Why You Shouldn't Use St. John's Wort for Bipolar

St. John's Wort Controversy. Mario Tama / GettyImages

St. John's 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 may be 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. John's wort may be an effective treatment. However, there are also reasons why this herb should may not be appropriate, so you should always talk to your doctor before you try this or any other natural supplement.

Why St. John's Wort Is Not Advised for Bipolar Disorder Patients

The following reasons are cited as to why St. John's wort is not recommended for people with bipolar disorder.

Serotonin Syndrome

Serotonin syndrome is a condition can occur after the use of certain serotonergic medications and supplements. Symptoms include dizziness, cognitive difficulty, faintness when standing or walking, unsteadiness when walking, muscle spasms, and a racing heartbeat. People may experience this group of symptoms if they take St. John's Wort when they are also taking an SSRI such as fluoxetine (Prozac) or SNRI like duloxetine (Cymbalta), or and MAOI.

Because St. John's wort may increase the amount of serotonin available, combining the herb with an SSRI such as Prozac or Paxil is not recommended.

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. John's 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. John's 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.

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. John's wort and certain prescription medications.

Researchers found that the use of St. John's wort significantly reduces the effectiveness of some AIDS medications (indinavir and other antiretroviral agents).

Because of the way St. John's 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; and
  • The 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).

A Word From Verywell

For a number of reasons, then, the bottom line with St. John's 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.

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  1. Nierenberg AA, Burt T, Matthews J, Weiss AP. Mania associated with St. John's wortBiol Psychiatry. 1999;46(12):1707–1708. doi:10.1016/s0006-3223(99)00233-4

  2. James JS. St. John's wort warning: do not combine with protease inhibitors, NNRTIsAIDS Treat News. 2000;(No 337):3–5.

  3. FDA. Drug-herbal interactions. Updated April 7, 2016.

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