St John’s wort (Hypericum perforatum)-induced psychosis: a case report

Abstract

BackgroundSt John’s wort (Hypericum perforatum) has been known for centuries for its therapeutic properties and its efficacy as an antidepressant has been confirmed by a growing body of evidence. During the last two decades it has also come to prominence with a wider public, due to advertising efforts across Europe and United States of America. However, its availability without prescription, as an over-the-counter medication, raises some concern regarding its clinical management and unsupervised administration to individuals with psychopathological risks. To date, the evidence available regarding the administration of Hypericum in people with severe mental health problems is still meager and refers mainly to affective disorder spectrum or psychotic relapse in people with established diagnoses. To the best of our knowledge, this is the first report regarding the onset of psychotic features in a patient presenting with psychotic diathesis.Case presentationThe case discussed in this report is a 25-year-old white man, not known to the psychiatric services, with a history of brief and self-remitting drug-induced psychosis and a positive family history of psychotic depression. He was admitted to hospital due to the onset of florid psychotic symptoms concomitant with self-administration of Hypericum perforatum.ConclusionsThe aim of this report is to promote further systematic research, draw the attention of clinicians to the potential risks of Hypericum precipitating psychosis, and raise awareness among health professionals to investigate and caution their patients on the haphazard use of phytotherapeutics such as Hypericum.

The efficacy and safety of St. John’s wort extract in depression therapy compared to SSRIs in adults: A meta-analysis of randomized clinical trials

“…Unlike our results, case studies by Ferrara et al 30 and Arold et al 31 did not find SJW to be a perfectly safe and convincing alternative. They reported risks associated with its use, and suggested checking its dose and side effects more carefully before using it in the treatment of depression.…”

“…However, the evidence regarding St. John's wort efficacy for the treatment of depression with fewer adverse effects is still insufficient since many studies, like the case study by Ferrara et al 30 and Arold et al, 31 did not find it perfectly safe and reported risk associated with its use in the treatment of depression. The contradictions regarding St. John's wort's safety and efficacy arise due to the limited amount of available case reports, use of unblinded assessments, and lack of refined analysis and evidence-level grade assessment.…”

Suspected adverse reactions to performance enhancing dietary supplements: Spontaneous reports from the Italian phytovigilance system

“…The suspected product contained H. perforatum aerial parts (hypericin 0.3%) and R. rosea root (rosavin 3%). Several cases (n = 14) of psychotic symptoms associated with H. perforatum administration have been published, although a past psychiatric history of mental disorder was usually present (Bostock, Kirkby, Garry, Taylor, & Hawrelak, 2018;Ferrara, Mungai, & Starace, 2017). Regarding R. rosea, one case of restlessness and trembling has been reported but with the concomitant assumption of the SSRI paroxetine (Maniscalco, Toffol, Giupponi, & Conca, 2015).…”

Biological Activity of Hypericum Perforatum L. (Hypericaceae): A Review

“…Однако, препараты H. perforatum имеют бóльшую частоту возникновения специфических побочных эффектов, включая реакции со стороны нервной и репродуктивной систем, органов слуха и зрения, печени и почек [28]. Сообщается о развитии психоза у пациента, принимавшего настой H. perforatum без назначения врача [29].…”