Can St. John's wort interact with antidepressants?

Question

Hello doctor,

I had a serotonin reaction to a single Aropax tablet that caused dilated pupils, hypertonic, and agitation 17 years ago. I was given a Valium to call me down, and I slept overnight in the hospital. However, the next day, panic attacks and hypervigilance kicked in. I could not relax or sleep, I developed panic disorder, and I was too scared to take any more medications. So I suffered like this for almost nine months before; out of sheer exhaustion, I tried Mirtazapine and was able to sleep and slowly get better. It was a living hell for nine months, and I have PTSD from the experience. I have never had an explanation as to what happened to me and why it was like a switch flicked after one pill, and I was not the same. I had taken St John’s wort before taking Aropax but had stopped at least three weeks before. Is anyone able to explain what happened to me? I feel it would give me great peace to understand, as I still have fear it could happen to me again. Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Serotonin syndrome is rare, and it does not depend only on medication dose. Sometimes, it also depends upon a person's susceptibility to it. It can even happen with just one pill of medication. While St. John's wort is known to affect serotonin levels, three weeks is typically sufficient for it to clear from your system. However, individual variations in metabolism and drug interactions can sometimes result in lingering effects. You are not stable on Mirtazapine; you must continue it. You should also follow the below lifestyle to deal with your panic disorder. It will help you. Also, follow the below suggestions:

Exercises daily for 30 to 45 minutes, like at least going for a walk.
Meditate for 20 minutes daily, just sit in one place in a comfortable position, and try to concentrate on your normal breathing, do not stop or force yourself to stop your thoughts, just let it be. It will help you to relax.
Eat healthy home-cooked foods, and avoid junk foods.
Drink enough water.
Spend quality time with friends and family daily or do video calls if you are living away from your family.
Spend time on creative hobbies like reading good books, writing journals, painting, drawing, and learning new skills or language or musical instruments.
Get seven to eight hours of sleep daily.
Avoid tobacco, alcohol, or any substance abuse.

I hope that you get your answer. Please let me know if you want some help.

Thank you.