SSRIs (General) and St. John's Wort: Interaction Overview
St.
Mechanism of Interaction
St. John's Wort (Hypericum perforatum) inhibits reuptake of serotonin, dopamine, and norepinephrine via its active compounds hypericin and hyperforin. Combined with SSRIs (which also block serotonin reuptake), serotonin levels can reach toxic levels, causing serotonin syndrome — symptoms include agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle twitching, and in severe cases, seizures or death. This is one of the most well-documented dangerous supplement-drug interactions.
Recommendation
DO NOT combine. This is a contraindicated combination. If you wish to explore herbal support for mood while on SSRIs, consult your prescribing physician. Allow at least 2 weeks after stopping SSRIs before considering St. John's Wort (MAOI washout analogy).
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