NutriStack
Escitalopram and St. John's Wort, contraindicated.
Combining escitalopram with St. John's Wort significantly increases the risk of serotonin syndrome. Escitalopram is the most selective SSRI, and adding St. John's Wort's serotonergic activity creates dangerous serotonin excess. St. John's Wort may also reduce escitalopram levels via CYP3A4 induction while paradoxically increasing serotonin toxicity risk.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
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At a glance
- Substances
- Escitalopram and St. John's Wort
- Pair type
- Contraindicated
- Evidence (highest tier)
- Strong
- Source citations
- 1 source
- Stack Score effect
- −25 to your Stack Score (per scored contraindication row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Contraindicated · Strong evidence
Contraindicated
What is happening. Combining escitalopram with St. John's Wort significantly increases the risk of serotonin syndrome. Escitalopram is the most selective SSRI, and adding St. John's Wort's serotonergic activity creates dangerous serotonin excess. St. John's Wort may also reduce escitalopram levels via CYP3A4 induction while paradoxically increasing serotonin toxicity risk.
Mechanism. Escitalopram is a highly selective serotonin reuptake inhibitor. St. John's Wort adds serotonin reuptake inhibition via hyperforin and potential MAO inhibition. The dual serotonergic mechanism causes excessive 5-HT receptor stimulation, particularly at 5-HT1A and 5-HT2A receptors.
Recommendation. Do not take St. John's Wort with escitalopram. If mood support beyond your SSRI is needed, discuss evidence-based options with your prescriber.
Sources (1)
Stack Score
How this pair moves the number.
Effect on the composite score
If both Escitalopram and St. John's Wort are in the same stack, this pair applies −25 to your Stack Score (per scored contraindication row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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