The Safety of St. Johns Wort for Bipolar Disorder

The Safety of St. John's Wort for Bipolar Disorder Bipolar Disorder Treatment Medications Print Why You Shouldnt Use St. Johns Wort for Bipolar By Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. Learn about our editorial policy Marcia Purse Updated on January 04, 2020 Bipolar Disorder Overview Symptoms & Diagnosis Causes Treatment Living With In Children Your Rights St. Johns Wort Controversy. Mario Tama / GettyImages St. Johns wort (SJW) has a beautiful flower, but could it be dangerous for bipolar disorder sufferers? The herbal supplement is most commonly made from the species Hypericum perforatum, a perennial weedy type and this is whats used for the treatment of mild depression. Although clinical trials are ongoing for this increasingly popular herbal supplement, it seems clear that for mild depression, St. Johns wort may be an effective treatment. However, there are factors that indicate that this herb should not be used by persons who have bipolar disorder. For example, it has been designated as a noxious weed because grazing animals who eat this plant can become hypersensitive to sunlight which may also affect humans. What Is St. Johns Wort Used For and Can It Benefit You? Why St. Johns Wort Is Not Advised for Bipolar Disorder Patients The following reasons are cited as to why St. Johns wort is not recommended for people with bipolar disorder. Serotonin Syndrome Camilla Cracchiolo, R.N., who is studying St. Johns wort in-depth, has found that patients using the herb all reported a gradual onset of dizziness, cognitive difficulty, faintness when standing or walking, unsteadiness when walking, muscle spasms and a racing heartbeat. Because St. Johns wort may increase the amount of serotonin available, combining the herb with an SSRI such as Prozac or Paxil is not recommended. How Serotonin Syndrome Is Diagnosed and Treated Mania Trigger It is well known that any antidepressant, when taken without a mood stabilizer, can set off a manic or hypomanic episode. Some people never exhibit mania at all until treated for depression with a triggering drug. Since St. Johns wort acts as an anti-depressant, there is good reason to exercise caution. Researchers at Harvard Medical School and the University of Michigan have issued warnings regarding St. Johns wort as a possible triggering substance. Published case reports have documented several cases of sudden onset of mania in bipolar patients who were using the herbal supplement. How to Recognize a Manic or Hypomanic Episode Drug Interactions In February of 2000, the US Food and Drug Administration released a Public Health Advisory warning that there was a risk of dangerous interactions between St. Johns wort and certain prescription medications. Researchers found that the use of St. Johns wort significantly reduces the effectiveness of some AIDS medications (indinavir and other antiretroviral agents). Because of the way St. Johns wort operates in the body, the FDA also warned that it may also be unsafe to take it along with some common medications for heart disease, transplant rejection, and cancer, among others. Drugs mentioned by name that is used in the treatment of mood disorders were: The tricyclic antidepressants ?Tofranil (imipramine), Asendin (amoxapine), and Elavil (amitriptyline);The anti-seizure medication Tegretol (carbamazepine), used as a mood stabilizer; andThe cancer medication Tamoxifen, which is being studied as a mood stabilizer. It would be safer to assume that other drugs related to these would also be in the same category, including other tricyclics such as Vivactil (protriptyline) and Pamelor (nortriptyline) and the mood stabilizer ?Trileptal (oxcarbazepine). St. Johns Wort Drug Interactions With Antidepressants The Bottom Line For a number of reasons, then, the bottom line with St. Johns wort for persons with manic-depressive illness should be Better safe than sorry. If you or someone you love who is bipolar insists on using this supplement, use extreme caution. Notify your physician or psychiatrist, and be on the lookout for any complications and changes in mood or behavior that could be dangerous.