St. Johns Wort Drug Interactions With Antidepressants

St. Johns Wort Drug Interactions With Antidepressants Depression Treatment Medication Print St. Johns Wort Drug Interactions With Antidepressants Risk of Serotonin Syndrome With St. Johns Wort and Antidepressants By Nancy Schimelpfening Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be. Learn about our editorial policy Nancy Schimelpfening Medically reviewed by Medically reviewed by Steven Gans, MD on January 24, 2020 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on February 04, 2020 Depression Overview Types Symptoms Causes & Risk Factors Diagnosis Treatment Coping ADA & Your Rights Depression in Kids B. Boissonnet / Getty Images In This Article Table of Contents Expand How St. John's Wort Works Pontential Interactions Risk of Serotonin Syndrome Other Drugs & Serotonin Syndrome Nutritional Supplement Cautions View All St. Johns wort is a dietary supplement people often take as a natural treatment for depression. The herb has similar actions as antidepressants, which means taking the supplement can interact with, or add to, the effect of certain medications prescribed to treat depression. If you plan to take St. Johns wort, there are a few things you should know about how it can interact with your other medications as well as potential side effects. How Does St. Johns Wort Work? St. Johns wort is an herbal supplement marketed as a natural remedy for depression, anxiety, and other mood disorders. Proponents of St. Johns wort believe the herb can increase the amount of  serotonin in the brain. Serotonin is a neurotransmitter (a chemical signal in the brain) that may be deficient in some people with depression. The Health Benefits of St. Johns Wort Potential Interactions Between Antidepressants St. Johns Wort St. Johns wort can interact with antidepressant medications. As a result, your doctor will likely advise you to avoid the combination. If youre considering adding St. Johns wort to your treatment plan, its important to discuss why you are considering taking both medications with your doctor. Instead, your doctor may suggest adjusting your dose or trying a new medication rather than taking St. Johns wort and a prescription antidepressant together. Some people try taking St. Johns wort as a way of reducing or minimizing their need for prescription medication. Its important to realize, however, that St. Johns wort is an active medication and should be approached the same way you would a pharmaceutical prescribed to you. St. Johns wort has the potential to interact with several different classes of antidepressant drugs, including: Selective serotonin reuptake inhibitors (SSRIs): These medications work by blocking the reuptake of serotonin in nerve cells, which effectively increases the amount of serotonin present to bind with and communicate a signal to the next cell.Selective norepinephrine reuptake inhibitors (SNRIs): These medications raise both serotonin and norepinephrine levels in the brain.Tricyclic antidepressants (TCAs): Tricyclic antidepressants are an older generation of medications that also raise serotonin and norepinephrine levels in the brain.Monoamine oxidase inhibitors (MAOIs): MAOIs raise serotonin, norepinephrine, and dopamine levels in the brain. There are specific medications in each class, including well-known drugs like Prozac (fluoxetine), Cymbalta (duloxetine), and Zoloft (sertraline). In addition to being prescribed as a treatment for depression, many of these medications can be used to treat anxiety and other mental health conditions such as bipolar disorder. Selective Serotonin Reuptake Inhibitors Common SSRIs include: Prozac (fluoxetine)Paxil (paroxetine)Zoloft (sertraline)Celexa (citalopram)Luvox (fluvoxamine)Lexapro (escitalopram) Selective Norepinephrine Reuptake Inhibitors Common SNRIs include: Cymbalta (duloxetine)Savella (milnacipran)Effexor (venlafaxine)Pristiq (desvenlafaxine) Tricyclic Antidepressants Common TCAs include: Elavil (amitriptyline)Tofranil (imipramine)Ascendin (amoxapine)Anafranil (clomipramine)Pamelor (nortriptyline)Norpramin (desipramine)Vivactil (protriptyline)Surmontil (trimipramine)Sinequan (doxepin) Monoamine Oxidase Inhibitors Common MAOIs include: Parnate (tranylcypromine)Nardil (phenelzine) The 5 Major Classes of Antidepressants Risk of Serotonin Syndrome Increasing serotonin may help improve symptoms of depression, but levels that are too high can cause a potentially serious condition known as serotonin syndrome. If you are using a prescription antidepressant and/or a nutritional supplement for depression, its important to know the symptoms of serotonin syndrome. Elevated serotonin levels can result if you are taking: A high dose of a single antidepressantTwo or more antidepressants or an antidepressant plus St. Johns wortSt. Johns wort or an antidepressant plus another medication that interacts with and raises serotonin levels (including common medications found in cold and cough preparations) Serotonin syndrome is a serious condition that can be fatal without treatment. Contact your healthcare provider right away if you are experiencing symptoms while taking medications or supplements used to treat depression. Symptoms When serotonin levels are too high, a serious set of symptoms can occur. Symptoms of serotonin syndrome may include: HeadacheFeverShiveringSweatingHigh blood pressureRapid or irregular heartbeatUpset stomach, diarrheaAgitation, confusionInvoluntary twitching, tremors, overactive reflexesSeizuresLoss of consciousnessComa Treatment The first step in treating serotonin syndrome is stopping all medications and nutritional supplements (including St. Johns wort). Due to the risk of a condition known as SSRI discontinuation syndrome, you should not stop taking these medications suddenly or without first consulting your doctor. While SSRI discontinuation syndrome can be uncomfortable, serotonin syndrome can be quite serious if not life-threatening, and it requires immediate medical treatment. Treatment for serotonin syndrome may include the administration of serotonin antagonists such as methysergide and cyproheptadine. Benzodiazepines, such as Ativan (lorazepam) or Valium (diazepam), may also be given in order to reduce symptoms such as muscle rigidity. Tapering Off Antidepressant Medications Prevention In order to prevent serotonin syndrome, closely follow your doctors prescription for taking your medications.  In addition, make sure each of your healthcare providers is aware of any medications or supplements you take, including herbal remedies like St. Johns wort and over-the-counter medications, such as those used for sleep or cold and cough medicine. If you want or need to transition from one antidepressant to another, or from a prescription antidepressant to herbal supplements which might potentially affect serotonin, only do so after talking with your doctor. Your serotonin levels could remain elevated for a period of time after you stop taking your medication. You may need to allow a washout period before starting another medication, herb, or supplement which may have similar effects on serotonin. Everything You Need to Know About Antidepressant Withdrawal Other Drugs Linked to Serotonin Syndrome If you are taking St. Johns wort or an antidepressant, its important to be aware of other drugs that may also lead to serotonin syndrome, such as: 5-HTP  (5-hydroxytryptamine or 5-HT)  Panax ginsengLithiumSelegilineBuspar (buspirone)Dextromethorphan (found in many cough and cold remedies)ChlorpheniramineTriptans (migraine medications)Pain medications including codeine, fentanyl, meperidine, and tramadolDopamine agonists including levodopa, amantadine, and bromocriptineIllegal drugs such as cocaine, LSD, ecstasy (MDMA), and amphetamines Using Caution With Nutritional Supplements The interaction of St. Johns wort with some antidepressant medications is just one example of how nutritional supplements, though marketed as natural, plant-based, and even organic, can cause side effects or interact with other medications as prescription drugs can. Before taking any herbal or nutritional supplement, discuss dietary supplement use with your doctor to ensure you are educated and empowered to make the right decisions for your health. A Word From Verywell If you are looking for non-medication methods to help manage your depression or anxiety, there are many options. Psychotherapy can be very helpful either alone, or when combined with an herbal supplement like St. Johns wort or an antidepressant. Short-term options such as interpersonal therapy for depression can also be effective for some people with depression. Other therapies, such as cognitive-behavioral therapy, behavioral therapy, and rational emotive behavior therapy, can also be used to help people cope with depression. You may also want to explore self-help strategies including self-help books, depression support groups, and online support communities. Healthy Ways to Cope With Depression