St. John's Wort: Three Cases of Possible Mania Induction

Moses, Eydie L.; Mallinger, Alan G.

doi:10.1097/00004714-200002000-00027

Cited by 52 publications

(5 citation statements)

References 5 publications

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“…Concomitant use of SJW with warfarin has been associated with decreased anticoagulation properties resulting in unstable or decreased International Normalized Ratio (INR) values and is reportedly responsible for decreased plasma levels of digoxin [ 15 ]. Use of SJW is also associated with the induction of mania or hypomania in patients suffering with bipolar disorder [ 16 ]. It has been postulated that the drug interactions observed with the co-administration of SJW and prescription medication such as those described above are mediated by different mechanisms.…”

Section: Introductionmentioning

confidence: 99%

Clinically relevant safety issues associated with St. John's wort product labels

Clauson

Santamarina

Rutledge

2008

BMC Complement Altern Med

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Background: St. John's wort (SJW), used to treat depression, is popular in the USA, Canada, and parts of Europe. However, there are documented interactions between SJW and prescription medications including warfarin, cyclosporine, indinavir, and oral contraceptives. One source of information about these safety considerations is the product label. The aim of this study was to evaluate the clinically relevant safety information included on labeling in a nationally representative sample of SJW products from the USA.

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Section: Introductionmentioning

confidence: 99%

Clinically relevant safety issues associated with St. John's wort product labels

Clauson

Santamarina

Rutledge

2008

BMC Complement Altern Med

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“…Fourteen case reports described mania, hypomania and two mixed states associated with St John's wort, in seven females [age in years M(SD) = 49.4(12.4)] and seven males [39.4 (17.8)]. Stated reasons for taking St John's wort were depression (12) ( 26 – 34 ), to improve energy (1) ( 29 ) and to relieve symptoms of post-traumatic stress (1) ( 29 ). The time of onset of manic symptoms from commencing HM ranged from 3 days to 2 months.…”

Section: Resultsmentioning

confidence: 99%

Mania Associated With Herbal Medicines, Other Than Cannabis: A Systematic Review and Quality Assessment of Case Reports

et al. 2018

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Background: DSM-5 introduced the diagnostic category of substance/medication-induced bipolar and related disorder. This systematic review examines published reports linking mania with the consumption of herbal medicines (HM), excluding cannabis. Putative pathophysiological mechanisms that may account for the reported HM being associated with mania are discussed.Methods: A systematic search of EMBASE, CINAHL, Health Source, PsychINFO, and PubMed. The quality of case reports meeting inclusion criteria was assessed using the modified Quality Assessment Scale by Agbabiaka.Results: Nineteen single and seven multiple-case reports met inclusion criteria. These yielded a study sample of 35 case reports, 28 of herbal medicine associated mania, 5 of hypomania, and two mixed states, in 17 females [age in years M(SD) = 43.1(13.2)] and 18 males [40.7(18.1)]. A total of 11 herbal medicines were implicated. Case reports by herbal medicine (number of reports) comprised: St John's wort (Hypericum perforatum) (14); Ginseng (Panax ginseng) (5); brindleberry (Garcinia cambogia) (4); ma-huang (Ephedra sinica) (3); “herbal slimming pills” (2); Herbalife products (2); Hydroxycut (1); horny goat weed (Epimedium grandiflorum) (1); “herbal body tonic” (1); celery root (Apium graveolans) (1), and a “herbal mixture” (1). All case reports were associated with use rather than withdrawal of herbal medicines. Only one case report was rated for probability of association using a standardized algorithm. Laboratory assays to confirm composition of the herbal preparation were reported in only one article describing two cases and indicating admixture of a likely causal pharmaceutical in the herbal preparation.Conclusions: Causal attributions are problematic given the limited number of reports, antidepressant co-prescribing in 7 cases, insufficient data regarding pattern and type of herbal medicine use, and lack of a reference frequency for spontaneous mania.The quality assessment scores across the 26 papers (35 case reports) were as follows: low quality (0), lower-medium quality (9), upper-medium quality (10) and high quality (7). Putative pathophysiological mechanisms were postulated for nine of the 11 herbal medicines and centered on HPA-axis activation and increased monoamine activity. Systematic study of the association between herbal medicines and the course of bipolar disorder may contribute to defining targets for pathophysiological research.

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“…The switch has been found with the use of selective serotonin reuptake inhibitors (SSRIs) (Burrai et al, 1991), bupropion (Aggarwal and Sharma, 2011), monoamine oxidase inhibitors (MAOIs) (Stoll et al, 1994) and tricyclic antidepressants (Wehr and Goodwin, 1979). Mania has also been associated with the use of the herbal supplements Yohimbine which acts as a mild MAOI (Price et al, 1984) and St John's wort, which is reported to have antidepressant qualities and has SSRI activity (Moses and Mallinger, 2000). Wehr et al (1988) demonstrated that, in those with rapid cycling BD (n ¼51), 37% showed remission or a slowing of symptoms following the discontinuation of antidepressant medication.…”

Section: Antidepressant Medicationmentioning

confidence: 99%

Comparison of precipitating factors for mania and partial seizures: Indicative of shared pathophysiology?

Bostock

Kirkby

Garry

et al. 2015

Journal of Affective Disorders

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St. John's Wort: Three Cases of Possible Mania Induction

Cited by 52 publications

References 5 publications

Clinically relevant safety issues associated with St. John's wort product labels

Clinically relevant safety issues associated with St. John's wort product labels

Mania Associated With Herbal Medicines, Other Than Cannabis: A Systematic Review and Quality Assessment of Case Reports

Comparison of precipitating factors for mania and partial seizures: Indicative of shared pathophysiology?

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