Chinese Herbs With Antidepressants and Other Mental Health Medicines
What is known about mixing Chinese herbs and patent medicines with antidepressants, antipsychotics and other mental health medicines, including one large cohort study, hidden drugs and what not to do.
Content last updated . This page has not been medically reviewed.
If you are in distress
If you are thinking about suicide or are in emotional crisis in the United States, call or text 988 (the 988 Suicide & Crisis Lifeline), which is available 24/7 and is free and confidential. [1] For a medical emergency call 911.Do not stop your medicine
Do not stop or change a prescribed mental health medicine because of a herb, and do not start a herb in its place. The NHS says not to stop any prescribed medicine without first talking to your doctor. [2] Plan any change in your medicines with your prescriber.Check before you combine
The NHS lists antidepressants among the medicines that may not mix well with herbal medicines, and advises checking with a pharmacist first. [2] NCCIH advises telling all your health care providers about any complementary approach you use. [3] A practitioner of Chinese medicine and your psychiatrist or prescriber should know about each other.This page is about combining. For how Chinese medicine describes and treats emotional distress, see TCM mental health practice.
What research shows
| Question | What the source found | Label |
|---|---|---|
| Bupleurum root (chai hu) formulations with the antipsychotic quetiapine | In a Japanese claims-database cohort of 7,552 people taking both and 30,091 matched controls, combined use was linked to more acute adverse events (hazard ratio 1.28) and more central nervous system depression (1.35) [4] | Promising signal of harm, limited (observational) |
| Specific Chinese formulas with SSRIs or other antidepressants | Proper evidence not found in a PubMed search on herb-antidepressant interactions | Insufficient evidence |
| Stimulant herbs such as ephedra | Linked to high blood pressure, seizure, stroke and psychosis; banned in US supplements [5] | Evidence of harm |
| Hidden drugs in "natural" products | Psychosis, steroid excess and low blood sugar were the most common harms in a Hong Kong series [6] | Established |
The quetiapine study is observational, so it shows association, not proof of cause. The authors reported about two extra events per 100 person-years and called the difference clinically significant. [4] It was run in Japan, and the abstract names the herb (Bupleuri Radix) but not which formulas people used. Only the abstract was read.
Who should be extra careful
If you take several medicines, ask a pharmacist before any herb. The NHS also advises against herbal medicines in children and during pregnancy or breastfeeding. [2]Questions for your prescriber
- Does anything on my list change how my medicine works?
- Could this herb worsen sleep, anxiety or mood?
- What symptoms should make me call you?
Related: anxiety disorders, medication interactions: how they work, talking with a health professional.
Frequently asked questions
Can I take Chinese herbs with antidepressants?
Not without checking. The NHS lists antidepressants among medicines that may not mix with herbal medicines. [2]
Does a herb work as well as my medicine?
This page does not compare effectiveness. Do not substitute a herb for a prescribed medicine. [2]
Is St. John's wort part of Chinese medicine?
It is a Western herb, but it is the herbal product with the best-documented antidepressant interactions. [7]
What did the Bupleurum and quetiapine study find?
Combined use was associated with more acute adverse events in a Japanese cohort study. [4]
Where do I turn in a crisis?
In the US call or text 988. [1]
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
St. John's wort: the best-documented herbal interaction
Other cautions
- Ephedra (ma huang) can cause anxiety, insomnia and personality changes in addition to cardiovascular harm. [5]
- Ginseng. Insomnia is its most common side effect. [9] A supplement review also observed cardiovascular instability with ginseng and ephedra. [10]
- Undeclared drugs. Reported adulterants in Chinese patent medicines include corticosteroids, which can cause psychiatric problems. [11] See undeclared drugs in Chinese patent medicines.
- Mineral ingredients are covered in heavy metals in Chinese medicines.
References
- 988 Suicide & Crisis Lifeline (US), home page. Read 2026-10-22.
- NHS (England), Herbal medicines and complementary therapies (page last reviewed 1 May 2026). Read 2026-10-22.
- NCCIH, Traditional Chinese Medicine: What You Need To Know (US). Read 2026-10-22.
- Mu X et al. Risk of adverse events associated with co-administration of quetiapine and Bupleuri Radix: a population-based cohort study. Pharmacol Res 2026. Read 2026-10-22.
- NCCIH, Ephedra (US). Read 2026-10-22.
- Ching CK et al. Adulteration of proprietary Chinese medicines and health products with undeclared drugs: experience of a tertiary toxicology laboratory in Hong Kong. Br J Clin Pharmacol 2018. Read 2026-10-22.
- NCCIH, St. John’s Wort (US). Read 2026-10-22.
- Izzo AA. Drug interactions with St. John's Wort (Hypericum perforatum): a review of the clinical evidence. Int J Clin Pharmacol Ther 2004. Read 2026-10-22.
- NCCIH, Asian Ginseng (US). Read 2026-10-22.
- Wang CZ, Moss J, Yuan CS. Commonly used dietary supplements on coagulation function during surgery. Medicines (Basel) 2015. Read 2026-10-22.
- FDA, Nhan Sam Tuyet Lien Truy Phong Hoan may be harmful due to hidden drug ingredients (US, notice current as of 11-01-2024). Read 2026-10-22.