Documented concern based on cited evidence — not a personalized safety check, not medical advice, and not a decision to combine or avoid. That decision belongs with your prescriber.

Significant interaction — talk to your prescriber before combining

Significant documented interaction. Talk to your prescriber before combining these two.

Mechanism and evidence

Both substances push serotonin signaling: SSRIs block reuptake directly, and St John's wort is thought to add serotonergic activity of its own. Published case reports describe serotonin syndrome when the two were combined, with sertraline and paroxetine among the named drugs. No trial has stacked the two deliberately, and none should.

Evidence tier: case-reports-review

The tier names the strongest cited study design. Some anchors studied the supplement on its own, or a related drug in the same class — in those pairs the grade rests on that evidence plus established pharmacology, as agreed with our medical reviewer.

What to discuss with your prescriber

  • Do not add St John's wort on top of an SSRI — this exact combination has published case reports of serotonin syndrome.
  • If you already take both, watch for agitation, tremor, sweating, racing heart, fever, and muscle twitching: that cluster is a same-day medical conversation.
  • Disclosure is the reader's part: every interaction on this page is invisible to a prescriber who does not know the herb is in the picture.

← All reviewed pairs for SSRI antidepressants (sertraline, paroxetine, escitalopram)