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Can I take St John's wort with SSRIs like Zoloft or Lexapro?

No, not unless your prescriber says so. The risk is on the drug's label: the sertraline (Zoloft) and escitalopram (Lexapro) labels name St John's wort among products that raise the risk of serotonin syndrome, a reaction to too much serotonin that can be life-threatening. Case reports describe it in people who combined them. Speak to your prescriber or pharmacist before adding St John's wort to any antidepressant.

How well documented: On the drug’s label. The medicine’s FDA-approved label names this supplement, or the kind of product it is.

Last reviewed

How we grade evidenceEditorial policy

What's known

  • On the label. The sertraline (Zoloft) and escitalopram (Lexapro) labels warn that SSRIs can cause serotonin syndrome, a potentially life-threatening condition, and that the risk rises when they are combined with other drugs that raise serotonin. Both labels name St John's wort in that list, along with tryptophan, triptan migraine drugs and tramadol. Serotonin syndrome can also happen on an SSRI alone. (Zoloft label; Lexapro label)
  • Case reports. Doctors described a series of five patients who developed serotonin syndrome after combining prescription antidepressants with St John's wort. A 2001 review of the published reports found mild serotonin syndrome when St John's wort was used with sertraline, paroxetine or nefazodone. No study has measured how often it happens. (Lantz 1999; Izzo 2001)
  • What NIH says. NCCIH says that taking St John's wort with certain antidepressants, or other drugs that affect serotonin, may lead to serotonin-related side effects that can be serious. It also warns that St John's wort weakens many other medicines. (NCCIH)
  • Who is at risk. Anyone taking an SSRI, at any age: the label warning has no age limit. The risk rises with each extra serotonin drug, such as a triptan or tramadol. (Zoloft label)

What to do

  • Talk to your prescriber or pharmacist before you take St John's wort with any antidepressant. If you'd rather use St John's wort instead of your medicine, that's a conversation for your prescriber, not a switch to make yourself.
  • Know the warning signs the labels list: agitation, confusion or hallucinations, a fast heartbeat, sweating, flushing, a high temperature, shaking, stiff or twitching muscles, poor coordination, seizures, nausea, vomiting or diarrhea. Contact your health care provider or go to an emergency room if they appear. (Zoloft label)
  • Don't stop or change a prescribed medicine on your own. The Zoloft label tells prescribers to lower the dose gradually rather than stop it suddenly.
  • If you're pregnant, planning a pregnancy or breastfeeding, ask your doctor or midwife first: NCCIH says St John's wort may be unsafe in pregnancy, and breastfed babies can have colic and drowsiness.

Sources

  1. US National Library of Medicine. Zoloft (sertraline) tablets and oral solution: prescribing information. DailyMed, revised August 2023. DailyMed
  2. US National Library of Medicine. Lexapro (escitalopram) tablets and oral solution: prescribing information. DailyMed, revised October 2023. DailyMed
  3. National Center for Complementary and Integrative Health. St. John's Wort. Last updated May 2025. NCCIH
  4. Lantz MS, et al. St. John's wort and antidepressant drug interactions in the elderly. J Geriatr Psychiatry Neurol. 1999. PubMed 10447148 · doi:10.1177/089198879901200103
  5. Izzo AA, et al. Interactions between herbal medicines and prescribed drugs: a systematic review. Drugs. 2001. PubMed 11772128 · doi:10.2165/00003495-200161150-00002