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.1 In addition, treatment with amitriptyline has been associated with a reduction in CoQ10 levels.2 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.
Phenothiazine drugs similar to perphenazine can cause changes in heart activity in some people, which might be prevented by supplementing with coenzyme Q10.3 , 4 Therefore, some health practitioners may recommend coenzyme Q10 supplementation to people taking perphenazine.
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.5 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.6 , 7
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.8 Oral supplementation with SAMe has demonstrated antidepressant activity, independent of its combination with imipramine.9
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.10 The subjects in this study were institutionalized, so it is unclear if these results apply to persons living at home.
Brewed black tea (Camellia sinensis) 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 sePte ingestion of tea and tricyclic antidepressants by at least two hours.
An animal study found that the effects of chlorpromazine, a drug similar to (perphenazine, prochlorperazine, thioridazine), were enhanced when a bacopa extract was given along with it.12 Until more is known, people taking medications from this family of drugs (called phenothiazines) should not take bacopa.
Preliminary research has suggested that St. John’s wort (Hypericum perforatum) may reduce blood levels of the tricyclic antidepressant amitriptyline.13 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.14 , 15 Until more is known, people taking tricyclic antidepressants should avoid St. John’s wort.
Taking phenothiazine drugs can stop menstruation in some women. Two women taking phenothiazines similar to perphenazine began menstruating following supplementation with 6 grams of vitamin C each day.16 Controlled studies are needed to determine whether vitamin C supplementation might benefit women specifically taking perphenazine who are experiencing menstrual changes. Some health practitioners recommend vitamin C supplementation to women who stop menstruating while taking perphenazine. Vitamin C might also enhance the effectiveness of neuroleptic drugs such as perphenazine in the treatment of schizophrenia. One uncontrolled study showed that 10 of 13 individuals experienced a reduction in disorganized thoughts, hallucinations, and suspicious thoughts when 8 grams of vitamin C was added to their daily drug therapy.17 Controlled studies are needed to show whether people taking perphenazine for schizophrenia might benefit from vitamin C supplementation.
1. 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.
2. Moreno-Fernandez AM, Cordero MD, Garrido-Maraver J, et al. Oral treatment with amitriptyline induces coenzyme Q deficiency and oxidative stress in psychiatric patients. J Psychiatr Res 2012;46:341-5.
3. Kishi T, Makino K, Okamoto T, et al. In Yamamura Y, Folkers K, Ito Y, eds. Biochemical and Clinical Aspects of Coenzyme Q, Volume 2. Amsterdam: Elsevier/North Holland Biomedical Press, 1980, 139-57.
4. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, Inc., 1997, 212.
5. Chouinard G, Young SN, Annable L, Sourkes TL. Tryptophan-nicotinamide, imipramine and their combination in depression. Acta Psychiatr Scand 1979;59:395-414.
6. Walinder J, Skott A, Carlsson A, et al. Potentiation of the antidepressant action of clomipramine by tryptophan. Arch Gen Psychiatry 1976;33:1384-9.
7. Shaw DM, MacSweeney DA, Hewland R, Johnson AL. Tricyclic antidepressants and tryptophan in unipolar depression. Psychol Med 1975;5:276-8.
8. 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.
9. Bressa GM. S-adenosyl-l-methionine (SAMe) as antidepressant: Meta-analysis of clinical studies. Acta Neurol Scand 1994;154(suppl):7-14.
10. 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.
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. Ganguly DK, Malhotra CL. Some behavioral effects of an active fraction from Herpestis monniera Linn. (Brahmi). Indian J Med Res 1967;55:473-82.
13. 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.
14. Nebel A, Schneider BJ, Baker RK, Kroll DJ. Potential metabolic interaction between St. John's wortand theophylline [letter]. Ann Pharmacother 1999;33:502.
15. 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.
16. Kanofsky JD, Kay SR, Lindenmayer JP, Seifter E. Ascorbic acid action in neuroleptic-associated amenorrhea. J Clin Psychopharmacol 1989;9:388-9 [letter].
17. Beauclair L, Vinogradov S, Riney SJ, et al. An adjunctive role for ascorbic acid in the treatment of schizophrenia? J Clin Psychopharmacol 1987;7:282-3 [letter].
Last Review: 04-29-2014
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