Recently Korean Food and Drug Administration approved Hypericum perforatum preparations (St. John's wort) as an over-the-counter drug. The authors reported a case of Hypericum perforatum induced mania in a patient with major depressive disorder and reviewed. A seventy-five years old female patient was diagnosed as major depression 5 years ago, and had been admitted in the psychiatric ward twice and had received regular outpatient treatment. Since October 1998, she took paroxetine 20 mg, and bromazepam 1.5 mg constantly. But all of a sudden, she stopped taking the drugs on June 20th 2000, and took Hypericum perforatum 300 mg three times daily. Ten days after, she became abruptly talkative, irritable, hyperactive, and euphoric. She was diagnosed as Hypericum perforatum-induced mania. Manic symptoms came down after several days by discontinuation of taking Hypericum perforatum. Since then she has been got a continuous treatment with paroxetine 20 mg, and she is in full remission state now. Hypericum perforatum is one of herb extracts, which is known to have the antidepressant effect like traditional and newer antidepressants. The side effects of Hypericum perforatum are gastrointestinal disturbance, allergy reaction, fatigue, photosensitivity. And more serious side effect is drug-drug interaction due to it's inducing effect of cytochrome P450 and P-glycoprotein. It is possible to switch from depression to manic episode as was in this case. Although it was approved as an over-the-counter drug in Korea, the use of Hypericum perforatum need to be thoroughly examined to prevent misused if not fully understood.
Antidepressive Agents ; Bipolar Disorder* ; Bromazepam ; Cytochrome P-450 Enzyme System ; Depression* ; Depressive Disorder, Major ; Fatigue ; Female ; Humans ; Hypericum* ; Hypersensitivity ; Korea ; Outpatients ; P-Glycoprotein ; Paroxetine ; United States Food and Drug Administration