St. John's Wort vs. Sertraline Side Effect Profile

Key Differences in Tolerability

Moderate-quality evidence confirms St. John's wort has lower discontinuation rates due to adverse events compared to second-generation antidepressants like sertraline, as recommended by the American College of Clinical Pharmacology 1, 2

The adverse effects associated with St. John's wort include mild gastrointestinal symptoms, fatigue or sedation, and headache, according to the National Institute of Mental Health 2

St. John's wort is a potent inducer of CYP3A4 and P-glycoprotein, which decreases plasma concentrations of numerous medications, as reported by the Mayo Clinic 3, 1, 4
This mechanism causes treatment failure of other medications rather than causing direct adverse effects, as noted by the American College of Clinical Pharmacology 1, 4
Critical interactions include: oral contraceptives, immunosuppressants, warfarin, HIV medications, cancer drugs, and cardiovascular medications, according to the National Institutes of Health 1, 4

Lack of FDA regulation means no standardization of content or potency in U.S. preparations, as reported by the American College of Clinical Pharmacology 1, 2
Drug interaction profile makes it unsuitable for patients on multiple medications, as recommended by the National Institute of Mental Health 1, 4
For perioperative management, St. John's wort must be held for 2 weeks due to multiple drug interactions, serotonin syndrome risk, and potential effects on platelet aggregation, as recommended by the American Society of Anesthesiologists 3