Miracon Science

Selective serotonin reuptake inhibitors (SSRI)

Active substances and pharmaceuticals concerned

Name of active substance Trade name Affected micronutrients
Citalopram Cipralex®, Pram®, Seropram® 5-HTP
Folic acid
Omega-3 fatty acids
Magnesium
Fluoxetine Felicium®, Flux®, Mutan®
Paroxetine Ennos®, Paroxat®, Seroxat®
Sertraline Ennos®, Paroxat®, Seroxat®

 

Mechanism of interaction

Mechanism of interaction
Folic acid A low folic acid status influences the response rate to SSRIs. The conversion of noradrenaline to adrenaline by means of N-methyltransferase is SAM-dependent. Folic acid deficiency and the commonly associated vitamin B12 deficiency interfere with this methylation. In addition, a folic acid deficiency increases the level of neurotoxic homocysteine and the development of depression is thus promoted.
5-HTP WARNING: When 5-HTP and SSRI are taken simultaneously, the effect is increased. The risk of toxic serotonin concentration increases considerably (serotonin syndrome). This also applies to MAO inhibitors.
Omega-3 fatty acids EPA/DHA play a role in neurotransmitter metabolism in the CNS. For example, they influence the uptake and reuptake of dopamine and serotonin. They also increase the stability and fluidity of the nerve cell membrane.
Magnesium The neuronal energy metabolism in the CNS is regulated by magnesium. It influences the serotonin availability of L-tryptophan and reduces the release of stress hormones. Magnesium is a natural NMDA receptor antagonist.

Consequences and possible symptoms of the interaction

Negative consequences of the interaction  
Folic acid Decreased folic acid levels
  • Anorexia, pallor, depression, weakness, forgetfulness
  • Risk of neural tube defects during pregnancy
  • Impairment of erythropoiesis and development of pernicious anemia, thrombocytopenia, leukopenia, hyperhomocysteinemia
  • Increased risk of stroke due to increase in blood homocysteine levels
  • Increased risk of dementia and polyneuropathy
  • Glossitis, stomatitis, mucosal atrophy in the GIT and urogenital tract
5-HTP Increase in serotonin levels
  • Toxic serotonin levels in the brain increase
  • Strong rise in blood pressure
  • Unrest increases
  • Tremor
  • Coma
  • Risk of shock
  • Hyperthermia
Positive consequences of the interaction Possible symptoms
Omega-3 fatty acids Supporting effect
  • Bioavailability of serotonin increases
    • Effect of antidepressants is positively supported
  • Antidepressant need decreases
Magnesium Supporting effect
  • Bioavailability of serotonin increases
  • Effect of antidepressants is positively supported
  • Antidepressant need decreases

Recommended Supplementation

Medical substance Recommended supplementation Dosage
SSRI Folic acid as Metafolin 1-2 mg/d p.o.
Omega-3 fatty acids (EPA/DHA) 2000 mg/d p.o.
Magnesium 500 mg/d p.o.

Special instructions for use

Recommended supplementation
Folic acid It is important to recommend a combination of folic acid with vitamin B12 (1000–2000 µg/d p.o.) and vitamin B6.

References

References
Alpert M et al. Prediction of treatment response in geriatric depression from baseline folate level: interaction with an SSRI or a tricyclic antidepressant. J Clin Psychopharmacol. 2003 Jun;23(3):309-13.
Barragán-Rodríguez L et al. Efficacy and safety of oral magnesium supplementation in the treatment of depression in the elderly with type 2 diabetes: a randomized, equivalent trial. Magnes Res. 2008 Dec;21(4):218-23.
Gertsik L et al. Omega-3 fatty acid augmentation of citalopram treatment for patients with major depressive disorder. J Clin Psychopharmacol. 2012 Feb;32(1):61-4. doi: 10.1097/JCP.0b013e31823f3b5f.
Gröber U. Mikronährstoffe. Metabolic Tuning – Prävention – Therapie. 3. Auflage, 2011
Gröber U. Arzneimittel und Mikronährstoffe. Medikationsorientierte Supplementierung.
3. Akt. und erw. Auflage, 2014.
Stargrove Mitchell Bebel, Treasure Jonathan, McKee Dwight L.: Herb, Nutrient, and Drug Interactions: Clinical Implications and Therapeutic Strategies. 2008

 

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