Tyramine

Generic Names:

This is a large group, including:-

Amitriptylene	Amoxapine
Bupropion	Clomipramine
Desipramine	Dothiepin
Doxepin	Imipramine
Lofepramine	Nortriptyline
Paroxetine	Phenelzine
Protriptyline	Tranylcypromine
Trazodone	Trimipramine

Trade Names:

Amoxapine	(Asendin)
Bupropion	(Wellbutrin)
Desipramine	(Norpramin)
Doxepin	(Adapin, Sinequan)
Imipramine	(Tofranil)
Nefazodone	(Serzone)
Nortriptyline	(Pamelor)
Paroxetine	(Paxil)
Phenelzine	(Nardil)
Protriptyline	(Vivactil)
Sertraline	(Zoloft)
Tranylcypromine	(Parnate)
Trazodone	(Desyrel)
Trimipramine	(Surmontil)
Venlafaxine	(Effexor)

Description:

These are tricyclic antidepressants, for serious depression.

The other main category of antidepressants is MAO inhibitors. Both have been used together but this can be extremely dangerous.

Nutritional Considerations:

Anyone taking MAO inhibitors should avoid foods containing Tyramine. (See under Tyramine Restricted Diet)

Avoid tryptophan (Threlkeld).

A high fiber diet may reduce the efficacy of the drug.

Hydration: insure adequate fluid intake unless directed otherwise. (Dry mouth is a common side effect.)

Riboflavin supplements are recommended. Imipramine (Tofranil) may deplete riboflavin. [Pinto]

Avoid alcohol (Naranjo).

Herbal Considerations:

The pressor effect of: arnica, geranium, lily of the valley or skunk cabbage may be markedly potentiated by monoamine oxidase inhibitors (MAOI's) and tricyclic antidepressants.

Due to their spasmolytic nature, dill, gum plant, kava kava, Lady's slipper, lavender, meadowsweet, mouse ear, nutmeg, oats, osha, Roman chamomile, sundew and thyme may interact in unknown ways with CNS depressants, or stimulants (Newell).

Dong quai, elecampane, greater celandine, guarana, kelp plant, lobelia, marigold, Passion flower, pulsatilla, sage, silverweed, skunk cabbage, slippery elm, southernwood, squill, St. John's wort and yohimbe should be used with caution in conjunction with CNS depressants.

Other authors state that hops and St. John's wort are contra-indicated, entirely, in patients with depressive illness. (Newall, Demott, Gordon)

Ginger may cause malabsorption of psychoactive agents (Huang).

The psycho- and physicostimulant property of ginkgo, lemon balm, Linden tree, ma huang and mandrake may be assumed to interact, in presently unknown ways, with other psychoactive central and peripheral nervous system stimulants and depressants.

It is sometimes easy to overlook weight loss products,m often described as "Thermogenic", that contain ma huang (or similar products) as it may be listed in very small print, or appear under its alternative names: ephedra, or ephedrine.

CNS depressants are enhanced due to the sedative and muscle-relaxant effects of kava kava.

The psychotropic constituents of Thorn apple interact with almost all psychoactive drugs, including antianxiety, antidepressant, antipsychotic, sedative, hypnotic, anesthetic, anticonvulsant and muscle relaxant agents. Thorn apple should be used with caution in conjunction with CNS depressants or stimulants. Furthermore, tricyclic antidepressants may display additive anticholinergic effects with thorn apple.

Tobacco speeds the elimination of tricyclic antidepressants.

Herbs with a sedative action may potentiate the sedative side-effects already present in antidepressants. A list has been compiled by Newall:

Herb	Effect
Calamus	Potentiation barbiturate sleeping time
Celery	In vivo
Chamomile German	Human
Couchgrass	In vivo
Elecampane	In vivo
Ginseng	CNS depressant and stimulant
Goldenseal	In vivo
Hops	In vivo
Hydrocotyle	In vivo
Jamaica Dogwood	In vivo
Nettle	CNS depression, in vivo
Passionflower	In vivo
Sage	In vivo
Skullcap	Reputed action
Shepherd's Purse	Potentiation barbiturate sleeping time
St. John's Wort	Traditional use, bioflavonoids
Valerian	Human, in vivo
Wild Carrot	In vivo
Wild Lettuce	In vivo, related species

St. John's Wort has approval status by the German Commission E as an antidepressant.

References:


Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.

Demott K. St. John's wort tied to serotonin syndrome. Clinical Psychiatry News 1998;26:28.

Gordon JB. SSRIs and St. John's wort: possible toxicity? Am Fam Physician 1998;57:950.

Huang Q, et al: The effect of ginger on serotonin-induced hypothermia and diarrhea. Yakugaku Zasshi 110, 936-942, 1990.

Naranjo CA, Pouos CX, Bremner KE, Lanctot KL. Fluoxetine attenuates alcohol intake and desire to drink. Int Clin Psychopharmacol 1994;9:163-72.

Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-care Professionals. London: The Pharmaceutical Press, 1996:21,45,63,282.

Pinto, J.T. & Rivlin, R.S. : Drugs that promote renal excretion of riboflavin. Drug Nutrient Interactions, 1987, 5: 143-151.

Stewart, DE: High fiber diet and serum tricyclic antidepressant levels. J. Clin. Psychopharmacol. 1992, 12:438-440.

Tatro, D.S. (Ed.): Drug Interaction Facts. 1995.

Threlkeld DS, ed. Central Nervous System Drugs, Antidepressants, Selective Serotonin Reuptake Inhibitors. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Apr 1997.

Tinguely D, Jonzier M, Schopf J, et al: Determination of compliance with riboflavin in an antidepressive therapy, Arneimittelforschung, 1985, 35 (2):536-8.