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Hypericum perforatum
This herb is NOT recommended during pregnancy due to potential risks to the developing fetus.
This herb is NOT recommended while breastfeeding as effects on infants are unknown.
Consult your healthcare provider before use.
This herb may interact with medications you are taking. Review the interactions table below and consult your healthcare provider before use.
St. John's Wort is a flowering plant that has been used medicinally since ancient Greece. It is best known for its use in treating mild to moderate depression, where clinical evidence supports its efficacy comparable to some conventional antidepressants. It is named for its traditional harvest on St. John's Day.
St. John's Wort (Hypericum perforatum) is the most extensively studied botanical antidepressant, with Level A evidence for mild to moderate depression. Standardized extracts (0.3% hypericin, 2-4% hyperforin) demonstrate efficacy comparable to SSRIs.
Hyperforin inhibits serotonin, norepinephrine, and dopamine reuptake non-competitively. Also modulates NMDA receptors. St. John's Wort is a potent CYP3A4 and P-glycoprotein inducer, explaining many drug interactions.
Mild to moderate depression
Cochrane: superior to placebo, equivalent to SSRIs
Severe major depression
Not effective; insufficient evidence
Somatoform disorders
Some positive trials
| Drug | Severity | Description |
|---|---|---|
| Sertraline (Zoloft) | Contraindicated | Concurrent use with sertraline significantly increases the risk of serotonin syndrome. Multiple case reports document this dangerous interaction. |
| Paroxetine (Paxil) | Contraindicated | St. John's Wort combined with paroxetine can cause serotonin syndrome. This combination should be strictly avoided. |
| Citalopram (Celexa) | Contraindicated | Risk of serotonin syndrome when combined with citalopram, an SSRI antidepressant. |
| Simvastatin (Zocor) | Severe | St. John's Wort reduces simvastatin levels by approximately 50%, significantly diminishing its cholesterol-lowering effect. |
| Omeprazole (Prilosec) | Moderate | St. John's Wort may reduce the effectiveness of omeprazole by increasing its metabolism. |
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