St. John's Wort

Tier 2 — promising · Mild-moderate depression

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