Table 1. Differences between St. John's wort and the most common antidepressant groups.

SSRI: selective serotonin reuptake inhibitors; GABA: gamma-aminobutyric acid; NSAIDs: non-steroidal anti-inflammatory drugs.

PARAMETER	St. JOHNS WORT	TRICYCLIC ANTIDEPRESSANT (TCA)	SEROTONIN REUPTAKE INHIBITORS (SSRI)
Efficacy	Almost the same as conventional antidepressants	Effective treatment for depression	First-line treatment for depression
Safety	Same as conventional antidepressants	Safe use	Safe use
Most common adverse effect	Less than conventional antidepressants	Cardiac arrhythmia	Serotoninergic syndrome
Mechanism of action	Inhibition of the reuptake of serotonin monoamine oxidase activity reduces GABA binding.	Inhibition of the reuptake of serotonin and norepinephrine	Inhibition of the reuptake of serotonin
Cost	Low	Higher	High
Rate of discontinuation due to side effects	Low	Higher than St John's Wort	Higher than St John's Wort
Withdrawal symptoms rate	Low	Higher than St John's Wort	Higher than St John's Wort
Long-term antidepressant effects	Limited data	Well known long effectiveness	Well known long effectiveness
Approved by FDA	No	Yes	Yes
Drug interactions	HIV drugs, ciclosporin, tacrolimus, digoxin, oxycodone, warfarin, etc.	SSRI, anticholinergic, antihypertensive. antihistamine, etc.	NSAIDs, aspirin, warfarin, and all drugs increase serotonin, etc.