Sale of St John's wort

Sir: Maidment's (Psychiatric Bulletin, June 2000, 24, 232-234) review of St John's wort is timely, but fails to mention the problem of its wide availability as a herbal preparation. Randomised trials indicate that it is an effective anti-depressant, with a variety of plausible mechanisms for action. Because it is a herbal remedy it is subject to none of the usual regulations applied to drugs. On a recent visit to a well-known high street chemist I found St John's wort on sale with no information about indications, side-effects or interactions, or any of the information which would be expected in a patient information leaflet for prescribed or over the counter medication. This may have serious consequences. First, patients are unaware of the potential interactions (including two recent cases where an interaction with cyclosporin caused rejection of a heart transplant (Ruschitzka et al, 2000)). Second, there is no mechanism for reporting serious adverse events. St John's wort is a drug and should be marketed as such. The current situation, where effective herbal remedies are not subject to the usual scrutiny, is an unacceptable double standard.