What is happening. Both saffron and St. John's Wort have serotonergic activity. Combining them may additively increase serotonergic tone and, in theory, the risk of serotonin excess, particularly if other serotonergic agents are present.
Mechanism. Additive enhancement of serotonergic signaling; St. John's Wort inhibits serotonin, dopamine, and norepinephrine reuptake while saffron constituents also modulate serotonin reuptake.
Recommendation. Avoid routine combination unless supervised by a clinician. Do not stack with prescription antidepressants. Watch for agitation, sweating, tremor, rapid heartbeat, or confusion.