SSRIs and St. John's Wort

I am looking for research on the efficacy/snake-oil-ness of St John’s Wort. I am not looking for medical advice.
How does St. John’s Wort compare to SSRIs when it comes to relieving depression? How much does it increase serotonin levels and increase the number of serotonin receptors compared to SSRIs?

How does it compare to SSRIs when it comes to SSRIs’ off-label uses like anti-anxiety?
If St John’s Wort is effective for those purposes, are there forms or brands which have proven more effective? One of the most widespread SSRIs is citalopram and atypical dose if 20mg, what’s dose of St John’s Wort would be equivalent?
About how much St John’s Wort per kg of bodyweight will result in serotonin syndrome in a healthy adult?

University of Maryland Fact Sheet. Credible source.

Unknown.

Not mentioned in the fact sheet, but the sheet does mention that St. John’s Wort is not effective in OCD disorders.

WebMD mentions that anxiety is being studied, but offers no conclusions.

900 mg/day St. John’s Wort vs. 20 mg Celexa

Taken on its own, St. John’s Wort is very safe. Any mention of Seratonin Syndrome (which is a very rare condition) is only on woo-woo sites.

Taken with SSRIs or other medications, the risk increases.

It’s important to note that studies comparing SJW with prescription SSRIs for depression (not all of which conclude they have equivalent effectivness) typically use an extract of SJW which has known/standardized amounts of active ingredient(s).

By contrast, the SJW pills you can buy over the counter vary considerably in regards to what the label says and what they actually contain.

*"Classified as an OTC herbal supplement, St. John’s Wort is not under FDA regulation. The concentration and purity of the product’s content can vary from brand to brand, and therefore its effectiveness is not guaranteed.

Furthermore, the packaging of St. John’s Wort often includes misleading labels. Studies have revealed a discrepancy between the product’s actual contents and the label on the bottle. It turned out that the amount of the active ingredient hypericin varied greatly from product to product, ranging from 56% to as high as 130% of the stated amount."*

Also, beware if you are taking any other medications. I asked my DR about SJW and whether it was safe to take with my current medications. DR answered with a resounding NO! So consult your DR.

J.

A data point; I have found St Johns Wort completely ineffective against depression.

And I really wanted it to work.

St. John’s Wort can trigger Serotonin Syndrome if you mix it with something else that also affects serotonin, such as most antidepressants and some OTC cough syrups. That’s not to say that you can’t ever take SJW together with one of those, but that you need to ask a doctor or pharmacist first.

How long did you take it? SSRIs need about 1/1.5 months to really kick in because the serotonin receptors need time to increase.

If it’s not having a significant effect after about 4 weeks, it probably isn’t going to be effective.

People’s response to antidepressants (including SJW) varies considerably.

I take St John’s Wort (a lower dose than usually suggested) and do feel it had a positive effect. It helped me “snap out of” a major depressive episode a few years back, and I’ve taken since along with fish oil.

At first, I actually thought the improvement was just placebo effect due to having a more steady morning self-care ritual of taking my pills. It genuinely felt to me like it made a difference, though, especially since I’ve stopped taking the SJW a few times and every time I’ve felt more stressed and tired within a few weeks.

Two weeks, if memory serves.

This. I took 600 mg/day for about 3 months, with no change.