St. John's Wort vs Prescription Antidepressants: What Trials and Regulators Say
What trials and health bodies say about St. John's wort compared with prescription antidepressants, and why combining them can be dangerous. Information only.
Content last updated . This page has not been medically reviewed.
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Do not stop, swap or add anything to a prescribed antidepressant on your own. The NHS (England) says not to stop an antidepressant suddenly or without talking to your doctor first. [1] St. John's wort can interact in dangerous, sometimes life-threatening ways with many medicines, and combining it with certain antidepressants can cause a potentially life-threatening rise in serotonin. [2][3] If you are in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline, US) or call 911. For serotonin warning signs see serotonin syndrome and other reaction signs.
The question
Is St. John's wort an alternative to prescription antidepressants? This page sets out what the sources say. It does not tell anyone to switch. Depression is serious, and NCCIH says not to treat it on your own or to use St. John's wort to postpone seeing a health care provider. [3]What each one is
- St. John's wort (Hypericum perforatum) is a yellow-flowered plant used in Greek, Islamic and Chinese traditional medicine. In the US it is sold as a dietary supplement. [2][3][4]
- Prescription antidepressants, including the SSRIs (selective serotonin reuptake inhibitors), are prescription medicines. The NHS describes SSRIs as the most widely used type. [1]
What the trials found (research, not tradition)
| Question | What the source found | Strength of evidence |
|---|---|---|
| Is it better than placebo for mild to moderate depression? | NCCIH: appears more effective than placebo and as effective as standard antidepressants for mild or moderate depression. [2] | Promising but limited |
| Large review | A Cochrane review pooled 29 trials: 18 against placebo and 17 against standard antidepressants. [5] | The Cochrane authors concluded the extracts tested were similarly effective as standard antidepressants. [5] Promising but limited |
| Where results disagree | Results were mixed. In one NCCIH-funded trial it was no more effective than placebo for major depression of moderate severity. [3] The Cochrane authors noted that trials from German-speaking countries reported more favorable findings, which complicates interpretation. [5] | Mixed |
| Severe depression, or use longer than 12 weeks | NCCIH: uncertain. [2] | Insufficient evidence |
| Side-effect drop-outs | In the Cochrane review, fewer people given hypericum extracts than older antidepressants dropped out because of side effects. [5] | Trial finding only; see the interaction section |
The extracts tested in trials are not the same as every product on a shelf, and results for one extract do not transfer to another. Comparisons that run longer than 12 weeks: NCCIH calls the evidence uncertain, and we did not find stronger evidence in the sources we read.
What health bodies say about combining them
- NCCIH: taking St. John's wort with certain antidepressants or other drugs that affect serotonin may lead to serious side effects. [2]
- Symptoms of too much serotonin start within minutes to hours and can include agitation, diarrhea, fast heartbeat, high blood pressure, hallucinations and raised body temperature. [3] If these appear after combining medicines, get urgent medical help.
- The NHS lists St John's wort among things that can cause problems when taken with antidepressants, and advises asking a pharmacist or doctor if unsure. [1]
- St. John's wort can also weaken other medicines, including birth control pills, cyclosporine, warfarin and some antidepressants such as amitriptyline and bupropion. [2] NIH LiverTox adds that it may change how other drugs are processed. [6]
Other cautions
- Case reports describe worsening psychotic symptoms in people with bipolar disorder or schizophrenia, and it can be a stimulant that worsens anxiety in some people. [3]
- Large oral amounts or skin use might cause severe skin reactions after sun exposure. [2]
- It may be unsafe in pregnancy because of possible birth defects. [2] Breastfed infants of mothers who take it can have colic, drowsiness and lethargy. [2]
- Tell your surgical team about any supplement before an operation. See supplements before surgery.
No universal winner
Neither choice suits everyone, and the right one depends on the person, the severity and the other medicines they take. That is a decision for a prescriber, not a web page. More: St. John's wort profile, herbs and antidepressants, and interactions by medicine group.Frequently asked questions
Is St. John's wort as good as an antidepressant?
For mild to moderate depression NCCIH says it appears as effective as standard antidepressants, but results are mixed and uncertain for severe depression. [2][3] That is not advice to switch.
Can I take St. John's wort with my antidepressant?
Often not. Certain combinations can raise serotonin to dangerous levels. Ask a pharmacist or prescriber first. [3][1]
Can I stop my antidepressant and use St. John's wort instead?
Do not do this on your own. The NHS says not to stop an antidepressant suddenly. [1] Speak to the prescriber.
Does St. John's wort harm the liver?
NIH LiverTox says it has not been convincingly implicated in clinically apparent acute liver injury, but it may raise the toxicity of other drugs by changing how they are processed. [6]
Who should be extra careful?
People on birth control, transplant medicines, blood thinners or HIV and cancer medicines, people with bipolar disorder or schizophrenia, and anyone pregnant. [2][3]
References
- NHS (England). Antidepressants (page last reviewed 12 June 2025). Read 2026-10-23.
- National Center for Complementary and Integrative Health (NCCIH, NIH, United States). St. John’s Wort: Usefulness and Safety. Available at www.nccih.nih.gov. Read 2026-10-23.
- National Center for Complementary and Integrative Health (NCCIH, NIH, United States). St. John’s Wort and Depression: In Depth. Available at www.nccih.nih.gov. Read 2026-10-23.
- GBIF Backbone Taxonomy, species-match service (gbif.org); accepted names checked 2026-10-23 for Ginkgo biloba L., Panax ginseng C.A.Mey., Bacopa monnieri (L.) Pennell, Hypericum perforatum L., Cinnamomum verum J.Presl, Cinnamomum aromaticum Nees, Silybum marianum (L.) Gaertn. and Camellia sinensis (L.) Kuntze.
- Cochrane Database of Systematic Reviews. St John's wort for major depression. PubMed record 18843608. Read 2026-10-23.
- NIH LiverTox, St. John's Wort entry, as indexed in PubMed. PubMed record 31644187. Read 2026-10-23.