# SSRIs and St. John's Wort **URL:** \ **Category:** Factual Questions\ **Created:** [January 21, 2015, 12:36pm UTC](https://boards.straightdope.com/t/ssris-and-st-johns-wort/710477 "2015-01-21T12:36:19Z")\ **Posts on this page:** 11\ **Page:** 1
**Author:** ![MichaelEmouse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/michaelemouse/32/101_2.png) [@MichaelEmouse](https://boards.straightdope.com/u/MichaelEmouse)\ **Post date:** [January 21, 2015, 12:36pm UTC](https://boards.straightdope.com/t/ssris-and-st-johns-wort/710477/1 "2015-01-21T12:36:19Z")
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? ---
**Author:** ![LibrarySpy](https://avatars.discourse-cdn.com/v4/letter/l/f9ae1b/32.png) [@LibrarySpy](https://boards.straightdope.com/u/LibrarySpy)\ **Post date:** [January 21, 2015, 2:56pm UTC](https://boards.straightdope.com/t/ssris-and-st-johns-wort/710477/2 "2015-01-21T14:56:31Z")
[University of Maryland Fact Sheet](http://umm.edu/health/medical/altmed/herb/st-johns-wort). Credible source. > [@](#): > > How does St. John’s Wort compare to SSRIs when it comes to relieving depression? > > As effective for mild-to-moderate depression. Keep in mind SSRIs don’t have a great reputation for curing depression either in major studies vs the placebo effect. > [@](#): > > How much does it increase serotonin levels and increase the number of serotonin receptors compared to SSRIs? Unknown. > [@](#): > > How does it compare to SSRIs when it comes to SSRIs’ off-label uses like anti-anxiety? Not mentioned in the fact sheet, but the sheet does mention that St. John’s Wort is not effective in OCD disorders. [WebMD](http://www.webmd.com/vitamins-and-supplements/lifestyle-guide-11/supplement-guide-st-johns-wort) mentions that anxiety is being studied, but offers no conclusions. > [@](#): > > One of the most widespread SSRIs is citalopram and atypical dose if 20mg, what’s dose of St John’s Wort would be equivalent? 900 mg/day St. John’s Wort vs. 20 mg Celexa > [@](#): > > About how much St John’s Wort per kg of bodyweight will result in serotonin syndrome in a healthy adult?" 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. ---
**Author:** ![Jackmannii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackmannii/32/311_2.png) [@Jackmannii](https://boards.straightdope.com/u/Jackmannii)\ **Post date:** [January 21, 2015, 3:37pm UTC](https://boards.straightdope.com/t/ssris-and-st-johns-wort/710477/3 "2015-01-21T15:37:45Z")
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](http://drugtopics.modernmedicine.com/drug-topics/news/drug-topics/chains-business/st-john%E2%80%99s-wort-should-be-behind-counter?contextCategoryId=14) 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."\* ---
**Author:** ![jharvey963](https://avatars.discourse-cdn.com/v4/letter/j/54ee81/32.png) [@jharvey963](https://boards.straightdope.com/u/jharvey963)\ **Post date:** [January 21, 2015, 5:39pm UTC](https://boards.straightdope.com/t/ssris-and-st-johns-wort/710477/4 "2015-01-21T17:39:19Z")
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. ---
**Author:** ![Bert\_Nobbins](https://avatars.discourse-cdn.com/v4/letter/b/aeb1de/32.png) [@Bert\_Nobbins](https://boards.straightdope.com/u/Bert_Nobbins)\ **Post date:** [January 21, 2015, 6:14pm UTC](https://boards.straightdope.com/t/ssris-and-st-johns-wort/710477/5 "2015-01-21T18:14:04Z")
A data point; I have found St Johns Wort completely ineffective against depression. And I really wanted it to work. ---
**Author:** ![robert\_columbia](https://avatars.discourse-cdn.com/v4/letter/r/e79b87/32.png) [@robert\_columbia](https://boards.straightdope.com/u/robert_columbia)\ **Post date:** [January 21, 2015, 6:17pm UTC](https://boards.straightdope.com/t/ssris-and-st-johns-wort/710477/6 "2015-01-21T18:17:59Z")
> [@jharvey963](#): > > 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. St. John’s Wort can trigger [Serotonin Syndrome](http://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/basics/causes/con-20028946) 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. ---
**Author:** ![MichaelEmouse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/michaelemouse/32/101_2.png) [@MichaelEmouse](https://boards.straightdope.com/u/MichaelEmouse)\ **Post date:** [January 21, 2015, 11:35pm UTC](https://boards.straightdope.com/t/ssris-and-st-johns-wort/710477/7 "2015-01-21T23:35:34Z")
> [@Bert\_Nobbins](#): > > A data point; I have found St Johns Wort completely ineffective against depression. > > And I really wanted it to work. 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. ---
**Author:** ![Jackmannii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackmannii/32/311_2.png) [@Jackmannii](https://boards.straightdope.com/u/Jackmannii)\ **Post date:** [January 22, 2015, 12:51am UTC](https://boards.straightdope.com/t/ssris-and-st-johns-wort/710477/8 "2015-01-22T00:51:51Z")
> [@MichaelEmouse](#): > > 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. ---
**Author:** ![typoink](https://avatars.discourse-cdn.com/v4/letter/t/ecb155/32.png) [@typoink](https://boards.straightdope.com/u/typoink)\ **Post date:** [January 22, 2015, 3:16am UTC](https://boards.straightdope.com/t/ssris-and-st-johns-wort/710477/9 "2015-01-22T03:16:46Z")
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. ---
**Author:** ![Bert\_Nobbins](https://avatars.discourse-cdn.com/v4/letter/b/aeb1de/32.png) [@Bert\_Nobbins](https://boards.straightdope.com/u/Bert_Nobbins)\ **Post date:** [January 23, 2015, 4:48pm UTC](https://boards.straightdope.com/t/ssris-and-st-johns-wort/710477/10 "2015-01-23T16:48:43Z")
> [@MichaelEmouse](#): > > 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. Two weeks, if memory serves. ---
**Author:** ![panache45](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/panache45/32/64_2.png) [@panache45](https://boards.straightdope.com/u/panache45)\ **Post date:** [January 23, 2015, 7:14pm UTC](https://boards.straightdope.com/t/ssris-and-st-johns-wort/710477/11 "2015-01-23T19:14:38Z")
> [@Bert\_Nobbins](#): > > A data point; I have found St Johns Wort completely ineffective against depression. > > And I really wanted it to work. This. I took 600 mg/day for about 3 months, with no change.