White Capsules Spilling Out Of Bottle

Answer

It is not recommended to take Lexapro (escitalopram), or any SSRI (selective serotonin reuptake inhibitor) for that matter, with L-tryptophan. Taking both together increases the risk of a rare, but serious medical condition known as serotonin syndrome.

The mechanism behind the antidepressant effects of Lexapro isn't fully understood, but involves both increases in the neurotransmitter serotonin as well as a change in the balance of serotonin receptors in the brain.

L-tryptophan is an essential amino acid and when consumed (either via diet or as a supplement), is absorbed and converted to 5-hyrdoxytryptophan (5-HTP) and finally to serotonin (5-hydroxytryptamine). It is also metabolized to a variety of other compounds, including melatonin.

Caution is always recommended when combining drugs that have serotonergic effects and should not be done unless under the direction of your doctor.

Answer Summary

Both Lexapro (escitalopram) and L-tryptophan will increase the amount of serotonin in the brain. This increases the risk of a rare but serious condition known as serotonin syndrome.

Serotonin Syndrome

Several studies have warned against the use of SSRI antidepressants (like Lexapro) with drugs or supplements that increase serotonin levels. This would include L-tryptophan and 5-hyrdoxytryptophan (5-HTP).

With L-tryptophan specifically, although it appears to be rare, case reports have been published in which l-tryptophan in combination with a SSRI has produced serotonin syndrome, which is essentially serotonin toxicity from high concentrations.

Serotonin syndrome is characterized by a range of symptoms, including:

  • Increased body temperature
  • Increased blood pressure
  • Muscle spasm and rigidity
  • Dizziness
  • Increased heart rate
  • Mental status changes
  • Death (has been reported but is rare with appropriate treatment)

Serotonin syndrome, although rare, is serious if it occurs and must be treated immediately.

The prescribing information for Lexapro specifically warns against the use of serotonin precursors like L-tryptophan:

Based on the mechanism of action of SNRIs and SSRIs including Lexapro, and the potential for serotonin syndrome, caution is advised when Lexapro is coadministered with other drugs that may affect the serotonergic neurotransmitter systems, such as triptans, linezolid (an antibiotic which is a reversible non-selective MAOI), lithium, tramadol, or St. John's Wort (see WARNINGS-Serotonin Syndrome). The concomitant use of Lexapro with other SSRIs, SNRIs or tryptophan is not recommended.

More studies are needed to determine exactly how much L-tryptophan or other serotonin precursors increase the risk of serotonin syndrome. Nevertheless, they are not recommended to be used with Lexapro.

Section Summary

Serotonin syndrome is a serious medical condition that occurs as a result of serotonin toxicity in the brain. Lexapro (escitalopram) is not recommended to be taken with other serotonergic drugs unless directed by your doctor.

L-Tryptophan

L-tryptophan is a naturally occurring amino acid and is part of our daily food intake. It is found mostly in plant and animal proteins but is also present in smaller amounts in milk and oatmeal.

While we generally get sufficient amounts of L-tryptophan in our diet, it is a commonly used dietary supplement for a variety of indications including:

More studies are needed to evaluate the overall efficacy and safety of L-tryptophan for the treatment of depression but the ones that have been done show mixed results.

Studies have even used it in combination with antidepressants, but again, this isn't recommended as we have become more aware of potential interactions.

Section Summary

L-tryptophan is an essential amino acid found naturally in a variety of foods. It is also used as a supplement for a certain indications, like depression.

Separating Doses

In your question, you inquire about a safe length of time to separate dosing of Lexapro and either 5-HTP or L-tryptophan. If you are continuing therapy on Lexapro, it simply isn't recommended to take 5-HTP or L-tryptophan at all unless directed by your doctor.

If you are discontinuing Lexapro therapy, you should ideally wait at least a week prior to starting a serotonergic supplement.

The elimination half-life of Lexapro is roughly 27 to 32 hours. It generally takes around 5 to 6 half-lives for a drug to be eliminated from the body. This would equate to 5-8 days.

You also have to consider however the functional changes that are made to serotonin receptors when on SSRI therapy. These changes can take far longer to normalize than it takes for Lexapro to be eliminated.

Nevertheless, having only been on Lexapro for 2 days in your case, you most likely haven't experienced the full effects of the drug, which typically takes 2-6 weeks.


References
  1. Selective Serotonin Reuptake Inhibitors (SSRI) Pathway. PubMed
  2. Melatonin or L-tryptophan accelerates healing of gastroduodenal ulcers in patients treated with omeprazole. PubMed
  3. Effects and side effects associated with the non-nutritional use of tryptophan by humans. PubMed
  4. Treatment of depression with L-5-hydroxytryptophan combined with chlorimipramine, a double-blind study.. PubMed
  5. L-Tryptophan: Basic Metabolic Functions, Behavioral Research and Therapeutic Indications. PubMed
  6. Lexapro Prescribing Information. AccessFDA
  7. Sleep induced by L-tryptophan. Effect of dosages within the normal dietary intake. PubMed
  8. A placebo-controlled study of the effects of L-tryptophan in patients with premenstrual dysphoria. PubMed