Psychopharmacology: St John's wort interactions: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Psychopharmacology: St John's wort interactions

Sample item

A woman on sertraline starts an over-the-counter herbal remedy for low mood. A week later she has agitation, sweating, tremor, diarrhoea and hyperreflexia. Which herbal product is the likely cause?

ASt John's wortBKavaCValerianDGinkgo biloba

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. St John's wort

St John's wort has serotonergic activity and combined with SSRIs can cause serotonin syndrome. It also induces CYP3A4 and P-glycoprotein, lowering levels of many drugs including oral contraceptives, warfarin and ciclosporin.

Option by option

A. St John's wort (correct)
Correct. Serotonergic herb with an SSRI causes serotonin syndrome.
B. Kava
Kava is anxiolytic and is associated with hepatotoxicity.
C. Valerian
Valerian is a mild sedative and does not cause serotonin syndrome.
D. Ginkgo biloba
Ginkgo biloba mainly increases bleeding tendency.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is A, St John's wort. St John's wort has serotonergic activity and combined with SSRIs can cause serotonin syndrome.

Why is "Kava" not the answer?

Kava is anxiolytic and is associated with hepatotoxicity.

Why is "Valerian" not the answer?

Valerian is a mild sedative and does not cause serotonin syndrome.

Why is "Ginkgo biloba" not the answer?

Ginkgo biloba mainly increases bleeding tendency.

What concept does this question test?

It tests Psychopharmacology: St John's wort interactions in Psychiatry. It also induces CYP3A4 and P-glycoprotein, lowering levels of many drugs including oral contraceptives, warfarin and ciclosporin.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Psychopharmacology: St John's wort interactions?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.