Wait Hold Up - Being On An SSRI Means You Should Never Have Citrus Again? I Knew About Grapefruit But

wait hold up - being on an SSRI means you should never have citrus again? I knew about grapefruit but i figured that was because grapefruit can be fucking weird (my late grandpa had arythmia and some other issues as well as being a stroke survivor, one of the meds he ended up on had the no consuming grapefruit thing). I'm off the SSRI i was on, have been for a year or so. Should I not be drinking my lavender earl gray calm-the-fuck-down tea?! -shocked and sad noises-

Okay, clarifying, since I actually did an entire thesis paper on this for neurobiology/neuropsychology. This is the section specifically about bergamottin, which is the culprit that creates the grapefruit effect. That means bergamot oranges, grapefruit, lemons, limes, and pomelos? Nope, can’t have them. (Not that I liked grapefruit or pomelos in the first place.)I’ve been off the SSRI since about 2010 and I *still* cannot have these things on a regular basis. Some people don’t react as badly, but a cup of earl grey could potentially fuck me up for days.

I *can* have lemon or lime in small doses, but only if I’m using them to cook with.

Any other citrus is fine, though. I nom on clementines like nobody’s business with no ill effects. (Pun intended.)

Food and Pharmaceutical Interactions (The Grapefruit Effect)

At one time, I was prescribed theSSNRI known as Cymbalta (generic: duloxetine). An SSNRI is part of a group of drugs called selective serotonin andnorepinephrine reuptake inhibitors.  Basically,they keep serotonin and norepinephrine levels raised by preventing these twoneurotransmitters from being reabsorbed, thus making the effects of theirinitial release last longer. Cymbalta istypically considered an anti-depressant, but in my case it was meant as anattempt at treatment for certain painful aspects of fibromyalgia.  

The prescribing physician, an RNwho specialized in fibromyalgia and rheumatoid arthritis, gave me a shortdescription of what the drug would do, how I had to take it, and what I couldexpect from the medication.  At no pointdid she mention that there were specific foodsthat could not be combined with Cymbalta.

At the pharmacy, the grapefruitwarning label was applied directly to the pill bottle.  Noproblem, I thought at the time, as I didn’t eat grapefruit anyway.  However, grapefruit was not the only culprit;I quickly discovered that hibiscus tea also interfered with the metabolizing ofCymbalta.  No one had warned me abouttea…or about chocolate, another culprit of pharmaceutical interactions.  Worse, no one mentioned anything abouttryptophan.  While I was not takingtryptophan supplements, I had a diet very high in carbohydrates.  In essence, I was eating the Cymbalta intoineffectiveness.

Grapefruit, the biggest knownoffender for food and drug interactions, prevents the proper metabolisation of manydrugs commonly prescribed.50 Thisis commonly referred to as the Grapefruit Effect. Improper metabolisation is aproblem for any medication, but with neurological medications, particularlySSRIs or SSNRIs, it means that dangerous levels of serotonin can build up inthe brain in short order. Such a build-up can easily turn into Serotonin Syndrome.51  As well as anti-depressants, grapefruit juiceis known to easily interfere with immunosuppressants, antihistamines, calciumchannel blockers, blood pressure treatments, sedatives, anti-anxietymedications, and drugs to treat erectile dysfunction.

Grapefruit’s origin brings theculprit to light. Grapefruit was created when an orange was crossed with theAsian Pomelo fruit.52 Pomelo contains high amounts of bergamottin, 53a type of furanocoumarin, 54 which is an organic chemical compound producedby plants. (Bergamottin is also found in the bergamot orange, the oil of whichis used to make bergamot tea.) 

Bergamottin inhibits the cytochromeP450 enzyme, which performs first-pass oxidative metabolizing of specificdrugs. Without that metabolisation, high levels of the drug in question can buildup in the body.  “Researchers havediscovered that the molecule bergamottin, found in grapefruit juice,inactivates drug-metabolizing enzymes in the liver, allowing drug levels tobuild up in the bloodstream. It can take up to four days for the body to metabolizethe offending chemical, and for the effects of a single glass of grapefruit juice to wear off.” 53 [Emphasismine.] Grapefruit juice causes interactions with so many pharmaceuticalsthat more work is underway to create a further hybridization of grapefruit toremove, or greatly reduce, the amount of bergamottin it contains.  It is hoped that this will reduce the numberof drug interactions caused by grapefruit juice.

There are other culprits, thoughnone are currently as troublesome as grapefruit juice. Hibiscus tea is known tointeract with the body’s metabolizing of acetaminophen, hydrocodone, Vicodin,Caduet, and Darvocet.55  VitaminC and acid-rich fruit juices, along with magnesium, will reduce theeffectiveness of Adderall if consumed within an hour of dosing. Amitriptyline,a tricyclic antidepressant, does not work nearly as well if black leaf tea isconsumed within an hour of taking it. Dangerous interactions with St. John’sWort, a popular herb for treating depression, have been reported when taken incombination with other mood disorder or anti-depressive drugs.56  If you’re having trouble treating yourheadaches, acetaminophen’s pain-killing strength is also greatly reduced bycruciferous vegetables (cabbage, Brussels sprouts, and broccoli) foods high inpectin (jams and jellies) and carbohydrates.57

Many anti-depressants, MAOinhibitors, SSRIs and SSNRIs advise you never to take tryptophan supplements(also called 5-HTP) while taking them. It might also make sense to advise patientsto make sure their diet is low in tryptophan, as well. A high-carb diet—andthus, a diet high in tryptophan—will hinder the medicine’s ability to work withthe body, and could lead to serotonin excess or, again, serotonin syndrome.