Advertisement

Mania associated with St. John’s wort

  • Andrew A Nierenberg
    Correspondence
    Address reprint requests to Andrew A. Nierenberg, M.D., Depression Clinical and Research Program, Massachusetts Hospital, WACC 812, 15 Parkman Street, Boston, MA 02114
    Affiliations
    Depression Clinical and Research Program, Clinical Psychopharmacology Unit, Massachusetts General Hospital, Harvard Medical School, Boston (AAN, JM, APW) USA
    Search for articles by this author
  • Tal Burt
    Affiliations
    New York State Psychiatric Institute, Columbia University, New York (TB)., USA
    Search for articles by this author
  • John Matthews
    Affiliations
    Depression Clinical and Research Program, Clinical Psychopharmacology Unit, Massachusetts General Hospital, Harvard Medical School, Boston (AAN, JM, APW) USA
    Search for articles by this author
  • Anthony P Weiss
    Affiliations
    Depression Clinical and Research Program, Clinical Psychopharmacology Unit, Massachusetts General Hospital, Harvard Medical School, Boston (AAN, JM, APW) USA
    Search for articles by this author

      Abstract

      Background: St. John’s wort, the popular herbal remedy touted as an antidepressant, is generally thought to be benign, with few reported side effects. Given its possible efficacy as an antidepressant, evaluation of its propensity to cause affective switching should be evaluated.
      Methods: This report presents two cases of mania temporally associated with the use of St. John’s wort (hypericum).
      Results: As with other antidepressant agents, St. John’s wort may precipitate hypomania, mania, or an increased cycling of mood states, particularly in patients with occult bipolar disorder.
      Conclusions: Because the majority of people who take this popular over-the-counter preparation do so without formal psychiatric evaluations, risk of hypericum-induced mania may be significant. Physicians should screen patients for a history of hypomania or mania before recommending use of St. John’s wort for depression.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Biological Psychiatry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Allen D.
        • Horvath R.
        • Nutt D.
        Antidepressants and mania.
        Hum Psychopharmacol. 1993; 8: 357-360
        • Altshuler L.L.
        • Post R.M.
        • Leverich G.S.
        • Mikalauskas K.
        • Rosoff A.
        • Ackerman B.A.
        Antidepressant-induced mania and cycle acceleration.
        Am J Psychiatry. 1995; 152: 1130-1138
        • Angst J.
        • Felder W.
        • Frey R.
        • Stassen H.H.
        The course of affective disorders.
        Arch Psychiat Nervenkr. 1978; 226: 57-64
        • Goodwin F.K.
        • Jamison K.R.
        Manic-Depressive Illness. Oxford University Press, New York1990
        • Linde K.
        • Ramirez G.
        • Mulrow C.D.
        • Pauls A.
        • Weidenhammer W.
        • Melchart D.
        St. John’s wort for depression—An overview and meta-analysis of randomized clinical trials.
        BMJ. 1996; 313: 253-258
        • Lish J.D.
        • Dime-Meenan S.
        • Whybrow P.C.
        • Price R.A.
        • Hirschfeld R.M.
        The national depression and manic-depression association (DMDA) survey of bipolar members.
        J Affect Disord. 1994; 31: 281-294
        • O’Breasail A.M.
        • Argouarch S.
        Hypomania and St. John’s wort [Letter].
        Can J Psychiatry. 1998; 43: 746-747
        • Schneck C.
        St. John’s wort and hypomania.
        J Clin Psychiatry. 1998; 59: 689
        • Wehr T.A.
        • Goodwin F.K.
        Can antidepressants cause mania and worsen the course of affective illness?.
        Am J Psychiatry. 1987; 144: 1403-1411
        • Wehr T.A.
        • Sack D.A.
        • Rosenthal N.E.
        • Cowdry R.W.
        Rapid cycling affective disorders.
        Am J Psychiatry. 1988; 145: 177-184
        • Zink T.
        • Chaffin J.
        Herbal health products.
        Am Fam Physician. 1998; 58: 1133-1140