The best data base on side-effects comes from a large German study in which over 3,000 patients on St John’s Wort were monitored by their doctors, over 650 of whom participated in the survey. Only 48 patients (about 1.5 per cent) discontinued the medication in the study, and side-effects were reported by only 79 people (2.4 per cent). Of these side-effects, the most commonly reported problems were gastro-intestinal irritation, restlessness and allergic reactions, all of which were reported by fewer than 1 per cent of individuals. European experts whom I have interviewed about St John’s Wort side-effects agree with these very low percentages. Such low side-effect frequencies are especially good news for the treatment of depression in the elderly, who are typically highly susceptible to the side-effects of all sorts of medications.
Although time will tell whether the initial observations of such low frequencies of side-effects are correct, I have been impressed in my own clinical practice by the absence of any side-effects in some people who have proven to be highly sensitive to side-effects from a wide variety of other anti-depressants. It seems likely that St John’s Wort will indeed prove to have fewer side-effects than the synthetic anti-depressants currently in use.
As noted above, anyone with a history of hypomanic or manic episodes should be especially vigilant for the typical symptoms of activation after starting any anti-depressant. Sleeplessness, racing thoughts, pressured speech and euphoria or irritability are early warning signs of hypomania or mania that must be heeded. If these develop, you should stop St John’s Wort immediately and consult a doctor. The loss of sleep (which is often not experienced as unpleasant but rather as an extra opportunity to get more accomplished or have more fun) is harmful in itself as it can fuel the manic process. If caught early, the symptoms of hypomania or mania can often be checked with appropriate actions; if not, however, they can escalate into mania, which can be very unpleasant and damaging.
A few of my patients have developed increased anxiety after beginning St John’s Wort. Such reactions have also been reported to occur in certain individuals after starting all forms of antidepressants. People with a history of panic attacks or extreme anxiety are especially susceptible in this regard. Yet anti-depressants have actually been given for the treatment of anxiety and panic. In order to overcome the initial anxiety response, which may occur after taking even a single dose, it is necessary to back down on the dosage. For example, in treating such sensitive patients with Prozac I have often started with as little as 1 to 2 mg of liquid Prozac per day. After the person has become used to that dosage, it is then possible to increase the dosage slowly and carefully over the ensuing weeks until a therapeutic level is reached. If you are eager to persevere with St John’s Wort but happen to develop anxiety after taking 300 or 600 mg, it is possible to overcome the problem by obtaining an herbal extract in the form of an elixir. Begin by taking very low dosages of the elixir (say one-tenth of the recommended number of drops) and increase gradually at a rate that you can comfortably tolerate until you reach therapeutic levels.
Some people on St John’s Wort have complained about increased sensitivity to sunlight both with regard to the skin, with more reddening occurring than usual, and the eyes. At this time there is no reason to believe that either of these side-effects is of clinical concern, but if they cause discomfort, protecting your skin with sun block or the eyes with sunglasses would be a sensible preventative measure.
As noted above, anyone with a history of hypomanic or manic episodes should be especially vigilant for the typical symptoms of activation after starting any anti-depressant. Sleeplessness, racing thoughts, pressured speech and euphoria or irritability are early warning signs of hypomania or mania that must be heeded. If these develop, you should stop St John’s Wort immediately and consult a doctor. The loss of sleep (which is often not experienced as unpleasant but rather as an extra opportunity to get more accomplished or have more fun) is harmful in itself as it can fuel the manic process. If caught early, the symptoms of hypomania or mania can often be checked with appropriate actions; if not, however, they can escalate into mania, which can be very unpleasant and damaging.
A few of my patients have developed increased anxiety after beginning St John’s Wort. Such reactions have also been reported to occur in certain individuals after starting all forms of antidepressants. People with a history of panic attacks or extreme anxiety are especially susceptible in this regard. Yet anti-depressants have actually been given for the treatment of anxiety and panic. In order to overcome the initial anxiety response, which may occur after taking even a single dose, it is necessary to back down on the dosage. For example, in treating such sensitive patients with Prozac I have often started with as little as 1 to 2 mg of liquid Prozac per day. After the person has become used to that dosage, it is then possible to increase the dosage slowly and carefully over the ensuing weeks until a therapeutic level is reached. If you are eager to persevere with St John’s Wort but happen to develop anxiety after taking 300 or 600 mg, it is possible to overcome the problem by obtaining an herbal extract in the form of an elixir. Begin by taking very low dosages of the elixir (say one-tenth of the recommended number of drops) and increase gradually at a rate that you can comfortably tolerate until you reach therapeutic levels.
Some people on St John’s Wort have complained about increased sensitivity to sunlight both with regard to the skin, with more reddening occurring than usual, and the eyes. At this time there is no reason to believe that either of these side-effects is of clinical concern, but if they cause discomfort, protecting your skin with sun block or the eyes with sunglasses would be a sensible preventative measure.
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