Mania associated with St. John's wort

Background: St. John's wort, the popular herbal remedy touted as an antidep ressant, is generally thought to be benign, with few reported side effects. Given its possible efficacy as an antidepressant, evaluation of its propen sity to cause affective switching should be evaluated. Methods: This report presents two cases of mania tempor- ally associated wi th the use of St. John's wort (hypericum). Results: As with other antidepressant agents, St. John's wort may precipita te hypomania, mania, or an increased cycling of mood states, particularly i n 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 patien ts for a history of hypomania or mania before recommending use of St. John' s wort for depression, Biol Psychiatry 1999;46:1707-1708 (C) 1999 Society o f Biological Psychiatry.