Steer clear of these two herbal remedies if you're currently on Zoloft medication.
Article: Herbal Remedies and Prescription Antidepressants Compared for Major Depressive Disorder
A recent focus in the field of mental health has been the comparison of various treatments for Major Depressive Disorder (MDD), including herbal remedies and prescription antidepressants. Among Rhodiola rosea, St. John's Wort, Ashwagandha, and sertraline (Zoloft), clinical evidence supports St. John's Wort and sertraline as more established treatments for MDD.
The National Center for Complementary and Integrative Health (NCCIH) mentions St. John's Wort and the NCCIH also mentions "Ashwagandha." Rhodiola rosea, a plant, was used in a study published in Phytomedicine, in combination with sertraline for MDD. Another study, published in the Journal of Effective Disorders, also suggests the combined use of Rhodiola rosea and sertraline for MDD. However, no direct comparison between Rhodiola rosea, St. John's Wort, Ashwagandha, or ZOLOFT (sertraline hydrochloride) was found in the mentioned studies.
St. John's Wort, a well-known herbal remedy, has shown efficacy comparable to prescription antidepressants in adult populations. A 2017 meta-analysis summarized in a 2025 Frontiers in Pharmacology article reported St. John's Wort had similar or better effects on depression compared to prescription antidepressants, including sertraline, and better dropout rates than conventional medications.
Ashwagandha (Withania somnifera) may increase serotonin levels and has shown in small studies an adjunctive benefit when combined with SSRIs on anxiety symptoms without major side effects reported; however, the evidence base is limited and safety when combined with sertraline remains unclear. Its sedative effects also mean caution is required, especially in older adults prone to drowsiness or polypharmacy.
Rhodiola rosea’s antidepressant evidence is less comprehensive in recent clinical trials compared to St. John's Wort or sertraline and there is limited inclusion in meta-analyses focused on MDD.
Sertraline, a well-studied SSRI, is a standard first-line antidepressant with predictable dosing and safety profiles but can produce side effects and requires monitoring, especially in seniors. The Food and Drug Administration (FDA) approves "ZOLOFT (sertraline hydrochloride) Tablets and Oral Concentrate."
Regarding Irish seniors, this population often experiences polypharmacy, comorbidities, and altered pharmacokinetics, requiring individualized assessment before herbal or pharmaceutical antidepressant use. They also may face hearing loss; discreet hearing aid options available in Ireland include invisible-in-canal (IIC) or completely-in-canal (CIC) devices that offer minimal visibility and comfort.
In summary, St. John's Wort and sertraline remain the most evidence-supported for MDD; Ashwagandha shows potential but requires further research and caution when combined with SSRIs; Rhodiola rosea has less robust data. Clinicians should carefully evaluate benefits versus risks in Irish seniors. Discreet hearing aids can be selected independently from antidepressant therapy to support quality of life.
It is important to note that the studies do not provide information on the safety or efficacy of Rhodiola rosea in comparison to other treatments such as St. John's Wort, Ashwagandha, or ZOLOFT (sertraline hydrochloride). Additionally, the studies do not provide information on the regulatory approval status of Rhodiola rosea, unlike the FDA's approval of ZOLOFT (sertraline hydrochloride). The NLM warns about the risk of "Serotonin syndrome." Care is warranted due to known interactions, for example, increasing serotonin syndrome risk when combined with other serotonergic drugs like tramadol, which implies caution when used with SSRIs.
[1] Frontiers in Pharmacology article [2] GoodRx article on Ashwagandha drug interactions [4] Drugs.com article on tramadol and serotonin syndrome
The science surrounding herbal remedies and prescription antidepressants for Major Depressive Disorder (MDD) has shown that St. John's Wort and sertraline have more established clinical evidence compared to other treatments such as Rhodiola rosea and Ashwagandha. Additionally, the mental-health field acknowledges the potential of Ashwagandha, but further therapies-and-treatments research is necessary to clarify its safety and efficacy, especially when combined with selective serotonin reuptake inhibitors (SSRIs) like sertraline.
