hypericum and Bipolar-Disorder

There is a large evidence base of clinical trials that have investigated the efficacy of a range of nutraceuticals on mood disorders. The aim of the current review is to provide an update regarding the efficacy and safety of nutraceutical agents in mood disorders and to highlight considerations for future research.. Nutraceuticals such as omega-3, probiotics, zinc, saffron and curcumin have been recommended as adjunctive interventions to standard treatments for people with depression, while St John's wort has been recommended as a monotherapy. In contrast, less research has been devoted to investigating the effect of nutraceuticals in bipolar disorder, with omega-3 being weakly recommended as an adjunctive to standard treatments. Although the safety profile of most nutraceuticals appears acceptable, more insight into the long-term effects within a range of cohorts is recommended.. There are a number of nutraceuticals that have clinical trial support for their use as either adjunctive interventions for depression; however, there is mostly limited support for their use in bipolar disorder. Further randomized controlled trials that take into consideration a number of emerging mechanisms, potential nutraceutical combinations and factors that may predict treatment response are required to inform clinical use.

Topics: Bipolar Disorder; Dietary Supplements; Humans; Hypericum; Mood Disorders

There has been growing interest in the use of complementary and alternative treatments in pediatric bipolar disorder (BPD). There are limited data, however, regarding the safety and efficacy of these treatments. This article discusses select complementary and alternative treatments that have been considered for use in pediatric BPD and/or depression, including omega-3-fatty acids, inositol, St. John's wort, SAMe, melatonin, lecithin, and acupuncture. Background information, reference to available adult and pediatric data, proposed mechanisms of action, dosing, side effects, and precautions of these treatments are included. Across the board, more research is necessary and warranted regarding the long-term safety and efficacy of available complementary and alternative treatments for the management of pediatric BPD.

Topics: Acupuncture; Anticonvulsants; Antipsychotic Agents; Bipolar Disorder; Child; Humans; Hypericum; Inositol; Lecithins; Lithium Carbonate; Melatonin; S-Adenosylmethionine; Valproic Acid

Many patients look to complementary and alternative medicine for a herbal solution to depression. This literature review summarizes recently published research on the treatment of depression using St. John's wort (Hypericum perforatum).. The compounds in St. John's wort herbal preparations are more effective than placebo and, in several studies, more effective than common antidepressant medications in treating minor depression. However, the efficacy of St. John's wort for treating major depression, cyclothymia, or bipolar disorder is less evident. Although some studies are promising in the treatment of these major disorders, research support is lacking, and it is a controversial aspect of Hypericum therapy.. As with any herbal treatment, risks from adverse reactions and drug interactions exist. Providers have an ethical and legal obligation to stay current in knowledge and to provide useful, accurate information to patients.

Topics: Antidepressive Agents; Bipolar Disorder; Cyclothymic Disorder; Depression; Depressive Disorder; Holistic Nursing; Humans; Hypericum; Nursing Methodology Research; Phytotherapy; Research Design; Treatment Outcome

A growing number of patients with mood disorders are using complementary and alternative medicine (CAM) interventions. In this paper, we review the published scientific evidence on the benefits and risks of CAM for the treatment of patients with bipolar disorder. Since very few studies of CAM have involved patients with bipolar disorder, most available evidence is derived from trials conducted in patients with major depressive disorder. The use of omega-3 fatty acids has been studied in two controlled studies in bipolar disorder while St. John's wort (Hypericum perforatum), S-adenosyl-l-methionine (SAMe), and acupuncture have been studied in a series of randomized controlled trials in patients with major depression. Overall, the best evidence supports the use of St. John's wort for the treatment of mild to moderate depression. SAMe may also be effective for depression. However, both of these products have the potential to induce mania; the extent of this risk needs to be quantified. St. John's wort can also interact with a variety of medications. Evidence regarding the benefits of omega-3 fatty acids or acupuncture is inconsistent. Data regarding other CAM interventions (e.g., aromatherapy massage, massage therapy, yoga) are almost entirely lacking. In conclusion, better studies are needed before CAM interventions can be recommended to patients with bipolar disorder. In the meantime, patients need to be informed about the possible risks associated with the use of these interventions.

Topics: Acupuncture Therapy; Bipolar Disorder; Complementary Therapies; Fatty Acids, Omega-3; Humans; Hypericum; Phytotherapy; Plant Extracts; Plant Preparations; S-Adenosylmethionine; Treatment Outcome

Celery root belongs to a group of plants classified as the umbelliferous family, which contains phytoestrogens. Phytoestrogens are structurally similar to estrogen as they share a pair of hydroxyl groups and phenolic ring, which enables them to bind to estrogen receptors directly, making them a herbal remedy for low estrogen states such as menopause. We present a case of a female patient with depression who was stabilized on venlafaxine and St John's Wort, and who developed a manic episode due to elevated serum venlafaxine levels after she started taking celery extracts for menopausal related issues. We proffer a hypothesis for this unusual occurrence.

Topics: Antidepressive Agents, Second-Generation; Apium; Bipolar Disorder; Depressive Disorder, Major; Female; Herb-Drug Interactions; Humans; Hypericum; Menopause; Middle Aged; Phytotherapy; Plant Preparations; Plant Roots; Psychiatric Status Rating Scales; Treatment Outcome; Venlafaxine Hydrochloride; Withholding Treatment

Topics: Adult; Bipolar Disorder; Humans; Hypericum; Male; Nonprescription Drugs; Plant Preparations; Prescription Drug Overuse

We describe an alcohol and cocaine abusing female patient who developed a first manic episode in the context of a corticosteroid prescription. The differential diagnoses are discussed on the basis of the available literature on secondary manias.

Topics: Adenoma, Pleomorphic; Adult; Alcohol Drinking; Bipolar Disorder; Cocaine; Diagnosis, Differential; Drug Interactions; Facial Paralysis; Female; Humans; Hypericum; Parotid Neoplasms; Postoperative Complications; Prednisone

We report a case of mania induced by high doses of Hypericum perforatum in a 28-year-old depressed woman with no past history of mania or hypomania and no concomitant use of antidepressants.

Topics: Adult; Bipolar Disorder; Female; Humans; Hypericum; Phytotherapy

The use of herbal medicines has become a very common practice. While many are safe enough to be available over-the-counter, they may pose risks due to interactions with pharmaceutical medications and effects in specific clinical populations. The case of a female patient with a history of mild traumatic brain injury and resulting depression is presented. She experienced hypomania after adding St John's wort and Ginkgo biloba to her regimen of fluoxetine and buspirone, which remitted after discontinuation of the herbal medicines. Implications for interactions between various psychopharmacologic agents, including herbal medicines and selective serotonin reuptake inhibitors (SSRIs), as well as the need for appropriate patient and health care provider education are discussed.

Topics: Adult; Anti-Anxiety Agents; Bipolar Disorder; Brain Injuries; Buspirone; Depression; Drug Interactions; Drug Therapy, Combination; Female; Fluoxetine; Ginkgo biloba; Humans; Hypericum; Phytotherapy; Plant Preparations; Selective Serotonin Reuptake Inhibitors

A 23-year-old woman with no psychiatric history developed acute mania and psychosis while using St. John's wort at a high dosage (Valdispert 'balans', a combination of valerian extract and hypericin). She was diagnosed as having substance-induced mood disorder, with manic features (DSM-IV). Discontinuation of the use of the product and treatment with olanzapine led to complete recovery. No causal relationship between the use of the extract and the mania was established, but the course of the mania does suggest this association. St. John's wort is a popular herbal antidepressant. Hyperforin and hypericin, components of St. John's wort, inhibit synaptosomal serotonin, noradrenaline and dopamine uptake. The mechanism of action of St. John's wort is, however, not yet fully understood. St. John's wort should therefore be used with caution, especially in patients with a bipolar disorder.

Topics: Adult; Bipolar Disorder; Drug Combinations; Female; Humans; Hypericum; Phytotherapy; Plant Extracts; Remission Induction; Valerian

Topics: Aged; Bipolar Disorder; Depression; Female; Humans; Hypericum; Male; Middle Aged; Plants, Medicinal

We describe the case of a patient who developed depression following bilateral orchidectomy for cryptorchidism. He was treated with a conventional selective serotonin reuptake inhibitor antidepressant, but continued to take St John's wort (hypericum) against medical advice. He subsequently developed a manic episode. We discuss postulated modes of action of St John's wort and the possible aetiological importance of testosterone replacement and abnormal gonadotrophin levels in this case.

Topics: Administration, Oral; Adult; Antidepressive Agents; Arousal; Bipolar Disorder; Cryptorchidism; Depressive Disorder; Humans; Hypericum; Male; Orchiectomy; Plants, Medicinal; Postoperative Complications; Sertraline; Testosterone

The annual meeting of the American Psychiatric Association focuses on a variety of topics, including those on psychopharmacology. The latest developments are typically those found in the New Research sections, which is where this summary will focus.

Topics: Antidepressive Agents; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Citalopram; Depressive Disorder; Humans; Hypericum; Olanzapine; Phytotherapy; Pirenzepine; Plants, Medicinal; Psychiatry; Psychotropic Drugs; Societies, Scientific; Testosterone; United States

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.. This report presents two cases of mania temporally associated with the use of St. John's wort (hypericum).. 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.. 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.

Topics: Adult; Antidepressive Agents; Antipsychotic Agents; Bipolar Disorder; Drug Therapy, Combination; Female; Genetic Predisposition to Disease; Humans; Hypericum; Lithium; Male; Middle Aged; Plants, Medicinal; Treatment Outcome