Evidence review
Rhodiola for Depression
Rhodiola rosea
The short answer
Early or mixed evidencePossibly a little, for mild to moderate depression, but the evidence is thin and conflicting. A small company-funded trial found rhodiola better than placebo, an independent US trial found no significant difference from placebo, and a 2022 psychiatry taskforce does not currently recommend it. It is not a substitute for depression treatment, and it may interact with antidepressants.
6 key studies reviewed
Updated October 12, 2026
Key points
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01
Two small trials disagree
An Armenian trial of 89 people favored rhodiola over placebo. A US trial of 57 found no significant difference from placebo, with sertraline doing somewhat better than either.
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02
Guidelines are lukewarm at best
A 2022 WFSBP and CANMAT taskforce rated rhodiola “not currently recommended” for major depression. Canada’s 2023 CANMAT update lists it only as a third-line option for mild illness.
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03
Not an MAOI drug
Root extracts blocked MAO enzymes in test tubes, but no human study has shown this at supplement doses. Mixing it with antidepressants still needs a prescriber’s advice.
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04
Case reports with antidepressants
Reports describe a suspected serotonin syndrome with paroxetine and a racing heartbeat with another antidepressant; one man became manic on three times the label dose.
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05
Depression needs proper care
Never stop or swap a prescribed antidepressant for rhodiola. For thoughts of suicide in the US, call or text 988, the Suicide & Crisis Lifeline, or call 911 in an emergency.
Rhodiola might ease mild to moderate depression a little, but the evidence is thin and pulls in both directions. Only two placebo-controlled trials have tested rhodiola on its own in diagnosed depression. A 2007 Armenian trial of 89 people, funded by the company that makes the extract, reported a clear benefit. A 2015 US trial of 57 people, funded by the National Institutes of Health (NIH), found that rhodiola, the antidepressant sertraline, and a placebo (dummy pill) all helped somewhat, with no significant difference between them. A 2022 international psychiatry taskforce therefore rated rhodiola “not currently recommended” for major depression. Nothing here is medical advice. Depression is a real illness that deserves a proper assessment, and anyone with thoughts of suicide needs help now, not a supplement.
Depression, also called major depressive disorder or clinical depression, is more than ordinary sadness. The US National Institute of Mental Health (NIMH) describes it as an illness that can cause severe symptoms affecting how a person feels, thinks, sleeps, eats, and works, and notes that it is a risk factor for suicidal thoughts and behaviors. Rhodiola (Rhodiola rosea), also called golden root or Arctic root, is a plant of cold regions and high altitudes in Europe, Asia, and North America whose root and rhizome (underground stem) have been used in Russia, Scandinavia, and elsewhere in Europe for work performance, fatigue, and depression, according to the US National Center for Complementary and Integrative Health (NCCIH). Soviet researchers studied it as an “adaptogen,” a remedy said to raise resistance to stress, and the European Medicines Agency (EMA) now accepts it as a traditional herbal medicine for symptoms of stress such as fatigue and exhaustion. Its appeal for low mood is the hope of an antidepressant effect without the side effects of prescription drugs.
This page goes deeper than our general rhodiola monograph on one question: does it help depression? It covers the trials of rhodiola alone and added to an antidepressant, who paid for them and how reliable they are, what psychiatric guidelines and regulators say, and the doses and extracts actually tested. It also answers the questions people search for most: whether rhodiola works like an MAOI (monoamine oxidase inhibitor, an older class of antidepressant with strict food and drug rules), which drug interactions have been reported, who should avoid it, and which warning signs mean getting help straight away.
02 The trials
Key studies
The trials and reviews that carry the most weight for this question, with the product and dose each one tested. Results apply to the preparation studied.
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Sarris et al., 2022
Clinical guideline (WFSBP and CANMAT taskforce)
- Who
- 2 randomized trials, 146 people with major depression
- What and how much
- Rhodiola root extract, about 340–680 mg a day
- How long
- 6 and 12 weeks in the underlying trials
One positive and one null trial. Rated “not currently recommended” on its own or added to antidepressants for major depression until a larger multicenter trial is done.
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Urata et al., 2025
Systematic review of 8 randomized trials in milder depression
- Who
- 1,049 people in all; 100 in the single rhodiola trial
- What and how much
- Rhodiola capsule, 0.3 or 0.6 g a day, added to sertraline (Gao 2020)
- How long
- 12 weeks (rhodiola trial)
Listed rhodiola among possible options for mild depression on the strength of that one add-on trial, while stressing the shortage of high-quality trials.
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Hung et al., 2011
Systematic review of 11 placebo-controlled trials
- Who
- Healthy volunteers and patients; 2 trials in mental health conditions
- What and how much
- Oral Rhodiola rosea single-herb preparations
- How long
- Varied
Rhodiola may help physical and mental performance and certain mental health conditions, but none of the individual studies had been independently replicated.
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Darbinyan et al., 2007
Randomized, double-blind, placebo-controlled
- Who
- 89 adults with mild to moderate depression in Armenia
- What and how much
- SHR-5 extract, 340 or 680 mg a day (170 mg tablets)
- How long
- 6 weeks
Hamilton scores fell from about 24 to 16 on either dose but barely moved on placebo (24.17 to 23.41). Funded by the Swedish Herbal Institute, which makes SHR-5.
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Mao et al., 2015
Randomized, double-blind, placebo- and sertraline-controlled
- Who
- 57 US adults with mild to moderate major depression
- What and how much
- SHR-5, 340 mg capsules, 1 to 4 a day; sertraline 50–200 mg
- How long
- 12 weeks
No significant difference among groups (Hamilton change −5.1 rhodiola, −8.2 sertraline, −4.6 placebo). Side effects in 30%, 63%, and 17%. NIH-funded.
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Gao et al., 2020
Randomized, double-blind, placebo-controlled add-on trial
- Who
- 100 adults with mild to moderate major depression in China
- What and how much
- “Rhodiola capsule” 0.3 or 0.6 g a day plus sertraline; species and extract not stated in the abstract
- How long
- 12 weeks
Depression scores fell more with 0.6 g of rhodiola added to sertraline than with sertraline plus placebo. Funded by Chinese government health and science bodies.
03 Evidence
What the research shows
Our rating for Rhodiola for Depression, based on the studies below.
The first trial was run in Yerevan, Armenia. Darbinyan and colleagues (Nordic Journal of Psychiatry 2007) enrolled adults aged 18 to 70 with mild to moderate depression and a Hamilton Rating Scale for Depression (HAMD) score of 21 to 31, after a two-week period off all medication. People with a past suicide attempt or current suicidal thinking were excluded. For six weeks, 31 took 340 mg a day of the SHR-5 extract, 29 took 680 mg a day, and 29 took placebo. Average HAMD scores fell from 24.52 to 15.97 on the lower dose and from 23.79 to 16.72 on the higher dose, but barely changed on placebo (24.17 to 23.41); insomnia, emotional instability, and physical symptoms also improved, and no serious side effects were reported. The study was funded by project grants from the Swedish Herbal Institute, which makes SHR-5, the senior author worked for the company, and the paper notes a pending company patent on SHR-5 for depression. EMA’s assessor found the near-absent placebo response “untypical” for depression trials and called the reported significance questionable, and a statistical review by Blomkvist and colleagues, as summarized by EMA, criticized the trial’s tests and comparisons.
The most careful trial was independent and came out null. Mao and colleagues (Phytomedicine 2015) randomized 57 adults with mild to moderate major depression at the University of Pennsylvania to SHR-5 (20 people), sertraline (19), or placebo (18) for 12 weeks. Capsules held 340 mg of extract or 50 mg of sertraline, and the dose rose from one to as many as four capsules a day in people who had not improved by half. Hamilton scores fell by 5.1 points with rhodiola, 8.2 with sertraline, and 4.6 with placebo, with no significant difference between groups (p = 0.79). Compared with placebo, the odds of improving were 1.39 for rhodiola and 1.90 for sertraline, both with wide confidence intervals that crossed 1, meaning no clear effect. Side effects were reported by 30% on rhodiola, 63% on sertraline, and 17% on placebo, and two people stopped sertraline because of them. The NIH’s complementary medicine center (then NCCAM, now NCCIH) and a University of Pennsylvania fund paid for the work; the Swedish Herbal Institute donated the extract but had no role in the study. The authors acknowledged that the trial was small and underpowered and suggested rhodiola might offer a better balance of benefit and side effects for some people, a hypothesis that still needs a larger trial.
A third trial tested rhodiola as an add-on. Gao and colleagues (Journal of Affective Disorders 2020) randomized 100 adults with mild to moderate major depression in Fujian, China, to sertraline plus placebo or sertraline plus a “Rhodiola capsule” at 0.3 or 0.6 g a day for 12 weeks. Scores improved in all groups, and most with the higher rhodiola dose. The abstract does not name the species or extract, which matters because Chinese medicine often uses other Rhodiola species, and it was funded by Chinese government health and science bodies. Reviews add little new data. Hung, Perry, and Ernst (Phytomedicine 2011) found 11 placebo-controlled trials of rhodiola for any purpose, only two in mental health conditions, and noted that none had been independently replicated. Amsterdam and Panossian (Phytomedicine 2016), one of them from the Swedish Herbal Institute, counted two randomized trials with 146 people in major depression plus seven open-label studies (everyone knew they were taking rhodiola) of 714 people with stress-related mild depression, and judged a possible antidepressant action. Urata and colleagues (Neuropsychopharmacology Reports 2025) reviewed eight trials in milder depression and listed rhodiola as a possible option based on the Gao trial alone, while stressing the shortage of high-quality studies.
Psychiatric guidelines are cautious. The 2022 taskforce of the World Federation of Societies of Biological Psychiatry (WFSBP) and the Canadian Network for Mood and Anxiety Treatments (CANMAT), led by Sarris (World Journal of Biological Psychiatry 2022), weighed one positive and one null trial with 146 people in total and rated rhodiola, at about 340–680 mg a day, “not currently recommended” either on its own or added to antidepressants for major depression. It called for a large multicenter trial and noted that the older Russian research said to support rhodiola has not been translated and made available for public scrutiny. CANMAT’s own 2023 depression guideline (Lam and colleagues, Canadian Journal of Psychiatry 2024) is slightly warmer: it says rhodiola, saffron, and lavender have only modest evidence and, given the major limitations of their trials, keeps them as third-line treatments for mild depression, while St. John’s wort is first-line for mild episodes. Regulators make no depression claim. EMA’s 2024 monograph covers only the relief of stress symptoms such as fatigue and exhaustion, based on traditional use, and its assessment report concluded that the published trials have considerable deficiencies. NCCIH says there isn’t enough reliable evidence to know whether rhodiola is useful for any health purpose.
The MAOI question comes from the laboratory. Van Diermen and colleagues (Journal of Ethnopharmacology 2009) found that methanol and water extracts of rhodiola root blocked the enzymes monoamine oxidase A and B by roughly 82–93% in test-tube assays at 100 µg/ml, and the compound rosiridin was the most active against MAO B. Prescription MAOIs work by blocking these enzymes, which is why the finding is often repeated online. But we found no human study that has measured MAO inhibition after rhodiola, Memorial Sloan Kettering Cancer Center (MSKCC) describes the clinical relevance as yet to be determined, and we found no published report of the dangerous blood pressure spikes from tyramine-rich foods that make true MAOIs hazardous. Rhodiola should not be thought of as an MAOI, but nor should it be combined casually with antidepressants, as described under safety. The open questions are basic: whether a well-defined extract beats placebo in a large, independent trial, how it compares with standard treatment, whether it is safe and useful added to antidepressants, and what happens beyond 12 weeks.
04 In practice
How it was taken in studies
Most depression research used one product, SHR-5, a standardized dry extract of Rhodiola rosea root and rhizome made by the Swedish Herbal Institute. The Armenian trial gave 170 mg tablets, two a day (340 mg) or four a day (680 mg). The US trial used 340 mg capsules standardized to 3.07% rosavin and 1.95% rhodioloside (salidroside), starting at one a day and rising every two weeks, to a maximum of four (1,360 mg), in people who had not improved by half. The Chinese add-on trial used 0.3 or 0.6 g a day of a “Rhodiola capsule” whose extract is not described in its abstract. EMA’s traditional-use monograph, which covers stress symptoms rather than depression, specifies a dry extract (drug-to-extract ratio 1.5–5:1, made with 67–70% ethanol) at 144–200 mg once or twice a day, up to 400 mg a day, for adults only. The higher doses in the depression trials exceed that limit, and none of this is a dosing recommendation.
The trials lasted 6 and 12 weeks. The Armenian trial measured mood only at the start and after six weeks, so it cannot show how soon any change appeared; the US trial rated people repeatedly over 12 weeks and found no significant difference from placebo in how scores changed over time. No depression trial has run longer than 12 weeks, and NCCIH describes rhodiola as possibly safe for up to that long. EMA advises seeing a doctor if symptoms last longer than two weeks while taking a rhodiola product, or get worse. Teas, tinctures, and powdered root are traditional, but none has been tested in depression, and the amount of active compounds they deliver is unknown. Sleeplessness and nervousness are among the reported side effects, which is worth knowing for anyone whose depression already disturbs sleep.
Product quality is a real problem. Booker and colleagues (Phytomedicine 2016) analyzed about 40 commercial products and found that roughly one fifth of those labeled Rhodiola rosea contained no rosavin, the marker compound that identifies the species, some appeared to lack salidroside as well, and about 80% of the rest had less rosavin than registered medicines and seemed to be mixed with other Rhodiola species; one co-author worked for Dr. Willmar Schwabe, a herbal medicine maker. Registered traditional herbal medicines were the most consistent. Look for the full species name, the plant part, the extract ratio or rosavin and salidroside content, and independent quality testing. Multi-ingredient “mood” blends add uncertainty: a rhodiola and saffron tablet was tested in a single study of 45 adults without a placebo group, and all but one author were employees of Groupe PiLeJe, the remaining author a consultant to it (Bangratz and colleagues, Neuropsychiatric Disease and Treatment 2018).
05 Caution
Before you try rhodiola
In the depression trials rhodiola was generally well tolerated. In the US trial, 30% of people on rhodiola reported side effects, compared with 63% on sertraline and 17% on placebo; on rhodiola the ones reported by more than one person were nervousness and dizziness (two people each), and nobody stopped taking it because of side effects. The Armenian trial reported no serious side effects. EMA’s monograph lists headache, nausea, abdominal pain, diarrhea, skin rash, and itching, all of unknown frequency, and NCCIH lists dizziness, headache, insomnia, and either dry mouth or excess saliva. EMA found 26 reports involving rhodiola in the European adverse reaction database up to July 2021, mostly headache, nervousness, insomnia, dizziness, nausea, and vomiting. The trials were short and small, so rarer effects could have been missed.
EMA does not recommend rhodiola for anyone under 18, because safety has not been established, and depression in children and teenagers needs a specialist. It is not recommended in pregnancy or breastfeeding, for lack of data, and the depression trials excluded pregnant and nursing women; depression during or after pregnancy needs care too, so talk to an obstetrician or psychiatrist about options with better safety data. Do not use it if you are allergic to it. People with bipolar disorder, or a past episode of unusually high mood, should not use rhodiola without their psychiatrist. Whig and Leo (Primary Care Companion for CNS Disorders 2022) described a 58-year-old man with no psychiatric history who was taking three times the recommended amount for exercise and arrived at the emergency department loud, hyperactive, grandiose, and with a heart rate of 128; it settled within two days. The authors note that rhodiola’s safety in people vulnerable to bipolar disorder has not been established, and the US trial excluded them.
Interactions: EMA’s monograph states that no clinically relevant interactions have been observed, but its assessment report lists European reports of problems when rhodiola was taken with a single other drug, including agitation, insomnia, and memory problems with sertraline, and with paroxetine a suspected serotonin syndrome with restlessness and tremor and, in another case, nausea, tremor, and suicidal thoughts. Maniscalco and colleagues (Neuropsychiatrie 2015) described a 68-year-old woman on paroxetine 20 mg a day who developed restlessness and trembling 15 days after adding 400 mg a day of rhodiola, which they interpreted as a serotonergic syndrome. MSKCC notes a 26-year-old woman with a fast, irregular heartbeat after three days of rhodiola with her antidepressant and advises caution with prescription antidepressants. A Polish review of 147 herb–drug interaction cases (Woroń and Siwek, Psychiatria Polska 2018) named rhodiola among herbs with a significant risk of interactions with psychiatric drugs. In a human study summarized by EMA (Thu and colleagues 2016), two weeks of rhodiola slowed the liver enzyme CYP2C9 by about 21%, which matters for warfarin, phenytoin, and losartan, and NCCIH notes reported interactions with losartan. Given its laboratory MAO activity, do not combine rhodiola with an MAOI drug such as phenelzine or selegiline.
Depression can be life-threatening. If you or someone you know is having thoughts of suicide or self-harm, in the US call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org, which is free, confidential, and open around the clock, and call 911 in a life-threatening situation. Low mood that gets in the way of work, relationships, or self-care, or that comes with hopelessness, deserves a visit to a doctor or mental health professional, and EMA’s rule for rhodiola products is to see a doctor if symptoms last longer than two weeks or worsen. Never stop, cut down, or swap a prescribed antidepressant for rhodiola without your prescriber, and ask before adding it to any psychiatric medicine. Stop rhodiola and get help promptly for racing thoughts, very little need for sleep, reckless or grandiose behavior, worsening mood, or, if you take an antidepressant, new restlessness, trembling, agitation, or a racing or irregular heartbeat.
06 Questions
Frequently Asked Questions
Possibly a little for mild to moderate depression, but the evidence is weak. An Armenian trial of 89 people, funded by the extract’s maker, found rhodiola better than placebo over six weeks, though regulators questioned it because the placebo group barely changed. An independent US trial of 57 people found no significant difference between rhodiola, sertraline, and placebo over 12 weeks. A 2022 psychiatry taskforce rated it “not currently recommended,” and Canada’s 2023 guideline lists it only as a third-line option for mild depression. It should not replace proper treatment.
No. It is not an MAOI drug, and it is not regulated or prescribed as one. Root extracts blocked the enzymes monoamine oxidase A and B in test tubes, which is where the idea comes from, but no human study has shown that rhodiola blocks these enzymes at supplement doses, and we found no reports of the dangerous food reactions linked to true MAOIs. Its clinical relevance is unknown, so do not combine rhodiola with an MAOI medicine such as phenelzine or selegiline, and check with your prescriber before mixing it with any antidepressant.
Only with your prescriber’s agreement. European safety reports and case studies describe a suspected serotonin syndrome with paroxetine, agitation and insomnia with sertraline, and a racing, irregular heartbeat with another antidepressant. One Chinese trial added a rhodiola capsule to sertraline for 12 weeks, but a single small trial cannot show the combination is safe for everyone or with other drugs. If you try the combination with approval, stop and seek help for restlessness, trembling, agitation, or a fast heartbeat. Never stop your antidepressant to switch to rhodiola.
Antidepressants and other psychiatric drugs are the main concern, based on case reports of serotonin-type reactions, agitation, and heart rhythm problems. In a human study, rhodiola slowed the liver enzyme CYP2C9 by about 21%, which could matter for warfarin, phenytoin, and losartan, and NCCIH notes reported interactions with losartan. Laboratory studies also show effects on MAO enzymes, CYP3A4, and the drug transporter P-glycoprotein, with unclear relevance in people. EMA says no clinically relevant interactions have been observed, but if you take any regular medicine, ask a pharmacist first.
The trials lasted 6 and 12 weeks, and the Armenian trial measured mood only at the start and end, so how quickly any effect appears is unknown. They used the SHR-5 extract at 340 or 680 mg a day, and in the US trial 340 to 1,360 mg a day. EMA’s traditional dose for stress symptoms is lower, 144–400 mg a day of a defined extract, for adults only. Its advice is to see a doctor if symptoms last more than two weeks or worsen. No trial has run beyond 12 weeks.
Both have stronger evidence. St. John’s wort is recommended by the 2022 psychiatry taskforce and is first-line for mild depression in Canada’s guideline, but it interacts with many medicines. Saffron was provisionally recommended by the taskforce, and lavender weakly recommended, while rhodiola was not currently recommended. No trial has compared rhodiola with these herbs directly. Any of them should be discussed with a doctor, especially if you take other medicines or your depression is more than mild.
07 References
Sources
These references support the claims on this page. They are not an endorsement of any product. The rhodiola monograph carries its own full source list.
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Clinician guidelines for the treatment of psychiatric disorders with nutraceuticals and phytoceuticals: The World Federation of Societies of Biological Psychiatry (WFSBP) and Canadian Network for Mood and Anxiety Treatments (CANMAT) Taskforce
World Journal of Biological Psychiatry (PubMed 35311615), 2022
Sarris et al.: rhodiola root at about 340–680 mg a day “not currently recommended” for monotherapy or adjunctive use in MDD; 1 positive and 1 null RCT (n = 146); larger multicenter trial needed; untranslated Russian research; St. John’s wort recommended, saffron provisionally and lavender weakly recommended.
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Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults
Canadian Journal of Psychiatry (PubMed 38711351), 2024
Lam et al.: saffron, lavender, and roseroot have only modest evidence and remain third-line treatments in mild illness; St. John’s wort first-line for mild and second-line for moderate episodes.
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Efficacy of Pharmacological Interventions in Milder Depression: A Systematic Review and Meta-Analysis
Neuropsychopharmacology Reports (PubMed 40014460), 2025
Urata et al.: 8 RCTs, 1,049 participants; the single rhodiola trial (Gao 2020, add-on to sertraline) showed improvement over placebo; few high-quality trials in mild depression.
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Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression
Nordic Journal of Psychiatry (PubMed 17990195), 2007
Darbinyan et al.: 89 adults, HAMD 21–31, 340 or 680 mg SHR-5 or placebo for 6 weeks; HAMD 24.52 to 15.97 and 23.79 to 16.72 versus 24.17 to 23.41 on placebo; funded by the Swedish Herbal Institute, with a pending company patent.
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Rhodiola rosea versus sertraline for major depressive disorder: A randomized placebo-controlled trial
Phytomedicine (PubMed 25837277), 2015
Mao et al.: 57 adults, 12 weeks, SHR-5 340–1,360 mg a day versus sertraline versus placebo; HAM-D −5.1, −8.2, −4.6 (p = 0.79); adverse events 30.0%, 63.2%, 16.7%; NCCAM grant R21 AT005230; extract donated by the maker, which had no role.
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Antidepressants effects of Rhodiola capsule combined with sertraline for major depressive disorder: A randomized double-blind placebo-controlled clinical trial
Journal of Affective Disorders (PubMed 32090788), 2020
Gao et al.: 100 adults in China, sertraline plus placebo or plus Rhodiola capsule 0.3 or 0.6 g a day for 12 weeks; greater improvement with the higher dose; funded by Chinese government bodies.
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European Union herbal monograph on Rhodiola rosea L., rhizoma et radix (Revision 1)
European Medicines Agency (EMA/HMPC/24177/2023), 2024
Traditional use for relief of stress symptoms such as fatigue and exhaustion; 144–200 mg once or twice daily, up to 400 mg; not under 18 or in pregnancy and lactation; see a doctor after 2 weeks; listed side effects; no clinically relevant interactions observed.
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Assessment report on Rhodiola rosea L., rhizoma et radix (Revision 1)
European Medicines Agency (EMA/HMPC/24186/2023), 2024
Assessor calls the Darbinyan placebo response untypical; summarizes Blomkvist critique, MAO assays, EudraVigilance reports with sertraline and paroxetine, the Woroń and Siwek series, and the Thu CYP2C9 study; well-established use not accepted.
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Rhodiola
National Center for Complementary and Integrative Health (NIH), 2025
Traditional use for depression and fatigue; not enough reliable evidence for any health purpose; possibly safe up to 12 weeks; dizziness, headache, insomnia, saliva changes; losartan interaction; depression can be serious.
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Rhodiola
Memorial Sloan Kettering Cancer Center, About Herbs, 2026
Caution with prescription antidepressants after a tachyarrhythmia case in a 26-year-old woman; MAO inhibition may add serotonergic effects, clinical relevance yet to be determined; CYP2C9, CYP3A4, and P-glycoprotein cautions.
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Monoamine oxidase inhibition by Rhodiola rosea L. roots
Journal of Ethnopharmacology (PubMed 19168123), 2009
Van Diermen et al.: methanol and water extracts inhibited MAO A by 92.5% and 84.3% and MAO B by 81.8% and 88.9% at 100 µg/ml in vitro; rosiridin most active on MAO B.
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The interaction of Rhodiola rosea and antidepressants. A case report
Neuropsychiatrie (PubMed 25413939), 2015
Maniscalco et al.: 68-year-old woman with recurrent depression developed restlessness and trembling after adding rhodiola to paroxetine, interpreted as a serotonergic syndrome.
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Mania Associated With Rhodiola Rosea: An Adaptogen With Antidepressant Effects
Primary Care Companion for CNS Disorders (PubMed 35303403), 2022
Whig and Leo: 58-year-old man without psychiatric history, taking 3 times the recommended amount, presented with mania that resolved in 2 days; safety in people vulnerable to bipolar disorder not established.
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The authenticity and quality of Rhodiola rosea products
Phytomedicine (PubMed 26626192), 2016
Booker et al.: about 40 products; roughly one fifth lacked rosavin; about 80% of the rest lower in rosavin than registered products and apparently adulterated with other Rhodiola species.