Herbs and Mental Health or Seizure Conditions: Mania, Psychosis and Epilepsy Cautions
What case reports and reviews say about St. John's wort, ginseng, ephedra and other herbs in mania, psychosis and seizure conditions, and when to get urgent help.
Content last updated . This page has not been medically reviewed.
Safety first. Supplements can cause side effects and interact with medicines. Read mushroom safety and interactions before you use any mushroom product.
Urgent help first. If you are in the US and someone is in crisis or thinking about suicide, call or text 988 (Suicide & Crisis Lifeline). In any medical emergency call 911. For suspected poisoning call Poison Help at 1-800-222-1222 (see Poison Help by Country outside the US). Do not stop or change a prescribed medicine on your own; ask the prescriber or pharmacist.
What this page covers
The sources we read for this page are case reports, adverse-event reports and narrative reviews, not trials in people with these conditions. Case reports describe what happened to individual people and cannot prove a herb was the cause. This page does not cover ordinary low mood or stress; see Herbs for Low Mood and Depression and Stress, Anxiety, Burnout and Depression.Mania and psychosis: what the sources found
| Herb or ingredient | What the source found | Evidence label |
|---|---|---|
| St. John's wort (Hypericum perforatum L.) | A 2004 review found 17 case reports linking it with psychotic events, 12 of them mania or hypomania, and said the reports raise the possibility it may trigger mania in vulnerable patients. [1] A 2018 review counted 14 St John's wort case reports among 35 case reports of herbal-medicine mania, hypomania or mixed states. [2] | Case reports only; causation uncertain |
| Ginseng (Panax ginseng C.A.Mey.) | The 2018 review counted 5 case reports. [2] | Case reports only |
| Ephedra / ma-huang (Ephedra sinica Stapf) | The 2018 review counted 3 case reports. [2] An analysis of 1,820 US FDA adverse-event reports for ephedra supplements found 57 serious psychiatric events, most often psychosis, severe depression, mania or agitation. [3] Two-thirds involved people with existing psychiatric conditions, other medicines or other substances. [3] | Adverse-event reports; confounded |
| Other herbal mixtures and slimming products | The 2018 review also lists Garcinia cambogia (4 reports), horny goat weed (1) and unnamed herbal mixtures. [2] | Case reports only |
The 2018 review cautions that causal attributions are problematic because of the limited number of reports and because antidepressants were also prescribed in 7 cases. [2] It found laboratory confirmation of the herbal product's contents in only one article, which indicated a likely pharmaceutical in the product. [2] Plant names were checked against GBIF. [4]
St. John's wort and antidepressants
NCCIH says St. John's wort taken with certain antidepressants or other drugs that affect serotonin may lead to serious serotonin-related side effects, and that it can weaken some antidepressants. [5] See Herbs and Antidepressants: Serotonin Syndrome and St. John's Wort Interactions. The NHS lists antidepressants among medicines that do not mix well with herbal medicines. [6]Seizures and epilepsy
A 2008 review in the journal Epilepsia says many herbs may increase the risk of seizures through proconvulsant properties or heavy-metal contamination, or by changing how liver enzymes and transporters handle seizure medicines. [7] It adds that further research is required. [7] It names no herb that is proven safe in epilepsy in the abstract we read.Specific documented points:
- St. John's wort can weaken seizure medicines including phenytoin and carbamazepine, according to NCCIH. [5]
- Ginkgo seeds: NCCIH says fresh ginkgo seeds are toxic when eaten. [8] A toxicology paper says a compound in the seeds has anti-vitamin B6 actions and ginkgo seed poisoning can induce convulsions. [9] This concerns seeds, not standardized leaf extract; NCCIH describes leaf extract differently. [8] Seeds should not be used as a remedy.
- Contaminated or adulterated products can carry heavy metals, per the 2008 review. [7] See Product Quality and Contamination.
Lithium and other mood medicines
Proper evidence not found in the sources we read for herb interactions with lithium, antipsychotics or mood stabilizers other than those named above. We searched PubMed for lithium and herbal interaction reports and did not find a source we could read. That is not evidence of safety. Ask a pharmacist before adding any herb; see Herbs for People Taking Many Medicines.Practical steps
- Tell every prescriber about herbs and supplements. The NHS says to check with a pharmacist before taking a herbal medicine if you already take other medicine. [6]
- The NHS says not to stop any prescribed medicine without first talking to your doctor. [6]
- If new sleeplessness, racing thoughts, confusion or unusual behavior starts after a new product, seek care and take the product label. See Mania and Bipolar-Related Concerns and Psychosis Vulnerability.
- Other plants and substances are covered elsewhere: Cannabis, Psychosis and Mania Vulnerability.
Frequently asked questions
Can St. John's wort cause mania?
A 2004 review of 17 case reports said the herb may trigger mania in vulnerable patients, but causation was not established. [1] Anyone with bipolar disorder should ask a clinician before using it.
Are any herbs safe if I have epilepsy?
Proper evidence not found for a herb shown safe in epilepsy in the sources we read. A 2008 review says many herbs may raise seizure risk or alter seizure medicine levels. [7]
Can herbs interact with seizure medicines?
Yes. NCCIH says St. John's wort can weaken some seizure medicines, including phenytoin and carbamazepine. [5]
Is ginseng linked to mania?
There are five case reports in a 2018 systematic review, which cautions that causation is hard to judge. [2]
Should I stop my medicine and use herbs instead?
No. The NHS says not to stop any prescribed medicine without first talking to your doctor. [6]
Related: Herbs and Antidepressants, St. John's Wort, Ephedra (Ma Huang).
References
- Stevinson C, Ernst E. Can St. John's wort trigger psychoses? Int J Clin Pharmacol Ther. 2004;42(9):473-480. Read 2026-10-23.
- Bostock E, et al. Mania associated with herbal medicines, other than cannabis: a systematic review and quality assessment of case reports. Front Psychiatry. 2018;9:280. Read 2026-10-23.
- Psychiatric effects of ephedra use: an analysis of Food and Drug Administration reports of adverse events. Am J Psychiatry. 2004. Read 2026-10-23.
- GBIF Secretariat. GBIF Backbone Taxonomy species match for Actaea racemosa L., Trifolium pratense L., Humulus lupulus L., Echinacea purpurea (L.) Moench, Hypericum perforatum L., Ginkgo biloba L., Glycine max (L.) Merr., Ephedra sinica Stapf and Panax ginseng C.A.Mey. (all returned as accepted names). Read 2026-10-23.
- NCCIH. St. John's Wort: Usefulness and Safety. Read 2026-10-23.
- NHS (UK). Herbal medicines and complementary therapies. Page last reviewed 1 May 2026. Read 2026-10-23.
- Samuels N, et al. Herbal medicine and epilepsy: proconvulsive effects and interactions with antiepileptic drugs. Epilepsia. 2008;49(3):373-380. Read 2026-10-23.
- NCCIH. Ginkgo: Usefulness and Safety. Read 2026-10-23.
- Gas chromatography-mass spectrometry analysis of 4-O-methylpyridoxine (MPN) in the serum of patients with ginkgo seed poisoning. J Anal Toxicol. 2002. Read 2026-10-23.