A client is taking fluoxetine (Prozac) and wonders if adding St. John's wort would help. Knowing that St
John's wort acts similar to selective serotonin reuptake inhibitors (SSRIs), the nurse is concerned that by taking both, the client may develop: 1. Nothing since these substances do not interact.
2. Serotonin syndrome.
3. Mania.
4. Depression.
2
Rationale: SSRIs should not be combined with St. John's wort. Too much serotonin presents a risk for serotonin syndrome. St. John's wort is stipulated for use as a treatment of depressive symptoms, not mania. There is indeed concern, SSRIs should not be taken with St. John's wort.
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