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Can St. John's wort trigger psychoses?

C Stevinson¹, E Ernst

¹Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK.

International Journal of Clinical Pharmacology and Therapeutics

|October 19, 2004

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St. John's wort (SJW) may trigger mania or hypomania in susceptible individuals, according to a review of case reports. Further research is needed to confirm this link.

Area of Science:

Psychiatry
Pharmacology
Herbal Medicine

Background:

St. John's wort (SJW) is a widely used herbal remedy for depression.
Recent reports suggest a potential link between SJW use and psychotic events.

Purpose of the Study:

To systematically review existing clinical evidence on the association between SJW and psychotic events.
To evaluate the potential for SJW to induce mania or hypomania.

Main Methods:

A comprehensive search of five electronic databases was conducted.
Relevant case reports were identified and data were extracted based on predefined criteria.

Main Results:

Seventeen case reports linked SJW use to psychotic events.

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Mania or hypomania was diagnosed in 12 of these cases.

Causality was deemed possible in most instances, with no positive rechallenge reported.

Conclusions:

Case reports suggest SJW may precipitate manic episodes in vulnerable patients.
Clinicians should consider this potential adverse effect.
Further research is warranted to establish a causal relationship.