St. John's Wort
What it is
Cochrane found it works as well as SSRIs for mild-to-moderate depression with fewer side effects. Critical warnings: activates CYP3A4 enzymes, dramatically reducing blood levels of warfarin, HIV medications, oral contraceptives, and chemotherapy. Never combine with SSRIs/SNRIs — risk of fatal serotonin syndrome. Not for severe depression. Medical supervision is essential.
Dose
900 mg/day (300 mg × 3) standardised extract (0.3% hypericin or 5% hyperforin); do not self-prescribe
Time of day & tips
Do not take this supplement without medical supervision. It interacts dangerously with many prescription drugs including contraceptives, warfarin, and antidepressants. Medical review is essential.
Cycling
Typically used for 4-12 weeks for mild-moderate depression. Do not stop abruptly — taper over 1-2 weeks. Requires careful medication review before starting.
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