Menu
Shedding Light on the Risks
& Benefits of Medications
Shedding Light on the Risks
& Benefits of Medications Can I Take St. John’s Wort With Lexapro?
Asian woman Search for information on Internet in smartphone with holding bottled drug. girl reading information online on mobile phone medicine healthcare product concept.
Combining St. John’s wort with Lexapro can amplify the risk of side effects, including the potentially serious condition known as serotonin syndrome.
January 29, 2025
0 Comments
republishAsian woman Search for information on Internet in smartphone with holding bottled drug. girl reading information online on mobile phone medicine healthcare product concept.
Medically Reviewed By: Sruthi S. Balakrishnan, Ph.D.
Sruthi S. Balakrishnan, Ph.D., is a science writer and fact-checker specializing in biology, with a doctoral degree in the field. Her favorite part of the job is diving into research rabbit holes and helping others understand scientist-speak.
on this page:
In 2023, one in five Americans reported experiencing symptoms of anxiety and depression, according to the Centers for Disease Control and Prevention (CDC). For those managing mild to moderate mental health challenges, it’s not uncommon to explore natural or herbal supplements as a way to support well-being, with St. John’s wort being among the more popular options.
Although further research is needed to fully understand the long-term effects of St. John’s wort on depression, studies suggest it can be an effective short-term treatment for mild to moderate symptoms.
However, because of an increased risk of serotonin syndrome, individuals already taking Lexapro (escitalopram) or other prescription antidepressants should steer clear of St. John’s wort.
St. John’s Wort and Lexapro Interactions: Increased Risk of Serotonin Syndrome
Commonly prescribed to treat depression and generalized anxiety disorder, Lexapro falls under a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). These types of medications are thought to work by boosting the brain’s serotonin levels. After being produced and transmitted in the brain, serotonin is usually reabsorbed by the nerve cells that originally released it, a process known as reuptake — SSRIs are thought to inhibit this process, increasing the amount of serotonin in the brain.
Lexapro may cause side effects such as nausea, diarrhea, sexual dysfunction, and tremors. If you experience severe symptoms like confusion, intense muscle stiffness, or fever, contact your doctor immediately, as these could indicate serotonin syndrome—a potentially life-threatening condition caused by excess serotonin in the body.
The risk of serotonin syndrome intensifies when drugs designed to boost serotonin production are taken together, such as Lexapro and St. John’s wort, says Alex Dimitriu, M.D., a dual board-certified specialist in Psychiatry and Sleep Medicine, and founder of Menlo Park Psychiatry & Sleep Medicine.
St. John’s wort works like a natural SSRI, increasing serotonin levels, notes Dr. Dimitriu. When the herbal supplement is taken alongside Lexapro, individuals might have too much serotonin in their systems and experience serotonin syndrome, he explains.
The supplement “also increases CYP3A4,” adds Dr. Dimitriu, referring to a family of enzymes that can break down many compounds, including drugs. By enhancing this pathway, St John’s wort can reduce the efficacy of many drugs, including Lexapro, while also increasing the risk of aforementioned side effects, he adds.
Dr. Dimitriu recommends against taking St. John’s wort and Lexapro together and emphasizes the importance of consulting a doctor before starting St. John’s wort in general.
Safer Alternatives to St. John’s Wort
To avoid an increased risk of serotonin syndrome, individuals taking Lexapro might consider taking omega-3 fatty acids, vitamin D, or L-theanine, says Dr. Dimitriu. These natural supplements can help reduce depression and anxiety without impacting serotonin levels, he adds. However, it’s best to consult with a doctor before trying any new supplement.
Dr. Dimitriu also recommends exploring lifestyle changes to help manage depression and anxiety. These changes could include increased exercise, therapy, good sleep, time in nature, or social engagements.
Want to learn more about how popular medications interact with supplements? Check out another article in our interaction series: Can I Take Fish Oil With Warfarin?
Want to Share Your Story?
If you’ve experienced side effects or medication issues related to this topic, we want to hear from you.
Submit Your Story- Protecting the nation’s mental health. (2024, August 8). Mental Health.
- St. John’s wort. (n.d.). Mount Sinai Health System.
- Ng, Q. X., Venkatanarayanan, N., & Ho, C. Y. (2017). Clinical use of Hypericum perforatum (St John’s wort) in depression: A meta-analysis. Journal of affective disorders, 210, 211–221.
- Peterson, B., & Nguyen, H. (2023, May 16). St. John’s Wort. StatPearls – NCBI Bookshelf.
- Escitalopram: MedlinePlus drug information. (n.d.).
- Lexapro (escitalopram oxalate). (2017). U.S. Food and Drug Administration.
- Chu, A., & Wadhwa, R. (2023, May 1). Selective serotonin reuptake inhibitors. StatPearls – NCBI Bookshelf.
- Overview – Selective serotonin reuptake inhibitors (SSRIs). (2024, November 20). nhs.uk.
- Escitalopram (Lexapro). (n.d.). NAMI.
- Serotonin syndrome: MedlinePlus Medical Encyclopedia. (n.d.).
- St. John’s Wort: Usefulness and safety. (n.d.). NCCIH.
- Klyushova, L. S., Perepechaeva, M. L., & Grishanova, A. Y. (2022). The Role of CYP3A in Health and Disease. Biomedicines, 10(11), 2686.
- Depression and Complementary Health Approaches: What the Science says. (n.d.). NCCIH.
- Akpınar, Ş., & Karadağ, M. G. (2022). Is Vitamin D Important in Anxiety or Depression? What Is the Truth?. Current nutrition reports, 11(4), 675–681.
- Li, M., Liu, H., Wu, D., Kenaan, A., Geng, F., Li, H., Gunaratne, A., Li, H., & Gan, R. (2022). L-Theanine: A Unique Functional Amino Acid in Tea (Camellia sinensis L.) With Multiple Health Benefits and Food Applications. Frontiers in Nutrition, 9.
DISCLAIMER: MedShadow provides information and resources related to medications, their effects, and potential side effects. However, it is important to note that we are not a substitute for professional medical advice, diagnosis, or treatment. The content on our site is intended for educational and informational purposes only. Individuals dealing with medical conditions or symptoms should seek guidance from a licensed healthcare professional, such as a physician or pharmacist, who can provide personalized medical advice tailored to their specific circumstances.
While we strive to ensure the accuracy and reliability of the information presented on MedShadow, we cannot guarantee its completeness or suitability for any particular individual’s medical needs. Therefore, we strongly encourage users to consult with qualified healthcare professionals regarding any health-related concerns or decisions. By accessing and using MedShadow, you acknowledge and agree that the information provided on the site is not a substitute for professional medical advice and that you should always consult with a qualified healthcare provider for any medical concerns.
on this page:
RECOMMENDED:
DONATE:
Help fund our fight for improved medication safety and transparency by supporting our independent journalism.
Give NowWe seek to create a world where there are safer medications for all and where all people are fully informed about their medication benefits and side effects, using our explanatory and investigative journalism to both inform and stimulate public discussion to drive toward solutions.
Republish This Story for Free
Creative Commons License (CC BY-NC-ND 4.0)MedShadow.org is dedicated to empowering people with our evidence-based journalism about the safest ways to take over-the-counter (OTC) and prescription (Rx) medications.
We also seek to stimulate public discussion about potential improvements to drug research, manufacturing and distribution processes. and also to encourage the improvement of processes to ensure that we are all better protected.
As a result, we encourage other nonprofit newsrooms, mission-aligned outlets, and advocacy organizations to republish our original content under the following conditions:
You May Republish Our Articles for Free If:
1. We Are Credited Fully and Clearly
You must include the byline and credit MedShadow.org as the original publisher. Please include a link to the original article at the top or bottom of the piece. Use the following attribution:
This article was originally published by MedShadow, a nonprofit foundation that focuses on the safest ways to take over-the-counter and prescription medications.
2. Our Content Isn’t Edited Without Permission
You may make small changes for clarity, such as adjusting headlines, subheadings, or transitions, but you may not change the core meaning, tone, or intent of the article. For substantive edits, email us at republish@medshadow.org for review and approval.
3. You Do Not Sell Or Use Our Content Commercially
Our work is free to share, but it may not be sold, monetized, or repurposed for commercial gain. You may not republish our articles behind a paywall or in publications whose primary purpose is advertising or product promotion. You may not place drug or supplement advertising adjacent to our story.
4. Photos, Graphics, and Multimedia Are Not Used Without Permission
Only the text of the article is available for republication. Images, graphics, and videos may not be reused without explicit written permission, unless they are clearly marked as Creative Commons licensed. Contact us if you’d like to request reuse of a visual asset.
You May Not:
- Use our content to promote a product, service, or political candidate
- Republish only part of an article or create derivative works without permission
- Add affiliate links, advertising overlays, or lead generators
- Translate the article without written permission
Contact Us
If you’re unsure whether your intended use falls within these guidelines, or would like to discuss a formal syndication or licensing arrangement, please email: republish@medshadow.org
We want our journalism to reach as many people as possible, especially those making critical decisions about medications and health.
Article HTML
<!-- wp:paragraph --> <p>In 2023, one in five Americans reported experiencing symptoms of anxiety and depression, according to the <a href="https://www.cdc.gov/mental-health/about/what-cdc-is-doing.html" target="_blank" rel="noreferrer noopener">Centers for Disease Control and Prevention (CDC)</a>. For those managing mild to moderate mental health challenges, it’s not uncommon to explore natural or herbal supplements as a way to support well-being, with <a href="https://www.mountsinai.org/health-library/herb/st-johns-wort" target="_blank" rel="noreferrer noopener">St. John’s wort</a> being among the more popular options.</p> <!-- /wp:paragraph --><!-- wp:paragraph --> <p>Although further research is needed to fully understand the long-term effects of St. John’s wort on depression, studies suggest it can be <a href="https://pubmed.ncbi.nlm.nih.gov/28064110/" target="_blank" rel="noreferrer noopener">an effective short-term treatment</a> for mild to moderate symptoms.</p> <!-- /wp:paragraph --><!-- wp:paragraph --> <p>However, because of an increased risk of <a href="https://www.ncbi.nlm.nih.gov/books/NBK557465/" target="_blank" rel="noreferrer noopener">serotonin syndrome</a>, individuals already taking Lexapro (<a href="https://medlineplus.gov/druginfo/meds/a603005.html" target="_blank" rel="noreferrer noopener">escitalopram</a>) or other prescription antidepressants should steer clear of St. John’s wort.</p> <!-- /wp:paragraph --><!-- wp:heading --> <h2 class="wp-block-heading">St. John’s Wort and Lexapro Interactions: Increased Risk of Serotonin Syndrome</h2> <!-- /wp:heading --><!-- wp:paragraph --> <p>Commonly prescribed to treat depression and generalized anxiety disorder, <a href="https://www.fda.gov/media/135185/download" target="_blank" rel="noreferrer noopener">Lexapro</a> falls under a class of antidepressants called selective <a href="https://www.ncbi.nlm.nih.gov/books/NBK554406/" target="_blank" rel="noreferrer noopener">serotonin reuptake inhibitors</a> (SSRIs). These types of medications are thought to work by boosting the brain’s serotonin levels. After being produced and transmitted in the brain, serotonin is usually reabsorbed by the nerve cells that originally released it, a process known as <a href="https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/ssri-antidepressants/overview/" target="_blank" rel="noreferrer noopener">reuptake</a> — SSRIs are thought to inhibit this process, increasing the amount of serotonin in the brain.</p> <!-- /wp:paragraph --><!-- wp:paragraph --> <p><a href="https://www.nami.org/about-mental-illness/treatments/mental-health-medications/types-of-medication/escitalopram-lexapro/" target="_blank" rel="noreferrer noopener">Lexapro may cause side effects</a> such as nausea, diarrhea, sexual dysfunction, and tremors. If you experience severe symptoms like confusion, intense muscle stiffness, or fever, contact your doctor immediately, as these could indicate <a href="https://medlineplus.gov/ency/article/007272.htm" target="_blank" rel="noreferrer noopener">serotonin syndrome</a>—a potentially life-threatening condition caused by excess serotonin in the body.</p> <!-- /wp:paragraph --><!-- wp:paragraph --> <p>The risk of serotonin syndrome intensifies when drugs designed to boost serotonin production are taken together, such as Lexapro and St. John’s wort, says <a href="https://www.doctoralex.com/" target="_blank" rel="noreferrer noopener">Alex Dimitriu,</a> M.D., a dual board-certified specialist in Psychiatry and Sleep Medicine, and founder of Menlo Park Psychiatry & Sleep Medicine.</p> <!-- /wp:paragraph --><!-- wp:paragraph --> <p><a href="https://www.nccih.nih.gov/health/st-johns-wort" target="_blank" rel="noreferrer noopener">St. John’s wort</a> works like a natural SSRI, increasing serotonin levels, notes Dr. Dimitriu. When the herbal supplement is taken alongside Lexapro, individuals might have too much serotonin in their systems and experience serotonin syndrome, he explains.</p> <!-- /wp:paragraph --><!-- wp:paragraph --> <p>The supplement “also increases <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC9687714/" target="_blank" rel="noreferrer noopener">CYP3A4</a>,” adds Dr. Dimitriu, referring to a family of enzymes that can break down many compounds, including drugs. By enhancing this pathway, St John’s wort can reduce the efficacy of many drugs, including Lexapro, while also increasing the risk of aforementioned side effects, he adds.</p> <!-- /wp:paragraph --><!-- wp:paragraph --> <p>Dr. Dimitriu recommends against taking St. John’s wort and Lexapro together and emphasizes the importance of consulting a doctor before starting St. John’s wort in general.</p> <!-- /wp:paragraph --><!-- wp:heading --> <h2 class="wp-block-heading">Safer Alternatives to St. John’s Wort</h2> <!-- /wp:heading --><!-- wp:paragraph --> <p>To avoid an increased risk of serotonin syndrome, individuals taking Lexapro might consider taking <a href="https://www.nccih.nih.gov/health/providers/digest/depression-and-complementary-health-approaches-science" target="_blank" rel="noreferrer noopener">omega-3 fatty acids</a>, <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC9468237/" target="_blank" rel="noreferrer noopener">vitamin D</a>, or <a href="https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2022.853846/full" target="_blank" rel="noreferrer noopener">L-theanine</a>, says Dr. Dimitriu. These natural supplements can help reduce depression and anxiety without impacting serotonin levels, he adds. However, it’s best to consult with a doctor before trying any new supplement.</p> <!-- /wp:paragraph --><!-- wp:paragraph --> <p>Dr. Dimitriu also recommends exploring lifestyle changes to help manage depression and anxiety. These changes could include increased exercise, therapy, good sleep, time in nature, or social engagements.</p> <!-- /wp:paragraph --><!-- wp:paragraph --> <p>Want to learn more about how popular medications interact with supplements? Check out another article in our interaction series: <a href="https://medshadow.org/can-i-take-fish-oil-with-warfarin/" target="_blank" rel="noreferrer noopener">Can I Take Fish Oil With Warfarin?</a></p> <!-- /wp:paragraph -->