St Johns wort appears to contain the same risk of serotonin syndrome as other antidepressants. It should not be combined with other agents that increase brain serotonin levels including other prescription SSRI and anti- depressants, MMAOIs, L-tryptophan and 5-HTP.

Number of anecdotal reports stating that, St Johns wort combined with oral contrceptives causes breakthrough bleeding. The mechanism is unclear and it is unknown whether this effect increases the risk of pregnancy.

Depression

Gatrointestinal upset, increased anxiety and minor palpitations, and paradoxically increased depression. Serious side effects reported are- cardiac symptoms, severe allergic reactions, liver failure, stroke, delusions and seizures.

Hypersensitivity

Special precautions:

Reports not available

Depression

Dosage

Starting dose usually is 300mg three times a day.

Pharmacology:

Hypericum contains atleast 10 substances that have been shown to have biological activity including hypericin, pseudohypericin, xanthones, monoterpenes, beta-sitosterol, quercelin, and catechin. Many of these substances have been shown to bind neurorecptors in the brain and to inhibit the uptake of various neurotransmitters thought to be involved in depression The mechanism of hypericin includes modulation of interleukin-6 activity and inhibition of the re-uptake of serotonin. Studies have shown that it reduces the interleukin- levels.

Pharmacokinetics:

After 2 weeks treatment with oral administration of 750micrograms of extracted hypericin, the median half-life was 0.6 hours, distribution was 0.6hours and and elimination was 43.1 hours. The systemic availability is roughly 14% for hypericin.