Escitalopram Interactions

Escitalopram is a selective SSRI cleared mainly by CYP2C19 and CYP3A4. St. John's wort independently raises serotonin tone and is a strong inducer of those same enzymes and P-glycoprotein. Taken together, the combination can add to serotonergic effects and, through enzyme induction, lower escitalopram levels and blunt its antidepressant effect. Documented serotonin syndrome cases with St. John's wort involve other SSRIs rather than escitalopram specifically, so the combination is best avoided rather than treated as a guaranteed emergency.