But when I recently told a friend I wanted to add primrose oil to my routine (which already included an SSRI) to help clear my skin, she told me to proceed with caution.
There are whisperings in wellness circles, my friend said, that some supplements can interfere with your meds, thus rendering them ineffective. Uh—what? I needed to investigate.
Keep reading to find out which supplements don't play well with antidepressants.
Supplements to avoid when you're taking antidepressants
Lisa Goldstone, PharmD, an associate professor of clinical pharmacy at USC, is quick to dish up some common sense advice for your supplement habit: "Consulting with both your physician and pharmacist is recommended prior to adding any non-prescribed medications, supplements, or vitamins to one’s diet," she says.
In my personal experience, however, traditional Western medical practitioners (e.g. psychiatrists) tend to err on the side of caution and recommend you abstain from all supplementation...just in case. Curious as to how necessary this really is, I press Dr. Goldstone to name names.
When taken on its own, St. John's Wort has been shown to improve the symptoms of depression just as well as antidepressants can. But when taken alongside an SSRI, the supplement can cause serotonin syndrome.
"St. John’s Wort is probably most well-known for interacting with many antidepressants as well as other medications," she says. When taken on its own, St. John's Wort has actually been shown to improve the symptoms of depression just as well as antidepressants can. But when taken alongside an SSRI, the supplement can cause serotonin syndrome (fever, diarrhea, chills, and even seizures). So even though it might be tempting for people suffering from depression to add the herb to their regimen—the more help their brains can get, the better, right?—it's best to stay away.
The New York City-based Osteopathic doctor Christopher Calapai adds two other supplements to the no-go list for those taking depression meds. "Antidepressant medications [and possibly antipsychotic meds] may not be absorbed well if people are taking a lot of vitamin E," he says. "Vitamin K may also decrease absorption of antidepressants."
When I ask Dr. Calapai if this means that women on antidepressants should be wary of even multivitamins, he tells me I'm being overly cautious. Multivitamins, he says, are "extremely important for every part of the body" and should therefore remain in your medicine cabinet. However, he recommends that individuals taking antidepressants get their blood work checked regularly to make sure their vitamin E and K levels are within a safe range.
Supplements that could enhance (or replace) your antidepressants
Some supplements, meanwhile, have been proven to have the opposite effect: They make antidepressants work better. According to research published in the American Journal of Psychiatry last year, adenosylmethionine (SAMe), methylfolate, omega-3s (primarily EPA or ethyl-EPA), and vitamin D are proven to enhance the effectiveness of SSRIs and SSNIs without any negative side effects save for "minor digestive disturbances."
Additionally, Dr. Calapai says some studies have shown that B-12 supplementation can safely work alongside antidepressants to decrease symptoms.
NYC-based functional nutritionist Dana James, meanwhile, recommends amino acid precursors (like 5-HTP) to treat depression and will often supplement them into her patients' diets in order to help slowly wean them off SSRIs. But she offers an important caveat to those looking to switch to a holistic mental health treatment: "If you are on medication, please work with an experienced practitioner who can find the right [amino acid precursor] dosage for you," she says. "The wellness expert at the Whole Foods supplement department doesn’t count!" Over-supplementation with amino acid precursors when taking antidepressants can, as is the case with St. John's Wort, cause serotonin syndrome.
"If you are on medication, please work with an experienced practitioner who can find the right [amino acid precursor] dosage for you. The wellness expert at the Whole Foods supplement department doesn’t count!" —Dana James
Finally, I ask about the two supplements that started me on this quest for this information in the first place: evening primrose oil (EPO) and Mucuna pruriens (MP), a Moon Juice favorite also known as "the dopamine bean," which a psychiatrist warned me was bad-news bears.
James tells me she's unaware of any research that would suggest evening primrose oil interferes with SSRIs. "I think this is a myth," she says. "EPO is rich in omega-6s, which are required for cell membrane integrity, including neurons. I would hypothesize that it makes the drug more effective because the neurons become more sensitive to the drug." (After doing some digging on my own, however, I find research that supports the rumor to some degree: EPO can, it seems, interact negatively with lithium-based treatments.)
"Your body will tell you if something is off." —James
When I tell James that a psychiatrist called MP "an unregulated antidepressant," she tells me that she understands what the doctor meant, but doesn't necessarily agree with her argument against the supplement. Much like the antidepressant Wellbutrin, James says, MP works by leveraging something called L-DOPA to increase dopamine in the brain. "MP's strength is less than Wellbutrin's, however, and if you overdo it, you’ll get a headache and feel nauseous," she says. "Your body will tell you if something is off."(Sidebar: This actually happened to me!) Dr. Calapai, meanwhile, tells me that there's simply not enough research on this buzzy supplement to safely recommend it as an adjunct or replacement therapy.
Dr. Calapai's warning echoes one Dr. Goldstone gave me in our very first conversation: In the scientific community, no news doesn't necessarily mean good news. There might not be research to support a dangerous link between a certain supplement and antidepressant pairing today, but tomorrow there may be. "This makes taking any supplement risky," Dr. Goldstone says.
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