St. John's wort + ADHD medications?

September 13, 2009 6:36 PM

What are your experiences with St. John's wort? In particular, have you ever taken it at the same time as ADHD medications like Ritalin/Focalin (methylphenidate), Adderall (amphetamine) etc?

Some sources seem to warn against taking then together, some say only that one will might decrease the effectiveness of the other, and many don't say anything at all, so I'd like to know if there's anything to worry about. Even if you have never taken the two together, I'd still be curious to hear what you thought of St. John's wort in general.

Throwaway email: [e-mail]

(Please don't tell me to ask a doctor; I'm asking because the doctors that wrote all the information I've read seem to disagree.)

posted by anonymous to health & fitness (16 answers total)

If I recall correctly, a few years ago St. John's Wort was very in vogue, and many people began to self-medicate with it, and it did not turn out well for many of them. This wasn't because St. John's Wort can't be a beneficial and effective treatment for some people, but because people react very differently to medications and various combinations of multiple medications. Without the guidance and oversight of a doctor, that can be a very dangerous game to play. Even though St. John's Wort is a more natural approach, from what I know it does do something, and unfortunately, it is not as simple as it being safe and/or good to combine with your prescription medication(s) because the determining factor is you and your specific brain chemistry. One person may thrive by combining the two, and for another, who may seem to have the exact same issue, it would be a disaster.

I know this is not the answer you want to hear, but presumably a doctor you trust has prescribed the ADHD meds you are taking. Ask your doc what s/he thinks before adding anything to your regimen. Most psychiatrists are as well-versed in alternative, non-prescription therapies as they are in prescription drugs, and your doctor knows you, so only s/he can give you the answer you can trust. Good luck!
posted by katemcd at 6:52 PM on September 13, 2009 [2 favorites]

I take St. John's wort every year to combat the winter time "blahs" that I get when we enter our rainy season here in Northern California.

I don't take any ADHD meds, so I can't comment on that, sorry.

I will say that I've noticed that St John's Wort takes some time to kick in, as is often noted. If I wait until the "blahs" hit, I'm stuck with them for at least a week. So I schedule my self-medication, starting on October 1st and ending on March 31st of every year.

I find the pills themselves very easy to take. Just taking a multi-vitamin can make me nauseous, but I've never had a problem with St John's Wort.
posted by FfejL at 7:10 PM on September 13, 2009 [1 favorite]

I took it the week leading up to my wedding to help cope with all the anxiety. It helped, but it wasn't quite as strong as I was hoping for.
posted by JuiceBoxHero at 7:14 PM on September 13, 2009

St Johns Wort contains psychoactive compounds with measureable biological activity, just like other antidepressants. However, unlike 'artificial' bioactives, the amount and mixtures of active ingredient in each set of pills can vary widely both between different brands and between different batches of the same pill. Just because two batchs have the same amount of plant matter in there doesn't mean they will have the same amount of active ingredients and this isn't regulated. Some batches may even have other, unexpected compounds that interact with your medications. So you really can't be sure what you're getting. 'Natural' in cases like this isn't better, it's just messier and less safe.

Add on top of that the varation in how different people react to certain drugs and to drug interactions and this is why you'll find contradictory evidence and a range of effects. Adding this on top of already pretty strong psychoactive medicine could do a number of things in your system, good or bad. None of us can guess what will happen for your specific case.

So at the very least you need to be doing this with your doctor's knowledge, even better if you get (and listen to) their input. You presumably wouldn't start taking prescribed antidepressants without talking to your doctor and this is really no different. I think katemcd summed it up very well: "Most psychiatrists are as well-versed in alternative, non-prescription therapies as they are in prescription drugs, and your doctor knows you, so only s/he can give you the answer you can trust."
posted by shelleycat at 7:42 PM on September 13, 2009 [5 favorites]

Apart from the mental health aspect, it made me sunburn through my clothes. The most minute sun exposure caused a burn. True, I am very fair, but it was a constant additional hassle you might want to consider.

I was extremely surprised when told that it is used to ease sunburn.
posted by jgirl at 7:51 PM on September 13, 2009 [1 favorite]

Do some research and Google the medication(s) in question, some may specifically say not to use with SJW. You can also ask the pharmacist. Not the order taker, but the guy that's there to make sure they don't screw-up and actually knows the medications and how they can interact. He'll know more than a GP doctor.
posted by hungrysquirrels at 8:10 PM on September 13, 2009 [1 favorite]

The magical google word you are looking for is contraindications.
posted by bigmusic at 9:00 PM on September 13, 2009

Some sources seem to warn against taking then together, some say only that one will might decrease the effectiveness of the other, and many don't say anything at all, so I'd like to know if there's anything to worry about.

If many reputable sources say that you shouldn't take them together or taking them together will decrease effectiveness, you probably have something to worry about. If they disagree, that is even more reason to worry.

There are other solutions, like prescription anti-depressants. Wellbutrin has been shown to help adult ADHD and depression and anxiety, maybe that would be a good choice for you. Or another antidepressant/stimulant combo. I'm not a doctor, but if you already have one she can help you find a combination of medications that can relive your depression and your ADHD.

If you're already taking St. John's Wort and want to start ADHD meds, know that ADHD meds might relieve your depression or anxiety on their own, by taking away the burden of ADHD and giving you hope and more ability to cope with everyday stresses. Perhaps you can phase out the St. John's Wort, try an ADHD med, and see where that leaves you before trying to combine two things with an unknown interaction.
posted by kathrineg at 9:22 PM on September 13, 2009

St. John's Wort is an MAO inhibitor. If you check the resources on Adderall, you will find that they highly recommend that you avoid using MAO inhibitors when taking Amphetamines due to the risk of high blood pressure.

I've taken St. John's Wort myself (but never with Adderall), but it made me incredibly dizzy, so I stopped taking it. I highly recommend that you not mix the two drugs, especially if you are self medicating.
posted by The Light Fantastic at 11:18 PM on September 13, 2009

Most psychiatrists are as well-versed in alternative, non-prescription therapies as they are in prescription drugs,

I wouldn't count on this, myself.
posted by small_ruminant at 11:32 PM on September 13, 2009

While it's absolutely true you shouldn't be mixing SJW with Adderall or other psychoactive drugs without supervision by a doctor, calling it an "MAO inhibitor" is somewhat misleading. There does appear to be some inhibition of monoamine oxidase by St. Johns Wort, but lots of drugs we don't refer to as MAOIs also inhibit monoamine oxidase. Adderall itself inhibits monoamine oxidase weakly and we certainly don't call it an MAOI.

The mechanism by which SJW works appears to be much closer to that of the SSRIs than the MAOIs. But either way it's not at all a good idea to take it in conjunction with other drugs. Helllllooooooo serotonin syndrome.
posted by Justinian at 11:38 PM on September 13, 2009

I was extremely surprised when told that it is used to ease sunburn.

Well, it all depends how you read that sentence, doesn't it?

I took SJW for a half-year once and noticed exactly zero effect of any kind. YMMV, obviously, but as it does seem to have common psychoactives in it, why not ask whoever prescribed your ADHD meds. Phone call. Free.
posted by rokusan at 11:56 PM on September 13, 2009

Never taken it in combination with anything, but I took a course of St John's Wort once and as with rokusan, it had absolutely no detectable effect on me whatever, good, bad, or indifferent. Again, YMMV.
posted by Phanx at 1:42 AM on September 14, 2009

I took it years ago at uni and I found it very calming and relaxing. I also found a tincture was much more effective for me than the pills. I used to drink half a teaspoon of tincture in fruit juice and about five minutes later could just feel myself relaxing and chilling out. The tincture was quite bitter, so tried pills instead but they did nothing for me. I wasn't taking any other medication at the time and I wouldn't have combined SJW with anything prescribed - there were plenty of warnings about it rendering anti-depressants ineffective at the time.
posted by t0astie at 2:34 AM on September 14, 2009

SJW gave me insane indigestion, so if your stomach is at all irritated by your ADHD medications, this might become an issue. However, I didn't take it for very long because I hated being in pain and getting no benefit, so that's my only experience.
posted by Unicorn on the cob at 8:18 AM on September 14, 2009

Old post, I know, but this should not stand uncorrected. St. John's wort is NOT a MAO inhibitor. It should not be taken with MAO inhibitors, though, as it's mechanism is close to a SSRI.
posted by Brennus at 5:37 PM on November 23, 2009