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Can You Take Ashwagandha and Escitalopram Together?

A 2025 American Academy of Neurology conference abstract reported a single case of serotonin syndrome in a person taking escitalopram who consumed high-dose ashwagandha.

Use cautionEvidence: Low

See the full Ashwagandha page and Escitalopram page for other reviewed interactions and reference information.

What the interaction means

A conference abstract presented at the American Academy of Neurology's 2025 annual meeting (Hanly-Jorda et al., "Serotonin Syndrome Induced by the Pharmacological Interaction of Withania Somnifera and Escitalopram," published in the Neurology annual-meeting abstract supplement, DOI 10.1212/WNL.0000000000210450) describes a single case: a 22-year-old woman on escitalopram (Lexapro) 10 mg/day for two years who, two days after consuming high-dose ashwagandha (a 600 mg pill plus 1,520 mg as tea), developed serotonin syndrome: "limb myoclonus, eyelid flutter, tachycardia, pyrexia, emesis, mydriasis, and cardiac arrhythmia." She recovered after stopping ashwagandha and receiving benzodiazepines and supportive care. Neurology's own published disclaimer for these annual-meeting abstracts states they "were not reviewed by Neurology and do not reflect the views of Neurology editors or staff" -- this is not a peer-reviewed journal article. NCCIH's ashwagandha fact sheet separately documents ashwagandha's sedative effects but does not name SSRIs/antidepressants as an interacting class, and escitalopram's own FDA label does not name ashwagandha.

Why it may happen

Not established with certainty by the abstract; the authors note ashwagandha's own reported sedative and GABAergic activity, and speculate about withanolide-mediated effects and individual variability in drug metabolism as possible contributors, alongside escitalopram's own serotonergic activity as an SSRI.

Practical context

This is a single reported case, presented as a conference abstract that was not peer-reviewed by Neurology's editors or staff -- not a controlled study, not a class-level regulatory statement, and not enough to establish how often this occurs or to confirm ashwagandha caused it. It is rated evidenceQuality "low" for exactly these reasons, even though it names escitalopram directly (a more specific lead than a similar unconfirmed report investigated elsewhere in this catalog involving a different SSRI, sertraline, which was deliberately not authored as a finding because the only available report named escitalopram, not sertraline). This finding is specific to escitalopram in this one case and should not be extrapolated to other SSRIs. Anyone taking escitalopram who is considering ashwagandha, especially at higher doses, should discuss it with their prescriber and be aware of serotonin syndrome symptoms (agitation, rapid heart rate, high fever, muscle twitching, sweating, tremor) as a rare but serious possibility.

What the sources say

Serotonin Syndrome Induced by the Pharmacological Interaction of Withania Somnifera and Escitalopram: A Case Report — American Academy of Neurology (abstract P12-2.009); published in Neurology, Vol. 104, Issue 7_Supplement_1Ashwagandha — National Center for Complementary and Integrative Health (NIH)Escitalopram Oxalate Tablets — FDA Prescribing Information — Legacy Pharmaceutical Packaging, LLC / Cipla Ltd. (via DailyMed, U.S. National Library of Medicine)

Last reviewed 2026-08-24

Medical information disclaimer: this information is general and educational. It does not diagnose conditions, prescribe treatment, or determine whether a combination is safe for you personally. Follow your prescription label and ask a pharmacist or clinician before starting, stopping, or combining products. Full disclaimer.

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