Tricyclic Antidepressants
Also indexed as: Adapin, Amitriptyline, Amoxapine, Asendin,
Clomipramine, Desipramine, Doxepin, Elavil, Imipramine, Janimine, Ludiomil, Maprotiline,
Norpramin, Nortriptyline, Pamelor, Pertofrane, Protriptyline, Sinequan, Surmontil, Tofranil,
Trimipramine Maleate, Vivactil
Tricyclic antidepressants are used to treat people with depression and less commonly to treat other
illnesses.
Summary of
Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem
contradictory. For clarification, read the full article for details about the summarized
interactions.
 May Be Beneficial: Depletion or
interference—The medication may deplete or interfere with the absorption or
function of the nutrient. Taking these nutrients may help replenish them. |
CoQ10*
|
| May Be Beneficial: Supportive
interaction—Taking these supplements may support or otherwise help your medication
work better. |
L-tryptophan*
Niacinamide
SAMe
Vitamin B1
Vitamin B12
Vitamin B2
Vitamin B3
Vitamin B5
Vitamin B6
Vitamin B-Complex
|
Avoid: Reduced drug absorption/bioavailability—Avoid these supplements
when taking this medication since the supplement may decrease the absorption and/or activity
of the medication in the body. |
Tea*
|
|
Avoid: Adverse interaction—Avoid these supplements when taking this
medication because taking them together may cause undesirable or dangerous results. |
St. John’s wort*
|
| Side effect reduction/prevention |
None known
|
An asterisk (*) next to an item in the summary indicates that the
interaction is supported only by weak, fragmentary, and/or contradictory scientific
evidence.
Interactions with Dietary Supplements
B vitamins
Giving 10 mg per day each of vitamins B1, B2, and B6 to elderly, depressed persons already on tricyclic
antidepressants improved their depression and ability to think more than placebo
did.1 The subjects in this study were institutionalized, so it is unclear if these
results apply to persons living at home.
L-tryptophan and
Vitamin B3
Combination of 6 grams per day L-tryptophan and 1,500 mg per day niacinamide (a form of vitamin B3) with imipramine has
shown to be more effective than imipramine alone for people with bipolar disorder.2 These levels did not
improve the effects of imipramine in people with
depression. Lower amounts (4 grams per day of L-tryptophan and 1,000 mg per day of
niacinamide) did show some tendency to enhance the effect of imipramine.
The importance of the amount of L-tryptophan was confirmed in other studies, suggesting
that if too much L-tryptophan (6 grams per day) is used, it is not beneficial, while levels
around 4 grams per day may make tricyclic antidepressants work better.3
4
Coenzyme
Q10
A number of tricyclic antidepressants have been shown to inhibit enzymes that require coenzyme
Q10 (CoQ10), a nutrient that is needed for normal heart function.5 It is therefore
possible that CoQ10 deficiency may be a contributing factor to the cardiac side effects that
sometimes occur with tricyclic antidepressants. Some practitioners advise patients taking
tricyclic antidepressants to supplement with 30–100 mg of CoQ10 per day.
SAMe
(S-adenosy-L-methionine)
SAMe may improve the clinical response to imipramine (Tofranil®). In a double-blind
trial, depressive symptoms decreased earlier in the people who received SAMe injections (200
mg per day) in combination with imipramine than in those who received imipramine with placebo
injections.6 Oral supplementation with SAMe has demonstrated antidepressant
activity, independent of its combination with imipramine.7
Interactions with Herbs
St. John’s
wort (Hypericum perforatum)
Preliminary research has suggested that St. John’s wort may reduce blood levels of the
tricyclic antidepressant amitriptyline.8 This may have occurred because certain
chemicals found in St. John’s wort activate liver enzymes that are involved in the
elimination of some drugs.9 10 Until more is known, people taking
tricyclic antidepressants should avoid St. John’s wort.
Tea
(Camellia sinensis)
Brewed black tea has been reported to cause precipitation of amitriptyline and imipramine in a
test tube.11 If this reaction occurred in the body, it could decrease absorption of
these drugs. Until more is known, it makes sense to separate ingestion of tea and tricyclic
antidepressants by at least two hours.
Interactions with Foods and Other Compounds
Alcohol
Tricyclic antidepressants can cause drowsiness and dizziness.12 Alcohol may
intensify these actions, increasing the risk for accidental injury. People taking tricyclic
antidepressants should avoid alcohol.
References:1. Bell IR, Edman JS, Morrow FD, et al. Brief communication: Vitamin B1,
B2, and B6 augmentation of tricyclic antidepressant treatment in geriatric depression with
cognitive dysfunction. J Am Coll Nutr 1992;11:159–63.
2. Chouinard G, Young SN, Annable L, Sourkes TL. Tryptophan-nicotinamide,
imipramine and their combination in depression. Acta Psychiatr Scand
1979;59:395–414.
3. Walinder J, Skott A, Carlsson A, et al. Potentiation of the
antidepressant action of clomipramine by tryptophan. Arch Gen Psychiatry
1976;33:1384–9.
4. Shaw DM, MacSweeney DA, Hewland R, Johnson AL. Tricyclic
antidepressants and tryptophan in unipolar depression. Psychol Med
1975;5:276–8.
5. Kishi T, Makino K, Okamoto T, Kishi H, Folkers K. Inhibition of
myocardial respiration by psychotherapeutic drugs and prevention by coenzymeQ. In Y Yamamura,
K Folkers, Y Ito, eds. Biomedical and Clinical Aspects of Coenzyme Q, Vol. 2.
Amsterdam: Elsevier/North-Holland Biomedical Press,1980:139–54.
6. Berlanga C, Ortega-Soto HA, Ontiveros M, Senties H. Efficacy of
S-adenosyl-L-methionine in speeding the onset of action of imipramine. Psychiatry Res
1992;44:257–62.
7. Bressa GM. S-adenosyl-l-methionine (SAMe) as antidepressant:
Meta-analysis of clinical studies. Acta Neurol Scand 1994;154(suppl):7–14.
8. Mai I, Schmider J, et al. Unpublished results, May, 1999. Reported in:
Johne A, Brockmöller, Bauer S, et al. Pharmacokinetic interaction of digoxin with an
herbal extract from St. John’s wort (Hypericum perforatum). Clin Pharmacol Ther
1999;66:338–45.
9. Nebel A, Schneider BJ, Baker RK, Kroll DJ. Potential metabolic
interaction between St. John’s wortand theophylline [letter]. Ann Pharmacother
1999;33:502.
10. Mai I, Schmider J, et al. Unpublished results, May, 1999. Reported
in: Johne A, Brockmöller, Bauer S, et al. Pharmacokinetic interaction of digoxin with an
herbal extract from St. John’s wort (Hypericum perforatum). Clin Pharmacol Ther
1999;66:338–45.
11. Lasswell WL Jr, Weber SS, Wilkins JM. In vitro interaction of
neuroleptics and tricyclic antidepressants with coffee, tea, and gallotannic acid. J Pharm
Sci 1984;73:1056–8.
12. Threlkeld DS, ed. Central Nervous System Drugs, Antidepressants,
Tricyclic Compounds. In Facts and Comparisons Drug Information. St. Louis, MO: Facts
and Comparisons, Apr 1990, 262L–3.