Editorial interaction review
Authoritative guidance and published case reports support clinically important interaction concerns when St. John's wort is combined with serotonergic antidepressants. The evidence is not equivalent to a randomized interaction trial for every antidepressant.
Why it is flagged
Authoritative guidance and published case reports support clinically important interaction concerns when St. John's wort is combined with serotonergic antidepressants. The evidence is not equivalent to a randomized interaction trial for every antidepressant.
Interaction mechanism
The concern includes pharmacodynamic serotonergic overlap, while St. John’s wort can also alter drug disposition through enzyme and transporter induction. The relevant mechanism depends on the specific medication.
Risk varies across antidepressants, doses, extracts, co-medications, and individual factors. Case-report evidence cannot quantify incidence, and this page does not determine whether a specific regimen is safe.
Primary studies are labeled separately from authoritative secondary guidance so the evidence chain is visible.
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