Can I Take St. John’s Wort With Lexapro?

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?