• Tricyclic Antidepressants

    Coenzyme Q 10 (CoQ 10) —Supplementation Possibly Helpful St. John's Wort, Yohimbe, 5-Hydroxytryptophan (5-HTP), S-Adenosylmethionine (SAMe) —Possible Dangerous Interactions St. John's Wort —Possible Harmful Interaction
    For many years, the tricyclics were the most popular antidepressants. Although superseded today by the less side-effect prone selective serotonin reuptake inhibitors (SSRIs), they are still used in certain cases.
    Antidepressants in this family include:
    • Amitriptyline hydrochloride (Elavil)
    • Amoxapine (Asendin)
    • Clomipramine hydrochloride (Anafranil)
    • Desipramine hydrochloride (Norpramin)
    • Doxepin hydrochloride (Sinequan)
    • Imipramine (Tofranil)
    • Nortriptyline hydrochloride (Aventyl, Pamelor)
    • Protriptyline hydrochloride (Vivactil)
    • Trimipramine maleate (Surmontil)
    • and others
    Coenzyme Q 10 (CoQ 10 )
    Preliminary evidence suggests that tricyclic antidepressants might deplete the body of coenzyme Q 10 (CoQ 10 ), a substance that appears to be important for normal heart function. 1,2 Based on this observation, it has been suggested (but not proved) that CoQ 10 supplementation might help prevent the heart-related side effects that can occur with the use of tricyclic antidepressants.
    St. John's WortYohimbe5-Hydroxytryptophan (5-HTP)S-Adenosylmethionine (SAMe)
    Based on one case report 3 and our general knowledge about the actions of these supplements, taking any of these in combination with some tricyclic antidepressants could conceivably present a risk of elevating serotonin levels too high.
    St. John's Wort
    St. John’s wort might decrease the effectiveness of tricyclic antidepressants by reducing blood levels of the drug. 4-5 Conversely, if you are taking St. John's wort already and your physician adjusts your dose of medication, suddenly stopping the herb could cause blood levels of the drug to rise dangerously high.

    References

    1 Folkers K. Basic chemical research on coenzyme Q 10 and integrated clinical research on therapy of diseases. In Lenaz G, ed. Coenzyme Q. New York, NY: John Wiley and Sons, 1985.

    2 Kishi T, Makino K, Okamoto T, et al. Inhibition of myocardial respiration by psychotherapeutic drugs and prevention by coenzyme Q. In: International Symposium on Coenzyme Q. Biomedical and clinical aspects of coenzyme Q. Vol. 2. New York, NY: Elsevier Publishing Co; 1980: 139-157.

    3 Iruela LM, Minguez L, Merino J, Monedero G. Toxic interaction of S-adenosylmethionine and clomipramine. Am J Psych. 150: 522, 1993.

    4 Roots J, et al. Interaction of a herbal extract from St. John’s wort with amitryptyline and its metabolites (Abstract). Clin Pharm Ther. 2000;67:159.

    5 Johne A, Schmider J, Brockmoller J, et al. Decreased plasma levels of amitriptyline and its metabolites on comedication with an extract from St. John's wort ( Hypericum perforatum ). J Clin Psychopharmacol. 2002;22:46-54.

    Revision Information

  • Join WellZones today.

    Make a Change For LifeLearn more

    Wellmont LiveWell is creating a new tradition of wellness in the mountains by providing individuals with tools and encouragement to live healthier lifestyles.

  • HeartSHAPE Spotlight

    At risk for a heart attack? Learn more

    Fight heart disease early and prevent heart attacks with HeartSHAPE® - a painless, non-invasive test that takes pictures of your heart to scan for early-stage coronary disease.

  • Calories and Energy Needs

    Calorie NeedsLearn more

    How many calories do you need to eat each day to maintain your weight and fuel your physical activity? Enter a few of your stats into this calculator to find out.

  • Ideal Body Weight

    Ideal Body WeightLearn more

    Using body mass index as a reference, this calculator determines your ideal body weight range. All you need to do is enter your height.

  • Body Mass Index

    Body Mass IndexLearn more

    This tool considers your height and weight to assess your weight status.


  • Can we help answer your questions?

    Wellmont Nurse Connection is your resource for valuable health information any time, 24 hours a day, seven days a week. Speak to a Nurse any time, day or night, at (423) 723-6877 or toll-free at 1-877-230-NURSE.