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Berkeley Wellness cites negative evidence concerning the use of St. John’s wort for
treatment of severe depression, depression of long duration, bipolar disorder, anxiety,
obsessive-compulsive disorder, seasonal affective disorder, sleep disorders, or
premenstrual syndrome. Brown et al. disagree concerning seasonal affective disorder.
Existing evidence does not resolve this controversy.
- MAJOR RISKS
The risks of serotonin syndrome in people already taking medication for depression
are significant. Serotonin syndrome is a condition defined by tremor, muscle rigidity,
fever or drop in body temperature, confusion, increased blood pressure and heart rate,
and coma. Using St. John’s wort with MAOIs may also increase the risk of severely
increased blood pressure. These symptoms may occur in people taking St. John’s wort
with SSRI antidepressants such as fluoxetine (Prozac) or sertraline (Zoloft) or with
monoamine oxidase inhibitors (MAOIs) such as isocarboxazid (Marplan), phenelzine
(Nardil), or tranylcypromine (Parnate).
Likewise, the risk of triggering cycling (speeding up the depression/mania cycle) in
people with bipolar illness is severe. These two risks make it imperative that people
who have already been under physician treatment, and especially people already taking
psychotropic medication, get physician advice before using St. John’s wort. Use of a
mood stabilizer may reduce this risk.
11. DRUG INTERACTIONS
The potential drug interactions with St. John’s wort are many and serious. This alone
caused the Mayo Clinic to give St. John’s wort a yellow caution light, saying, “You
shouldn't take St. John’s wort if you take prescription medications. It's also important to
talk to your doctor before taking St. John’s wort. If you have a more severe form of
depression, you may need a stronger medication."^17 All of the cited sources urge
caution in the use of St. John’s wort if any other medications are being taken and
counsel physician advice.
