Who Should Not Take St John's Wort: Mental Health And Surgery

Bipolar Disorder

Those with bipolar disorder experience a cycling between mania and depression. When manic, these people exhibit excessive activity and impulsive behaviors. St John’s wort is known to induce mania, so in a person with bipolar disorder, this can make the cycle between mania and depression more rapid.

ADHD

Some people think that St John’s wort is beneficial for those with ADHD, to aid with controlling the symptoms. However, because there has been evidence of the development in mania in people with ADHD, particularly if they are taking Methylphenidate at the same time, you should not take St John’s wort.

Major Depression

Like other mood disorders, taking St John’s wort for major depressive episodes could induce a state of mania, so it should not be taken.

Schizophrenia

St John’s wort can cause those with schizophrenia to develop psychosis, so it should definitely be avoided.

Alzheimer’s Disease

There are concerns that it may increase the level of dementia suffered by those with Alzheimer’s.

Surgery and Anesthesia

St John’s wort can cause serious heart complications during surgical procedures, so it should be avoided for at least two weeks before any scheduled operations. It can also affect the serotonin levels in the brain during surgery.

Drug Interactions

St John’s wort interacts with multiple different types of drugs, and many of these interactions can be severe, posing a serious health risk. As well as interacting with all forms of medication that is prescribed for mental health issues, other notable drug classes that interact with St John’s wort are those that are used to treat pain, seizures, cancer, heart disease and many others.  Following are the main drugs that St John’s wort interacts with and the effects that can be caused.

• Aminolevulinic Acid: Causes increased photosensitivity, leading to higher risk of sunburn, blistering and rashes on skin that is exposed to the sunlight.
• Contraceptive Pills: This interaction may result in an increase in the breaking down of estrogen, leading to failure of the birth control pill.
• Cyclosporine: Causes an increase of the speed at which Cyclosporine is broken down by the body, reducing the effectiveness of the Cyclosporine.
• Digoxin: The effectiveness of digoxin on the heart may be decreased when taken in association with St John’s wort.
• Imatinib (Gleevec): Also may increase the speed at which the Imatinib is broken down, reducing the effectiveness.
• Irinotecan (Camptosar): This cancer treating drug is compromised because of the increase in the speed at which the body breaks down the Irinotecan, leading to less effectiveness.
• Demerol: Because both Demerol and St John’s wort both cause an increase in serotonin, serious side effects can occur including anxiety and heart problems.
• Dilantin: Again St John’s wort effects how Dilantin works because it speeds up the breaking down of the Dilantin by the body, removing it too quickly.
• Warfarin: St John’s wort can increase how fast the Warfarin is broken down, potentially resulting in a higher risk of blood clotting.

To Take Or Not To Take?

Just like any other medicine, natural or pharmaceutical, whether or not you take a particular medicine should be discussed with your doctor. Generally, provided you don’t have any serious health issues and are not on other medications, short term usage may be quite safe for you, but this is something only your doctor can determine. Remember – just because it is natural, doesn’t mean it isn’t harmful.