Several patients taking sertraline developed
symptoms diagnosed as
serotonin syndrome, after also taking St John's wort. Another patient taking St John's wort developed severe sedation after taking a single dose of
paroxetine. Isolated cases of mania have also been reported when
SSRIs were taken with St John's wort.
The
incidence of an interaction is probably small, but because of the potential severity of the reaction it would seem prudent to avoid the concurrent use of any SSRI and St John's wort. The CSM in the UK advise that St John's wort should be stopped if patients are taking an SSRI.