Ginkgo biloba extract may reduce the side effects experienced by some persons taking SSRIs such as Reference fluoxetine or Reference sertraline. An open-label study with elderly, depressed persons found that 200 to 240 mg of ginkgo daily was effective in alleviating sexual side effects in both men and women taking SSRIs.¹

One case study reported that 180–240 mg of GBE daily reduced genital anesthesia and sexual side effects secondary to fluoxetine use in a 37-year-old woman.²

The alkaloid yohimbine (Pausinystalia yohimbe) from the African yohimbe tree affects the nervous system in a way that may complement fluvoxamine. One report studied Reference depressed people who had not responded to fluvoxamine. When 5 mg of yohimbine was added three times each day, there was significant improvement. Some people required higher amounts of yohimbine before their depression improved. Because yohimbine can have side effects, it should only be taken under a doctor’s supervision. Yohimbine is a prescription drug, but standardized extracts of yohimbe that contain yohimbine are available as a supplement.

Fluvoxamine works by increasing serotonin activity in the brain. 5-HTP (5-Hydroxytryptophan) and L-tryptophan are converted to serotonin in the brain, and taking them with fluvoxamine may increase fluvoxamine-induced side effects. Until more is known, 5-HTP and L-tryptophan should not be taken with any SSRI drug, including fluvoxamine.

In a study of healthy volunteers, ingestion of 250 ml (approximately 8 ounces) of grapefruit juice along with fluvoxamine increased the blood level of fluvoxamine by 60%, compared with ingestion of fluvoxamine with water.³ Because a higher concentration of the drug could increase its adverse effects, individuals should not consume grapefruit or grapefruit juice around the same time they take fluvoxamine.

Fluvoxamine works by increasing serotonin activity in the brain. 5-HTP (5-Hydroxytryptophan) and L-tryptophan are converted to serotonin in the brain, and taking them with fluvoxamine may increase fluvoxamine-induced side effects. Until more is known, 5-HTP and L-tryptophan should not be taken with any SSRI drug, including fluvoxamine.

Pomegranate juice has been shown to inhibit the same enzyme that is inhibited by grapefruit juice.^{4 , 5} The degree of inhibition is about the same for each of these juices. Therefore, it would be reasonable to expect that pomegranate juice might interact with fluvoxamine in the same way that grapefruit juice does.

One report describes a case of serotonin syndrome in a patient who took St. John’s wort and Reference trazodone, a weak SSRI drug.⁶ The patient experienced mental confusion, muscle twitching, sweating, flushing, and ataxia. In another case, a patient experienced grogginess, lethargy, nausea, weakness, and fatigue after taking one dose of Reference paroxetine (Paxil®, an SSRI drug related to fluvoxamine) after ten days of St. John’s wort.⁷ Until more is known about interactions and adverse actions, people taking any SSRI drugs, including fluvoxamine, should avoid St. John’s wort, unless they are being closely monitored by a doctor.

Fluvoxamine has been shown to significantly raise the amount of melatonin in the blood after oral administration.⁸ Researchers suggest that fluvoxamine may inhibit elimination of melatonin, but the clinical significance of this finding is as yet unclear.