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Generic Names:

This is a large group, including:-

Paroxetine Phenelzine

Trade Names:

Doxepin(Adapin, Sinequan)


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:

CalamusPotentiation barbiturate sleeping time
CeleryIn vivo
Chamomile GermanHuman
CouchgrassIn vivo
ElecampaneIn vivo
GinsengCNS depressant and stimulant
GoldensealIn vivo
HopsIn vivo
HydrocotyleIn vivo
Jamaica Dogwood In vivo
NettleCNS depression, in vivo
PassionflowerIn vivo
SageIn vivo
SkullcapReputed action
Shepherd's PursePotentiation barbiturate sleeping time
St. John's WortTraditional use, bioflavonoids
ValerianHuman, in vivo
Wild CarrotIn vivo
Wild Lettuce In vivo, related species

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


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.