Can Hypericum perforatum (St John’s wort) trigger psychoses?
The aim of this systematic review was to evaluate the clinical evidence associating H. perforatum with psychotic events. Five electronic databases were searched for all relevant reports. Data were extracted according to predefined criteria. Seventeen case reports associated use of H. perforatum with psychotic events. In 12 instances the diagnosis was mania or hypomania. Causality is in most cases possible. In no case was a positive rechallenge reported. These case reports raise the possibility that H. perforatum may trigger episodes of mania in vulnerable patients. Clinicians should be aware of this possibility and researchers should attempt to ascertain whether or not the association is causal.
