Q & A: Herbal supplements and antidepressants

by Jackie Hart, MD

Q:My doctor recently prescribed the antidepressant Paxil, but I have also been taking St. Johns Wort, kava kava, gotu kola, and valerian root. Is it safe to continue taking these herbal supplements while taking the Paxil?

A: Simply put, no, it is not safe to take these herbs with the antidepressant medication you mention. In addition, I am concerned that the combination of herbs you have been taking is not wise to mix either.

Paroxetine (Paxil) is one of a class of medications known as selective serotonin reuptake inhibitors, or SSRIs; fluoxetine (Prozac), sertraline (Zoloft) and citalopram (Celexa) are other examples of SSRIs. These drugs block the uptake and breakdown of serotonin, a brain chemical that influences mood and emotion. Low levels of serotonin can lead to depression. By blocking the breakdown and removal of serotonin, SSRIs increase the level of circulating serotonin and may thus improve mood.

The herbal supplement St. Johns Wort may also increase the amount of circulating serotonin. If taken together, therefore, SSRIs and St. Johns Wort may elicit a reaction called "serotonin syndrome," the symptoms of which include excessive sweating, altered and unclear thinking, irrational or erratic behavior, and extreme anxiety as well as panic attacks. Talk to your doctor about how to wean off of the St. Johns Wort if you are starting Paxil or any other medication for depression.

Kava kava, used in the United States and Europe for stress and anxiety, should be avoided by people taking St. Johns Wort or prescription antidepressant medications, because it may interfere with the intended effects of these substances. In addition, kava kava should be used only for short-term, not long-term, use, such as in the event of a particularly stressful or anxiety-producing situation.

Valerian is a sedative used for restlessness and sleep disturbances caused by nervousness and should also be avoided by people taking prescription antidepressants or St. Johns Wort, because of possible exaggeration of or interference with their medicinal effects. In addition, both Valerian and St. Johns Wort may inhibit absorption of iron; so, together, this problem could, in theory, be exacerbated.

Gotu kola is a stimulant. There is less information about gotu kola than the other herbs mentioned, but, suffice it to say that the combination of so many psychoactive substances that is, substances that affect the mind and mental processes is risky and should be determined as well as monitored by a physician.

Please make sure that your doctor knows which herbs you are taking and only continue those that he or she condones. If you would like to continue taking herbs, I would suggest you see a licensed, certified naturopathic doctor who can direct your care, in addition to seeing your physician who prescribes the Paxil.