Hi Ilene and Fiona -

Have posted in past about the recent review monograph of St. John's Wort ( SJW
- Hypericum perforatum) - Herbalgram #40 1997 - therapeutics section written
by Jerry Cott of the National Institute of Health (NIH) - while noting some
uterotonic effects documented for SJW thus cautioned during pregnancy, he
chose not to include any contraindication or specific caution during
lactation.

Fiona - he discusses the Linde et al. study 1996 - this was a meta-analysis of
23 randomized trials with a total of 1757 outpatients ( mild to moderately
severe depression).  Conclusions as discussed by Cott - standardized herb
significantly superior to placebo, comparably effective as standard
antidepressants - imipramine, maprotiline and amitryptiline named - while
producing fewer side effects. The short-comings of current studies were also
pointed out in this review - poorly defined pt. population, varying diagnoses,
lack of long-term studies, lack of control over compliance, low dosage of
comparison medications.
(paraphrasing  here.)

As Dr. Jack wrote, Cott characterizes SJW as a poor MAOI according to latest
studies - thus dietary restrictions were not included as a caution in this
review.  I would assume that lactating women would have been systematically
excluded from SJW studies.

Nobody currently knows the effects of SJW on baby or on lactation, if by
knowledge we mean prospective study of large enough groups to attach
statistical significance to the results.  We are only at the point of case
history collection and documentation.  In this sense, herb knowledge during
breastfeeding somewhat parallels medication knowledge during breastfeeding
about 20 years ago.  Thus the current dependence on anecdotes, or case studies
( pick your term) and toxicology information.

Lactnet allows the sharing of many lactation specialist's experiences, thus
acting as an "early warning device" for unexpected reactions to both
medications and herbs.   There is a post where the mom reports experienced a
sudden onset strong let-down with baby experiencing colicky
symptoms/restlessness, after only a few days on SJW.  Hale has posted that he
knows of several cases where  Prozac caused colicky symptoms in newborns(?) -
one case history noted in his book.  Is there a connection here?

 The fact that the mom had an episode of mastitis/baby sleepy may or may not
be related to the SJW.  I would want to know if the baby was jaundiced, sleepy
from birth, how often nursing, adequate milk transfer?, etc...Herbalists (
from Newall et al 1996) consider SJW to be sedative, and recent studies (as
per Herbalgram) describe it's anti-anxiety effects but do not characterize it
as particularily sedative ( ??).  Can you post more details here ?

Ruling out the usual explanations first is often more fruitful than suspecting
the "unknown" in the situation from the git-go. It is the natural tendency for
clinicians when confronted with a situation that contains " the unknown-to-
them", to overlook the obvious and suspect the unknown element ( often
breastfeeding is the "unknown" and thus is suspected of somehow being the
culprit in whatever the difficulty, as we know).

On the other hand, just because a certain medication is considered compatible
with breastfeeding does not mean that some individual mother and babies cannot
have difficulties.  E.g. iron supplements for mom - some babies are fussy as
long as mom takes iron-containing supplements, even though for most moms, this
does not present a problem.  I can't think why herbs/foods would be exempt
from this no matter what is eventually established regarding herbs and
lactation.

Sheila Humphrey  BSc(Botany)  RN  IBCLC