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Tricyclic Antidepressants

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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 Although superseded today by the less side-effect prone selective serotonin reuptake inhibitors (SSRIs), they are still used in certain cases.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.

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