What to Avoid with Psychiatric Medications

Psychiatric medications work to influence mood and thoughts by balancing chemicals in the brain. Like all medications, there is potential for interactions with foods, prescribed medications, and over the counter medications. This can lead to changes in these brain chemicals. A few of these interactions are discussed below because they may negatively impact mental health and should be avoided with psychiatric medications.

Alcohol

Consuming alcohol changes chemicals in the brain, which can impact mood. Alcohol can affect personal relationships and sleep, as well as increase risk for depression, anxiety, and suicide. It is important to be aware of reasons for drinking, and remember that alcohol will not make unhappy feelings go away. Drinking to manage stress can be unsafe, and other healthy activities, such as exercise or meditation, are more helpful.

It may also be dangerous to consume alcohol with certain medications used for depression and anxiety.3 For example, taking certain anti-anxiety medications (such as benzodiazepines) or pain medications (like opioids/opiates) with alcohol, can slow down breathing significantly.3 Pharmacists can be a great resource to help identify problems between alcohol and other medications.

Marijuana

Marijuana is the most commonly used illicit drug in the United States and has grown in popularity in recent years. While many believe marijuana is safe, there are health risks associated with its use. The combination of marijuana and psychiatric medications can cause depression and anxiety to worsen, especially with long term use.5 These effects may even last for days and weeks after stopping marijuana.

It is also important to know that marijuana has become more potent over the last decade, which is why even short-term use can cause hallucinations, feelings of paranoia, and anxiousness. It may also interfere with focus and memory.5 Marijuana has also been known to be laced, or mixed, with other substances that can also cause hallucinations, paranoia, and anxiety.6,7
 

Herbal Supplements

Herbal supplements are not regulated by the FDA, and some studies have shown varying results about the purity of some products. Individuals should talk to their physician or pharmacist before using any herbal supplement. It is important to know that taking a supplement should never replace or delay seeking help from a health care provider.

St. John’s wort is a common herbal supplement used in the United States for depression, although the appropriate use of this over the counter supplement remains an issue. St. John’s wort can interact with many medications, including birth control and blood thinners. The combination of St. John’s Wort with antidepressants can cause serotonin toxicity which includes symptoms ranging from mild (shivering and diarrhea) to severe (muscle rigidity, fever and seizures). Another common herbal supplement is valerian root. There is not enough information to prove valerian root is an effective option for anxiety or sleep. While most people do not experience side effects from valerian root, it should still be used carefully with other medications that cause sleepiness or drowsiness.

Dietary Issues

Maintaining a balanced diet is an important part of any healthy lifestyle, but it can also impact medications. Some individuals taking an older group of antidepressants known as monoamine oxidase inhibitors (MAOIs) should be careful when eating foods with tyramine.10 Tyramine is commonly found in aged meats, cheeses, and beer.10 If taken together, it may cause an unsafe rise in blood pressure.10 Sometimes food can change how a medication works. It is important to know if a medication should be taken with food or on an empty stomach. For example, individuals taking asenapine (Saphris®) should not eat or drink for 10 minutes after taking their medication11, while alternatively individuals taking lurasidone (Latuda®) or Ziprasidone (Geodon®) must have a certain amount of calories in order for the medications to work properly. Finally, if a person is taking lithium, it is important to avoid major changes in intake of liquids, salt, and caffeine. Excessive thirst or significant urination while taking lithium should be reported to a health care provider.12

Communication is Key

When starting a new medication, it is always important to share this information with your physician and pharmacist. While it may be safe with one medication, other medications may become toxic or less effective. Your pharmacist can provide more information regarding potentially harmful combinations and how to manage them. For example, did you know these combinations could be dangerous if not carefully managed?

  • Lithium with NSAIDs (ibuprofen, naproxen) or certain blood pressure medications (lisinopril, furosemide)
  • Clozapine with cigarette smoking
  • Benzodiazepine anti-anxiety medications (alprazolam, lorazepam) with opioid pain medications (hydrocodone, oxycodone, morphine)
  • Antacids with certain antipsychotics (chlorpromazine, fluphenazine)


 

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©2021 The College of Psychiatric and Neurologic Pharmacists (CPNP). Emily Selby, PharmD, MBA, March 2019

This information is being provided as a community outreach effort of the College of Psychiatric and Neurologic Pharmacists. This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the topic. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein. The College of Psychiatric and Neurologic Pharmacists disclaims any and all liability alleged as a result of the information provided herein. CPNP makes this document available under the Creative Commons Attribution-No Derivatives 4.0 International License. Last Updated: January 2016.​

To view the references for this resource, please visit cpnp.org/373510.