It’s an age old tale: You are feeling depressed. You go to your doctor and are prescribed an antidepressant. For a while things get a little better, but after a time, the depression starts to creep back. You go back to your doctor and your dosage is increased. This helps push back the feelings of sadness but now you are having difficulty sleeping and are gaining weight. Your doctor explains that these are common side effects of this medication and he switches you to a different kind of antidepressant. It’s the same story: At first things seem to go alright but the depression always comes back, and this time the side effects include: anxiety, struggling to focus and you feel detached emotionally. Another medication is added to your regimen to help with focus, and yet another is added to curb the feelings of panic. Every day now you go to your pill dispenser and swallow back a handful of medications. But you don’t feel happy and you don’t feel like yourself. You feel lost.

Does this sound familiar? If so, know that you are not alone.

There are five main reasons your SSRI may be causing you side effects:

1) Oxidative damage

Oxidative damage is a term you have probably heard in the news. It refers to damage to the cells and tissue caused by oxidation. Oxidation is a normal process where an oxygen molecule removes electrons from a another molecule or atom. This, however, causes damage to the cell, and can be problematic when there is too much of this process occurring.

We see that more oxidative stress is associated with a higher risk of becoming depressed and staying depressed (1)(2) and antidepressants can cause a worsening of depression by causing oxidative stress in the brain. For example, The Journal of Basic Clinical Physiological Pharmacology found that sertraline (Zoloft), which is an selective serotonin reuptake inhibitor (SSRI) antidepressant, caused oxidative stress in the brain of test subjects (3).

Our body is built to counteract oxidative damage through the production of enzymes that can neutralize the oxygen. Examples of enzymes include vitamins E and A. Consuming foods that are high in antioxidants, which are nutrients that inhibit oxidation, can provide your body with powerful tools in healing all of the tissues and cells in your brain and body. There are many additional powerful vitamins, minerals, and herbs that act as antioxidants to counteract the side effects of your antidepressant, heal the brain and improve your mood.

2) Increased demand for B vitamins

Antidepressants work by increasing the amount of available mood-supporting chemicals, called neurotransmitters, in the brain. Selective serotonin reuptake inhibitors (SSRI) antidepressants, for example, stop your brain from reuptaking  serotonin so that more of it remains available for use. In order to produce more chemicals like serotonin, dopamine, epinephrine and norepinephrine, the brain requires more building blocks. Particularly important building blocks include your B vitamins. For those taking antidepressants, an ongoing supply of the B vitamins must be available as cofactors to help manufacture the needed neurotransmitters (4)(5).

What often happens, is that in the beginning, your body has enough vitamins and minerals to produce adequate amounts of neurotransmitters. However, if the supply of building blocks does not increase in tandem with the demand, you will start to develop side effects from your antidepressant.. Symptoms will vary based on which nutrient is depleted, but most noteworthy is that it will appear that your antidepressant is not working properly any more. Also side effects will become more pronounced., You may be instructed to increase your dose of the drug, add on a new medication, or change to something different, when perhaps all you needed was a little nutritional support.

3) Blocking ATP

Adenosine triphosphate (ATP) functions in your body like the battery in a car. It is produced by every cell in your brain and body, and is used as  energy so that your cells can function. We get the building blocks to make ATP from our food and without enough ATP we will cease to function and live.

Antidepressants impair your cells ability to make ATP resulting in your cells not having  enough energy to carry out their normal functions. This causes myriad symptoms including but not limited to: depression, fatigue, muscle weakness, and diminished brain power (6).

There are many nutrients that can help you increase the amount of ATP in your cells. These may include: Coenzyme Q10, magnesium, vitamin B1, vitamin B2, and vitamin B3. It is important, however, to ensure you are taking the proper dosages and forms of these nutrients because some varieties of these nutrients are not well absorbed or utilized by the body.

4) Blocking CoQ10

CoQ10 (ubiquinone) is a coenzyme that is found in every single cell of your body. Healthy cells produce CoQ10 and it is used to protect the body and brain from oxidative damage and harmful substances. CoQ10 can be found in many types of foods like beef, sardines, and peanuts. You can also get it in a dietary supplement.

If you do not have enough CoQ10, you will be at a higher risk of depression, certain types of cancer, and more. Signs of low CoQ10 include: Depression, anxiety, high blood pressure, chest pain, memory loss, asthma, chronic fatigue, gum disease, migraines, weakness, nerve pain, and more.

Antidepressants can cause side effects and increase your risk of depression by actually depleting your body of CoQ10. In fact, low CoQ10 has been shown to play a role in “treatment resistant depression” which is depression that does not seem to improve despite treatment (7)(8)(9). Supplementing with the proper form and dosage of CoQ10 has been shown to be a powerful, natural, antidepressant and can help not only curb side effects of your antidepressants, but also help you feel less depressed to begin with.

5) Depletion of Melatonin

Melatonin is a molecule that is released by a gland in your brain, called the pineal gland. Melatonin is involved in regulating your sleep-wake cycle, called the circadian rhythm, and is also very closely linked to mood stability. When the sun goes down, there is less of a particular type of wavelength of light called “blue light,” and as a result the brain produces more melatonin to tell your brain it is time to go to sleep. Melatonin not only helps you get a good night’s rest but it is also a powerful antioxidant, protects against weight gain, heart disease and even migraine headaches and Alzheimer’s disease.

Research has shown that certain medications, including antidepressant medications like fluoxetine (Prozac), deplete the body of melatonin. This  may be in part why patients experience sleeping difficulties while taking these medications (10).

If you are taking an antidepressant, and are having difficulty sleeping it is possible that you may be having difficulties due to decreased melatonin stores. Before adding more medications to your regimen, like sleep aids, consider asking your doctor about if melatonin might be right for you.

Replace Nutrients for Better Health

If you are taking an antidepressant medication and are experiencing side effects, it is possible that proper supplementation may help to relieve your symptoms. There is an increasing body of evidence showing how vitamins, minerals, and certain herbs can help your brain and body heal. Know that you are not alone in your journey towards health, and that there are science-based solutions to helping you feel like yourself again. You can feel better, the journey starts with healing the body so that you can heal your mind. Get started today!

By: Dr. Nicole Cain, ND MA

References:
1)   Oxidative Stress is Related to Depression: “antioxidant levels are lower, and the serum free radical and oxidative damage product levels are higher than controls in depressed patients”: PLoS One. 2015 Oct 7;10(10):e0138904. doi: 10.1371/journal.pone.0138904.
2)   Novel Therapeutic Targets in Depression and Anxiety: Antioxidants as a Candidate Treatment Ying Xu,1,Δ Chuang Wang,2,Δ Jonathan J Klabnik,3 and James M O’Donnell1,* Curr Neuropharmacol. 2014 Mar; 12(2): 108–119. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964743/
3)   Antidepressants can cause oxidative stress in the brain: “Sertraline decreased catalase and PON1 activity which might expose the brain to further oxidative insults” J Basic Clin Physiol Pharmacol. 2013;24(2):115-23. doi: 10.1515/jbcpp-2012-0022. Brain and liver oxidative stress after sertraline and haloperidol treatment in mice. Abdel-Salam OM1, Youness ER, Khadrawy YA, Sleem AA.
4)   Bottiglieri T. “Folate, vitamin B12 and neuropsychiatric disorders.” Nutrition Review Dec 1996; 54(12): 382-390. Retrieved from http://nutritionreview.org/2013/04/practical-guide-avoiding-drug-induced-nutrient-depletion/
5)   Bottiglieri T, M Laundy, R Crellin, et al. “Homocysteine, folate, methylation, and monoamine metabolism in depression.” Journal of Neurology, Neurosurgery & Psychiatry Mar 2001; 70(3): 419. Retrieved from http://nutritionreview.org/2013/04/practical-guide-avoiding-drug-induced-nutrient-depletion/
6)   Oxford Journals. Toxicological Sciences. Mitochondrial Dysfunction Induced by Sertraline, an Antidepressant Agent. Yan Li*, Letha Couch†, Masahiro Higuchi‡, Jia-Long Fang† and Lei Guo†,1.
7)   Drugs that Deplete: Coenzyme Q102011). PennState Hershey. Milton S. Hersehey Medical Center. Retrieved on 4/1/15 from  http://pennstatehershey.adam.com/content.aspx?productId=107&pid=33&gid=000706
8)   Low COQ10 plays a role in the cause of depression, especially depression associated with treatment resistant depression, and chronic fatigue syndrome: “The results show that lower CoQ10 plays a role in the pathophysiology of depression and in particular in TRD and CFS accompanying depression” Neuro Endocrinol Lett. 2009;30(4):462-9. Lower plasma Coenzyme Q10 in depression: a marker for treatment resistance and chronic fatigue in depression and a risk factor to cardiovascular disorder in that illness. Maes M1, Mihaylova I, Kubera M, Uytterhoeven M, Vrydags N, Bosmans E. http://www.ncbi.nlm.nih.gov/pubmed/20010493
9)   Neuro Endocrinol Lett. 2009;30(4):462-9. Lower plasma Coenzyme Q10 in depression: a marker for treatment resistance and chronic fatigue in depression and a risk factor to cardiovascular disorder in that illness. Maes M1, Mihaylova I, Kubera M, Uytterhoeven M, Vrydags N, Bosmans E. http://www.ncbi.nlm.nih.gov/pubmed/20010493
10)  Penn State Hershey Milton S. Hershey Medical Center. Drugs that Deplete: Melatonin. Retrieved from:  http://pennstatehershey.adam.com/content.aspx?productId=107&pid=33&gid=000712