Perkup

Indications

St. John's Wort (Hypericum perforatum) is a herbal medicine made from the flowering tops of a yellow-flowered plant. It is used for mild to moderate low mood and depression, and sometimes for anxiety, low mood around the menopause and nervous tiredness. Some studies show benefit in mild to moderate depression, but it is not suitable for severe depression.

How It Works

Its main active substances, hyperforin and hypericin, are thought to increase the levels of brain chemical messengers such as serotonin, noradrenaline and dopamine, which help regulate mood. The effect builds up slowly over 2 to 4 weeks.

Dosage and Administration

Take as directed on the label or by your doctor. Standardised extracts are usually taken once to three times a day with food. Do not stop suddenly after long use; ask your doctor how to reduce it.

Interactions

St. John's Wort has many serious interactions because it speeds up the breakdown of many medicines in the liver. It can make the following less effective: hormonal contraceptives (pills, implants, patches), Warfarin, Digoxin, Ciclosporin, Tacrolimus, HIV medicines, some cancer medicines, Simvastatin, Omeprazole and some epilepsy medicines. Taken with antidepressants such as Fluoxetine, Sertraline or Amitriptyline, or with Tramadol or Triptans, it can cause serotonin syndrome. Always tell your doctor and pharmacist that you take it.

Contraindications

• Allergy to Hypericum.
• Use with interacting medicines listed above, especially other antidepressants, contraceptives, transplant medicines and HIV medicines.
• Bipolar disorder (it may trigger mania), severe depression, children and adolescents.

Side Effects

Possible effects include stomach upset, dry mouth, dizziness, tiredness, restlessness, headache and increased sensitivity of the skin to sunlight (sunburn more easily).

Get urgent medical help if you have thoughts of self-harm or suicide, signs of serotonin syndrome (agitation, confusion, fever, sweating, shaking, fast heartbeat, muscle twitching), or a serious allergic reaction.

Pregnancy and Lactation

Not recommended during pregnancy or breastfeeding because safety has not been established. Women relying on hormonal contraception must use an extra barrier method, as unplanned pregnancies have occurred.

Precautions and Warnings

• Depression is a serious illness. See a doctor for diagnosis, and do not use this instead of prescribed treatment.
• Avoid strong sunlight and sunbeds; use sun protection.
• Stop at least 2 weeks before surgery and tell your anaesthetist.
• Products vary in strength; use a standardised, registered product.

Overdose

Overdose may cause severe sun sensitivity, restlessness and stomach upset. Contact a doctor or poison centre and stay out of sunlight.

Therapeutic Class

Herbal antidepressant (Hypericum extract).

Storage

Store below 30°C in a dry place, away from light. Keep out of the reach of children.