Revivelife Clinic I Naturopath in Ottawa

Are your mood medications causing nutrient deficiencies?

8 IMPORTANT NUTRIENTS DEPLETED BY MOOD MEDICATIONS

Traditional drugs have their place, but are they being prescribed too quickly and are they an effective long-term solution? Research shows that there has been a 64% rise in the number of people over the age of 12 on antidepressant medication between 1999 and 2014.Although antidepressants such as TCAs, SSRIs or SNRIs can be helpful, sadly 36% of people using antidepressants will relapse within 1-2 years of stopping their meds, which indicates that while effective the medications may not address the underlying physiological changes associated with mood disorders.2 In studies compared to placebo, it has been found that antidepressants are about 20% more effective in  providing an improvement in symptoms.The more severe the depression, the greater the benefits will be.3 In other words, antidepressants are effective against chronic, moderate and severe depression. They don’t help in mild depression.3

Over half of all people who take antidepressants have side effects such as dry mouth, headaches, dizziness, restlessness and sexual problems. Antidepressants can cause dizziness and unsteadiness, increasing the risk of falls and bone fractures, especially in older people. Interactions with other medications can increase this risk.3 In certain situations mood medications may initially be helpful but then plateau in their positive effects and seem to cause other symptoms. Often these other symptoms are attributed to the mood disorder itself, however medications deplete vitamins, minerals and hormones that are vital to health. Studies show that pharmaceutical drugs can deplete your body of critical nutrients through multiple mechanisms, including increased excretion of vitamins and minerals, and impaired digestion, absorption and storage of nutrients. These deficiencies can add additional symptoms and increase the side effects. In fact, many drug “side effects” are simply nutritional deficiencies.

What compounds the situation is that nutrient deficiencies can be one of the main causes of mental illness. Being prescribed medication which further depletes vitamins, minerals and hormones just makes the situation worse.4 Because nutrient depletion takes time, both you and your doctor may not make the connection between the original medication(s) and your new symptoms. These additional symptoms and “side effects” may lead to additional prescription medications, which further depletes nutrients. So how can you break the vicious cycle?

Get tested for your nutrients and find out which vitamins, minerals or fatty acids you may be deficient in when you are feeling depressed, anxious and or if you are currently taking medications for your mood.

Psychiatric drugs commonly cause these drug-induced-nutrient- depletions:

  1. CALCIUM

Your body needs calcium to build and maintain strong bones. In addition, calcium also helps your heart, muscles, and nerves function properly. Mounting evidence suggests that calcium, along with vitamin D, may also help protect against cancer, diabetes and high blood pressure5.

Psychotropic drugs are a crucial element of treatment for psychiatric disorders; however there is an established association between many classes of psychotropic medications and fracture risk among older adults, and growing evidence that some classes of medications may also impact bone mineral density (BMD) increasing the risk for osteoporosis.6

Drugs that are linked to calcium depletion include:

  • Benzodiazepines: alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), estazolam (Prosom), flurazepam (Dalmane), lorazepam (Ativan)6
  • Antipsychotics: aripiprazole (Abilify), asenapine (Saphris), cariprazine (Vraylar), clozapine (Clozaril), lurasidone (Latuda), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal)6
  • Antidepressants: citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Selfemra, Prozac Weekly), fluvoxamine (Luvox), paroxetine (Paxil, Paxil CR, Pexeva), sertraline (Zoloft), vortioxetine (Trintellix, formerly known as Brintellix), vilazodone (Viibryd)6
  • Mood Stabilizers: carbamazepine (Carbatrol, Epitol, Equetro, Tegretol), divalproex sodium (Depakote), lamotrigine (Lamictal), lithium, valproic acid (Depakene)6

You can increase calcium through dairy or plant based sources including dark greens (spinach, kale, Swiss chard), nuts and seeds, and select fish like salmon.

  1. VITAMIN D

Vitamin D or more commonly known as your “sunshine vitamin“ is involved in calcium absorption, immune function, bone health, fighting inflammation, helping to prevent diabetes, your weight, strengthening your muscles, optimizing your mood and cardiovascular health.

Deficiency of vitamin D can lead to:

  • Fatigue7
  • Bone Deformities (such as rickets in children)7
  • Bone and or Joint Pain7
  • Reduced Bone Mineral Density7
  • Muscle Weakness, Aches, or Cramps7
  • Mood Changes (depression, insomnia)7
  • Heart Disease & High Blood Pressure7
  • Infections & Immune System Disorders7
  • Falls in the Elderly7
  • Select Cancers (colon, prostate and breast cancers)7
  • Multiple Sclerosis7

Mood medications such as antidepressants reduce vitamin D levels by potentially interfering with biological processes that affect uptake or metabolism of vitamin D resulting in low levels. 8

  • Benzodiazepines: alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), estazolam (Prosom), flurazepam (Dalmane), lorazepam (Ativan)6
  • Antipsychotics: aripiprazole (Abilify), asenapine (Saphris), cariprazine (Vraylar), clozapine (Clozaril), lurasidone (Latuda), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal)6
  • Antidepressants: citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Selfemra, Prozac Weekly), fluvoxamine (Luvox), paroxetine (Paxil, Paxil CR, Pexeva), sertraline (Zoloft), vortioxetine (Trintellix, formerly known as Brintellix), vilazodone (Viibryd)6
  • Mood Stabilizers: carbamazepine (Carbatrol, Epitol, Equetro, Tegretol), divalproex sodium (Depakote), lamotrigine (Lamictal), lithium, valproic acid (Depakene)6

You can get vitamin D from 20 minutes daily of natural sun exposure. Food sources include: fatty fish (salmon, tuna, mackerel, and sardines), and mushrooms (that are exposed to UV light).

  1. MAGNESIUM

Magnesium is one of my favourite minerals. It participates in more than 600 biochemical reactions in your body.9 A few of magnesium’s key actions include:

  • Energy Production: Helps convert food into energy.9
  • Protein Formation: Helps create new proteins from amino acids.9
  • Gene Maintenance: Helps create and repair DNA and RNA.9
  • Muscle Movements: Is part of the contraction and relaxation of muscles.9
  • Brain & Mood: Key role in neurotransmitter, enzyme and hormonal activity to optimize your brain, mood (reduces anxiety, depression and irritability) and nervous system9

Unfortunately, studies suggest that about 50% of people in the US and Europe don’t get the recommended daily amount of magnesium.10

Common magnesium deficiency symptoms include:

  • ADHD (Attention Deficit with Hyperactivity Disorder)
  • Drug Abuse
  • Headaches and Migraines
  • Heart Arrhythmias
  • Increased Blood Pressure
  • Insomnia
  • Mood Disorders: Anxiety, Depression, Suicidal Thoughts, Schizophrenia
  • Muscle Weakness, Cramps, Tremors, and Spasms
  • Nausea
  • Osteoporosis
  • Pain
  • PMS (Premenstrual Syndrome)
  • Seizures
  • Short-Term Memory & IQ Loss

Interestingly, these symptoms mirror common symptoms of both mood disorders and side effects of common psychiatric drugs.

The common psychiatric medications that deplete magnesium include:

  • Antidepressants: citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Selfemra, Prozac Weekly), fluvoxamine (Luvox), paroxetine (Paxil, Paxil CR, Pexeva), sertraline (Zoloft), vortioxetine (Trintellix, formerly known as Brintellix), vilazodone (Viibryd)11
  • Central nervous stimulants – amphetamine (Adderall), dextroamphetamine (Dexedrine), lisdexamfetamine (Vyvanse), methylphenidate (Ritalin, Concerta), atomoxetine (Strattera), dexmethylphenidate (Focalin)11

Magnesium rich foods include: pumpkin seeds, avocado, legumes, tofu, and whole grains.

  1. VITAMIN B2 (RIBOFLAVIN)

Vitamin B2 helps breakdown proteins, fats, and carbohydrates. Riboflavin helps convert carbohydrates into adenosine triphosphate (ATP) for energy.

Low levels of vitamin B2 are linked to:

  • Depression
  • Skin Concerns (Acne, Scaly Skin)
  • Vision Difficulties (Sensitivity to Light, Cracked Dry Mucus Membranes
  • Low Energy
  • Weight Gain
  • Thyroid Imbalances

The following mood medications can inhibit the absorption of vitamin B2:

  • Antidepressants: citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Selfemra, Prozac Weekly), fluvoxamine (Luvox), paroxetine (Paxil, Paxil CR, Pexeva), sertraline (Zoloft), vortioxetine (Trintellix, formerly known as Brintellix), vilazodone (Viibryd)12
  • Antipsychotics: aripiprazole (Abilify), asenapine (Saphris), cariprazine (Vraylar), clozapine (Clozaril), lurasidone (Latuda), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal)12
  • Anticonvulsants and Mood Stabilizers: phenytoin (Dilantin), carbamazepine (Tegretol), primidone (Mysoline), methsuxamide (Elontin), valproic acid (Depakote), topiramate (Topomax) and gabapentin (Neurontin)12

Food Sources of Vitamin B2 Include: dark green leavy vegetables (kale, spinach, arugula), pastured eggs, mushrooms, sunflower seeds, and almonds.

  1. VITAMIN B6 (PYRIDOXINE)

Vitamin B6 helps the body to use and store energy from protein and carbohydrates in food, the body form haemoglobin, the substance in red blood cells that carries oxygen around the body and is required for the conversion of tryptophan to serotonin and melatonin. It also plays a key role in the production of GABA (relaxes the brain) and dopamine (motivation hormone). Pyridoxine is vital to boost mood, promote quality sleep and support your entire nervous system.

Low levels of vitamin B6 are linked to:

  • Depression
  • Insomnia
  • Fatigue
  • Mental Confusion
  • Cardiovascular Disease
  • PMS (Premenstrual Syndrome)

Multiple medications have been shown to deplete vitamin B6 including:

  • Antidepressants: citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Selfemra, Prozac Weekly), fluvoxamine (Luvox), paroxetine (Paxil, Paxil CR, Pexeva), sertraline (Zoloft), vortioxetine (Trintellix, formerly known as Brintellix), vilazodone (Viibryd)12
  • Benzodiazepines: alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), estazolam (Prosom), flurazepam (Dalmane), lorazepam (Ativan)12

Drugs that deplete vitamin B2 will also indirectly deplete vitamin B2 is required to activate B6.

  • Antipsychotics: aripiprazole (Abilify), asenapine (Saphris), cariprazine (Vraylar), clozapine (Clozaril), lurasidone (Latuda), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal)12
  • Anticonvulsants and Mood Stabilizers: phenytoin (Dilantin), carbamazepine (Tegretol), primidone (Mysoline), methsuxamide (Elontin), valproic acid (Depakote), topiramate (Topomax) and gabapentin (Neurontin)12

Great food sources of vitamin B6 include pistachios, bananas, chicken and potatoes.

  1. FOLATE & VITAMIN B12

Folate and vitamin B12 are B vitamins that play an essential role in methylation. Methylation is the transfer of a “methyl“ group from one molecule to another that is one of the most important processes in the body and brain for optimal energy, detoxification, mood and nervous system function. Low levels of folate and B12 are linked to an inability to methylate properly and thus in supplementing it is important to use the active or methyl versions of these vitamins i.e. methylfolate and methylcobalamine. Methylfolate in addition helps to produce SAM-e in the body to further help reduce depression and improve mood.

Signs & Symptoms of folate & vitamin B12 deficiency include:

  • Depression
  • Fatigue
  • Cognition Difficulties
  • Pins & Needles (paraesthesia)
  • Red and Sore Tongue
  • Mouth Ulcers
  • Muscle Weakness
  • Visual Disturbances
  • Increased Homocysteine Levels (which leads to depression, irritability, fatigue, confusion, forgetfulness and increases the risk of cardiovascular and Alzheimer`s disease)

Common drugs that are prescribed for mood disorders that also cause folate and B12 deficiencies that aggravate psychological health include:

  • Antidepressants: citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Selfemra, Prozac Weekly), fluvoxamine (Luvox), paroxetine (Paxil, Paxil CR, Pexeva), sertraline (Zoloft), vortioxetine (Trintellix, formerly known as Brintellix), vilazodone (Viibryd)12
  • Antipsychotics: aripiprazole (Abilify), asenapine (Saphris), cariprazine (Vraylar), clozapine (Clozaril), lurasidone (Latuda), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal)12
  • Benzodiazepines: alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), estazolam (Prosom), flurazepam (Dalmane), lorazepam (Ativan)12
  • Anticonvulsants and Mood Stabilizers: phenytoin (Dilantin), carbamazepine (Tegretol), primidone (Mysoline), methsuxamide (Elontin), valproic acid (Depakote), topiramate (Topomax) and gabapentin (Neurontin)12

Good dietary sources of natural folate include leafy greens, broccoli, Brussels sprouts, asparagus, peas, chickpeas and kidney beans. B12 is found primarily in animal proteins such as meat, fish, dairy, eggs and plant based options include nutritional yeast, tempeh, chlorella, nori seaweed and fortified almond milk.

  1. COENZYME Q10 (COQ10)

CoQ10 is a molecule found in every cell of your body that plays a key role in energy production and protects your brain and body from free radical damage.13 Scientific research has linked oxidative stress and depression. High levels of CoQ10 have a significant antidepressant effect due to its well-documented antioxidant effect.14

Deficiency of CoQ10 Increases the Risk Of:

  • Fatigue
  • Brain Fog, Decreased Concentration, Memory
  • Depression
  • Irritability
  • Muscle Cramps
  • High Blood Sugar
  • Shortness of Breath
  • Oxidative Stress & Increased Aging
  • Cancer
  • Cardiovascular Disease (increased blood pressure, cholesterol)

Drugs that are linked to CoQ10 depletion include:

  • Antipsychotics – Aripiprazole (Abilify), Quetiapine (Seroquel), Risperidone (Risperdal), Olanzapine (Zyrexa), Haloperidol (Haldol), Paliperidone (Invega), Ziprasidone (Geodon)12
  • Antidepressants: citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Selfemra, Prozac Weekly), fluvoxamine (Luvox), paroxetine (Paxil, Paxil CR, Pexeva), sertraline (Zoloft), vortioxetine (Trintellix, formerly known as Brintellix), vilazodone (Viibryd)12

You can find CoQ10 food sources from fatty fish (trout, mackerel, sardines), meat, soy (tofu, tempeh, edamame – be sure and choose non-GMO organic), broccoli, and nuts and seeds (peanuts, pistachios).

  1. MELATONIN

Melatonin is made from serotonin during sleep that helps control your circadian rhythm or sleep wake cycles. It is critical for optimal brain and mental health as it required for deep and restorative sleep.

Insufficient melatonin is linked to:

  • Insomnia
  • Depression
  • Growth Hormone Deficiency
  • Blood Sugar Changes
  • Increased Risk of Cancer
  • Aging
  • Fatigue

Many mood medications deplete your natural stores of melatonin, increase your need for it or interfere with its activity. Lack of sleep aggravates mood disorders as well as increases the side effects of psychotropic drugs.

Common drugs that affect melatonin levels include:

  • Antidepressants: citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Selfemra, Prozac Weekly), fluvoxamine (Luvox), paroxetine (Paxil, Paxil CR, Pexeva), sertraline (Zoloft), vortioxetine (Trintellix, formerly known as Brintellix), vilazodone (Viibryd)12
  • Antipsychotics: aripiprazole (Abilify), asenapine (Saphris), cariprazine (Vraylar), clozapine (Clozaril), lurasidone (Latuda), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal)12
  • Benzodiazepines : alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), estazolam (Prosom), flurazepam (Dalmane), lorazepam (Ativan)12

Other nutrients found to be associated with drugs for mood disorders include:

  • Biotin: Benzodiazepines, Antipsychotics, Mood Stabilizers
  • Carnitine (involved in energy production): Antipsychotics
  • Essential Fatty Acids (omega-3): Antidepressants
  • Glutathione (the body`s master antioxidant): Antidepressants
  • Inositol: Mood Stabilizers, Antipsychotics
  • Potassium: Stimulants (Adderall)
  • Sodium: Antidepressants
  • Variety of Minerals (Zinc, Selenium, and Manganese) (needed for energy, immunity, thyroid function): Antidepressants
  • Vitamin A: Antipsychotics
  • Vitamin B1: Benzodiazepines, Antipsychotics
  • Vitamin B3: Antidepressants – deficiency in this vitamin often contributes to neuropsychiatric and neurodegenerative disorders
  • Vitamin C: Antidepressants, Stimulants (Adderall), Antipsychotics
  • Vitamin K: Benzodiazepines, Antipsychotics, Mood Stabilizers

CONCLUSION

Many mood medications that are prescribed for mental health come with side effects including reducing select essential nutrients. This compounds the fact that many vitamin and mineral deficiencies can cause mood disorders.

The solution: Get Tested for your nutrients if you have anxiety, depression or other mood concerns and then work with your Naturopathic Doctor to source high-quality active nutrients or receive IV therapy to promote higher tissue levels quickly all while by-passing the digestive system.

drjoelvilleneuve
References
  1. Pratt L.A., Brody D.J., & Gu Q. Antidepressant use among persons aged 12 and over: United States, 2011–14. NCHS Data Brief, No. 283. Hyattsville, MD: National Center for Health Statistics. 2017.
  2. Batelaan NM, Renske CM, Muntingh A, et al, Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials, BMJ 2017;358:j3927
  3. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Depression: How effective are antidepressants? [Updated 2020 Jun 18]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361016/
  4. Mohn ES, Kern HJ, Saltzman E, et al, Evidence of Drug–Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update, Pharmaceutics. 2018 Mar; 10(1):36
  5. Calcium and vitamin D: Important at every age. National Institutes of Health. https://www.bones.nih.gov/health-info/bone/bone-health/nutrition/calcium-and-vitamin-d-important-every-age. Accessed Oct. 18, 2020.
  6. Brown MJ, and Mezuk B, Brains, Bones, and Aging: Psychotropic medications and bone health among older adults, Curr Osteoporos Rep. 2012 Dec; 10(4): 303–311.
  7. Omeed Sizar; Swapnil Khare; Amandeep Goyal; Pankaj Bansal; Amy Givler., Vitamin D Deficiency, Treasure Island (FL): StatPearls Publishing; 2020 Jan-.
  8. Negative Skeletal Effects Caused by Antidepressants?, September 1, 2016, NCT01932931, https://clinicaltrials.gov/ct2/show/NCT01932931, Retrieved 1, 25, 2021
  9. de Baaij JF, Hoenderop JGJ, Bindels RJM, Magnesium in man: implications for health and disease, Physiol Rev . 2015 Jan;95(1):1-46.
  10. Rosanoff A, Weaver CM, Rude RK, Suboptimal magnesium status in the United States: are the health consequences underestimated?, Nutr Rev . 2012 Mar;70(3):153-64.
  11. Grober, Uwe, Magnesium and Drugs, Int J Mol Sci. 2019 May; 20(9): 2094
  12. Common Drug Classes, Drug-Nutrient Depletions, & Drug-Nutrient InteractionsPharmavite LLC, https://www.pharmacist.com/sites/default/files/files/RN126418%20PID13500%20PHV%20Common%20Drugs%20and%20DND%20Chart_12-12-16.pdf, Retrieved 1,25,21
  13. Michel TM, Pulschen D, Thome J, The role of oxidative stress in depressive disorders, Curr Pharm Des. 2012; 18(36): 5890-9.
  14. Aboul-Foutouh S, Coenzyme Q10 displays antidepressant-like activity with reduction of hippocampal oxidative/nitrosative DNA damage in chronically stressed rats, Pharmacol Biochem Behav 2013 Mar;104:105-12.
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