The short answer
Not known for SSRIs. We found no study that tested brahmi (Bacopa monnieri) with escitalopram, fluoxetine, sertraline or an anti-anxiety medicine. In lab tests, a standardised brahmi extract slowed several liver enzymes that clear medicines. That is a possible route for an interaction, not a measured one.
A 2023 review of adverse-event reports describes two people who took Bacopa with other antidepressants: a woman on agomelatine who had back pain and heavy sweating, and a man on moclobemide who had a heart attack. Both took other medicines too, so Bacopa may not be the cause. Tell your prescribing doctor before you start brahmi with any of these medicines.
Escitalopram is sold in India as Nexito, fluoxetine as Fludac, and buspirone as Buspin.
At a glance
| What was seen | How it may work | Direction | Evidence |
|---|---|---|---|
| Back pain and sweating with agomelatine; heart attack with moclobemide[1] | Not established; other medicines were also taken | Two adverse events, neither with an SSRI | Case report |
| Extract slowed CYP2C19, CYP2C9, CYP1A2 and CYP3A4[2] | Enzyme inhibition by the whole extract; purified bacosides had little effect | Could raise levels of drugs these enzymes clear | In vitro |
No listing is not a clearance. A missing interaction here never means a combination is safe.
The evidence, study by study
Review of adverse-event reports, 2023 Case report
Researchers went through 1,816 adverse-event reports and picked out 30 in which an adaptogen herb was taken with an antidepressant. Two involved Bacopa. A 42-year-old woman taking agomelatine had back pain and heavy sweating, and a 39-year-old man taking moclobemide had a myocardial infarction (heart attack). Neither drug is an SSRI, both people were on other medicines, and the reports give no drug levels.[1]
Laboratory study, 2014 In vitro
Human liver enzymes made in the lab were exposed to a standardised Bacopa extract. The whole extract slowed CYP2C19, CYP2C9, CYP1A2 and CYP3A4, while the purified bacosides had almost no effect. Lab findings like this show a possible route for an interaction. They do not show that one happens in people.[2]
What your doctor may watch for
- New agitation, sweating, tremor or confusion, or any other new symptom after starting brahmi. The escitalopram label warns that it and some other medicines can affect each other and cause serious side effects.[3]
What to tell your prescribing doctor
You can read this out, or show them this page:
“I am taking, or planning to take, brahmi (name of product, the Latin name on the pack, dose) along with my antidepressant or anxiety medicine. It has not been studied with SSRIs, and in lab tests it slowed enzymes that clear some medicines. Is this combination a concern for me, and what should I report?”
Withheld until review
Questions people ask
Related
Brahmi and sedatives or sleeping pills
Not tested in people. In lab tests brahmi slowed enzymes that clear some sedatives, so the effect on drowsiness is unknown.
InteractionAshwagandha and antidepressants (SSRIs, SNRIs)
Doctors in Poland reported side effects they judged were caused by ashwagandha with sertraline, escitalopram or paroxetine.
ConditionAnxiety and sleep problems: what Ayurveda offers
Ashwagandha extracts improved sleep a little and lowered stress scores in short trials. They were not trials in diagnosed anxiety disorder.
InteractionBrahmi and epilepsy medicines
Not tested in people. In rats, a brahmi extract raised carbamazepine levels about fourfold, and carbamazepine and phenytoin have a narrow safe range.
Sources
- Siwek M, Woroń J, Wrzosek A, Gupało J, Chrobak AA. Harder, better, faster, stronger? Retrospective chart review of adverse events of interactions between adaptogens and antidepressant drugs. Front Pharmacol. 2023;14:1271776. PMID 37829299.
- Ramasamy S, Kiew LV, Chung LY. Inhibition of human cytochrome P450 enzymes by Bacopa monnieri standardized extract and constituents. Molecules. 2014;19:2588-2601. PMID 24566323.
- Escitalopram oxalate oral solution, US prescribing information (DailyMed, Aurobindo Pharma).
- Walker EA, Pellegrini MV. Bacopa monnieri. StatPearls. Updated 17 March 2023.
- LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bacopa monnieri. Updated 24 April 2024.
Updated 4 November 2026
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