
- Flu-like symptoms
And caffeine may compound some of these symptoms due to its jittery effects, which may provoke further anxiety, according to Mayo Clinic. In other words, it may be best to skip the coffee until your withdrawal period is over.
At the same time, people who drink significant amounts of caffeine and then abruptly stop can also experience withdrawal syndrome categorized by jitteriness and headache.
