Can You Take HIV PrEP and Mental Health Medications Together? What LGBTQIA+ Communities Should Know
With the growing availability of HIV prevention tools like PrEP, more people—especially in the LGBTQIA+ community—are prioritizing their sexual health. At the same time, many are also managing depression, anxiety, ADHD, or other mental health conditions. That raises an important question: Is it safe to take PrEP if you're also on psychiatric medications?
The short answer: Yes, most mental health medications are safe to take alongside PrEP. Still, there are a few things to be aware of.
What is PrEP?
PrEP (pre-exposure prophylaxis) is a way to prevent HIV by taking medication before potential exposure. In the U.S., the three FDA-approved forms are:
Truvada® (tenofovir disoproxil fumarate/emtricitabine)
Descovy® (tenofovir alafenamide/emtricitabine)
Apretude® (cabotegravir), a long-acting injectable
These medications are highly effective for HIV prevention and widely used by individuals at increased risk, including many within the LGBTQIA+ population.
Most antidepressants do not interact with PrEP. This includes:
SSRIs like fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro)
SNRIs like venlafaxine (Effexor) and duloxetine (Cymbalta)
Bupropion (Wellbutrin)
Tricyclics like amitriptyline and nortriptyline
These mental health medications are metabolized through different pathways and do not reduce the effectiveness of PrEP or vice versa [1,2].
What About Antipsychotics or Mood Stabilizers?
There are no major interactions between PrEP and:
Antipsychotics like risperidone, aripiprazole, olanzapine
Mood stabilizers such as lamotrigine, valproic acid, and carbamazepine
One exception is lithium, which is cleared by the kidneys—just like Truvada. If you're taking lithium, your doctor may want to monitor kidney function more frequently [3].
ADHD Medications and PrEP
Stimulants like amphetamine (Adderall) and methylphenidate (Ritalin) do not have known pharmacokinetic interactions with PrEP. However, stimulant use can increase blood pressure and heart rate—factors worth keeping an eye on when starting any new medication [4].
Do PrEP Medications Affect Mood?
While PrEP doesn’t typically interfere with psychiatric drugs, some people report psychological side effects, especially when first starting. These may include:
Headaches
Sleep disturbances
Mild anxiety
These effects are usually short-lived. If they persist, a clinician can consider switching between Truvada and Descovy, or exploring injectable PrEP.
Injectable PrEP (Cabotegravir)
Apretude (cabotegravir) is injected every two months and is highly effective for HIV prevention. It doesn’t have significant drug interactions with mental health medications, making it a great option for those who struggle with adherence or pill fatigue—issues that can be more common among people managing mental health conditions [5].
Why This Matters for LGBTQIA+ Mental Health
For many in the LGBTQIA+ community, access to affirming care—including safe HIV prevention and reliable mental health support—is essential. Whether you're managing depression, navigating gender-affirming care, or dealing with trauma, it’s reassuring to know that PrEP and mental health medications can be safely combined in most cases.
Summary
Most psychiatric medications can be safely taken with PrEP.
If you’re taking lithium or have kidney issues, ask your provider about lab monitoring.
Work a psychiatrist who specializes in LGBTQIA mental health to maximize your chance of success and minimize side-effects.
References
Gilead Sciences. Truvada Prescribing Information. https://www.gilead.com
NIH HIV Drug Interaction Checker. https://www.hiv-druginteractions.org
Laprise C, et al. Kidney function in patients using PrEP. JAIDS. 2017;74(3):e45-e51.
Stahl SM. Stahl’s Essential Psychopharmacology. Cambridge University Press, 2013.
NIH Clinical Guidelines on PrEP Use in the U.S. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf
