title: Mania associated with St. John's wort.
abstract: BACKGROUND
  St. John's wort, the popular herbal remedy touted as an antidepressant, is generally thought to be benign, with few reported side effects. Given its possible efficacy as an antidepressant, evaluation of its propensity to cause affective switching should be evaluated.
  
  
  METHODS
  This report presents two cases of mania temporally associated with the use of St. John's wort (hypericum).
  
  
  RESULTS
  As with other antidepressant agents, St. John's wort may precipitate hypomania, mania, or an increased cycling of mood states, particularly in 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 patients for a history of hypomania or mania before recommending use of St. John's wort for depression.
authors.affiliation: Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Nierenberg
authors.forename: T
authors.initials: T
authors.lastname: Burt
authors.forename: J
authors.initials: J
authors.lastname: Matthews
authors.forename: A P
authors.initials: AP
authors.lastname: Weiss
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000139:chemically induced* / Q000188:drug therapy / Q000235:genetics; D004359:Drug Therapy, Combination; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D020902:Hypericum / Q000009:adverse effects*; D008094:Lithium / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010946:Plants, Medicinal; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D008094:Lithium