You may or may not be taking medication for anxiety and/or depression and I am not here to tell you if medication is right or wrong, or to dwell on the side effects. Medication has its place and purpose and can be a real life-saver for some. In this post, I am going to talk a little bit about my own previous experience with medication for anxiety/depression, how medication can cause nutrient depletion, why this is important to know, and how to replenish these nutrients so that you can stay in good health even whilst taking this type of medication if you have chosen to do so. 

 

Medications for Anxiety 

 

The most commonly prescribed medications for anxiety are SSRI’s (selective serotonin re-uptake inhibitors), SNRI’s (serotonin and noradrenalin re-uptake inhibitors), and TCA’s (tricylic anti-depressants). Benzodiazepines are used for shorter term, acute anxiety and beta-blockers are also prescribed (off-label) for performance anxiety (1). This post focuses on SSRI’s as this is the most commonly prescribed drug for both anxiety and depression.  

 

My Experience

 

 I went on SSRI’s at age 23 (citalopram was the drug of choice around 10 years ago) and found them to be extremely helpful for me at that time without any noticeable side effects. I had felt like I was on a downward spiral with anxiety and depression, and the medication halted this spiral and allowed me some mental space to lift myself out of the hole I found myself in. They gave me a rose-tinted perspective towards my troubles and things no longer seemed so bad. I thought I had found my panacea – I simply needed anti-depressants to feel like a normal human. I stayed on the SSRI’s for around 3 years.  

 

“Slowly during the period I took SSRI’s I noticed that other areas of my health started to suffer”

 

I was getting more frequent colds and infections, aches and pains, I developed allergies (I thought nothing of popping an anti-histamine nearly every day), the rose-tinted effect seemed to be wearing off, and for the first time in my life, I started with IBS. This may sound familiar to some of you reading this? 

I can’t blame the SSRI’s exclusively on the cluster of new symptoms, as there may have been other factors at play but what I didn’t realise back then was that the medication was most likely depleting me of key nutrients.  

 

“Drugs have an intended effect on the body, but in the process of helping you, they can sometimes put your body in a dangerous state by slowing depleting you of the very nutrients needed to maintain your health and to help you heal” (RPh Suzy Cohen (2)) 

 

Nutrients are essential for the metabolic function of every cell in our body impacting on digestion, immune function, liver detoxification, hormone production, growth and repair, brain function, and the nervous system.  

Even if you think you are getting your recommended daily intake of nutrients through your diet or additional supplements, you may still be depleted in a nutrient if you are taking medication and this may be having a knock-on effect in other areas of your health, as well as making your anxiety or depression worse.  

 

 

Which nutrients do SSRI’s deplete?

 

Selenium (2)

Selenium is a trace mineral that is important for the immune system. It is used to produce an antioxidant called glutathione. Glutathione protects us from damaging free radicals and inflammation (3).  Selenium is vital for brain health, the musculoskeletal system and heart health (4). Selenium depletion can result in a lower resistance to infections, increased inflammation and risk of cardiovascular disease, increased antibodies in auto-immune thyroiditis, depressed moods and joint problems (4).

The RDA for selenium is 75mcg for men and 60mcg for women. 1 in 7 people is said to have inadequate selenium intake in their diet due to mineral depletion in the soil (5). So it’s especially important for those taking SSRI’s to make sure they are getting adequate selenium in their diet or to supplement.

 

Good sources of selenium include the following: 

25g butter – 35mcg

100g herring – 141mcg

30g Brazil nuts – 33mcg

100g scallops – 77mcg

100g oats – 56mcg

Garlic, brown rice, lamb, turnips, steak, cod, milk, egg yolk and chicken contain reasonable amounts of selenium too (6).

If supplementing, you can supplement up to 200mcg per day, look for selenomethionine or selenocysteine (6).

 

 

Folate (2)

Folate is a water-soluble vitamin (vitamin B9) which works together with vitamin B12. It is crucial for DNA replication and helping the body make healthy new cells (6). It is also involved in serotonin production and metabolism (7). As we know, serotonin is important for regulating our moods. Folate depletion can impact depression and anxiety, even when taking SSRI’s.

Wheat flour in the UK is fortified with folic acid (8): the synthetic form of folate. This means that processed foods such as cereal, bread and biscuits contain the synthetic form of vitamin B9. What’s wrong with synthetic folic acid? It’s estimated that up to 40% of the population has a genetic mutation on the gene that is responsible for processing folic acid. The gene is known as MTHFR (methylenetetrahydrofolate reductase) (9). A genetic mutation on this gene means you are unable to metabolise folic acid as well as someone without the genetic mutation. Individuals with this genetic mutation may still be depleted in folate despite eating foods fortified with folic acid or supplementing with folic acid. Furthermore, high intakes of folic acid can actually create a folate deficiency (10).

As folate is crucial for serotonin synthesis, it’s important to make sure you are getting adequate amounts of folate in our diet or via supplementation. The RDA for adults is 200mcg. If supplementing, look for Methylfolate, Metafolin or Folinic Acid rather than folic acid, as these are more easily used by the body.

 

Food source of folate include:

Brewer’s yeast: 1 tsp – 100mcg

Black-eyed peas: 100g – 440mcg

Liver: 100g – 280mcg

Kidney beans: 100g – 180mcg

Asparagus: 100g – 110mcg

Lentils: 100g – 105mcg

Spinach (fresh): 100g – 75mcg,

Kale 100g – 70mcg

Peanut butter 100g – 56mcg

Broccoli, Brussel sprouts – 50mcg per 100g (6).

 

 

Melatonin (14)

Melatonin works with GABA (gamma-aminobutyric acid – a calming neurotransmitter) to help you sleep (2). Adequate sleep is crucial for every area of our health (11). Melatonin controls the biological rhythm of every cell in our body,  acts as an antioxidant, plays a role in immune function, regulates growth hormone needed for muscle mass and strength, energy and skin tone, and is also involved in cortisol rhythm (the stress hormone). Melatonin is further depleted by stress (12). Furthermore, a lack of melatonin may play a role in IBS, although the exact mechanism is unknown (13).

In the UK, melatonin is prescription-only so you won’t be able to buy melatonin over the counter. Food sources of melatonin include oats, corn, rice, ginger, tomato, banana, barley, cranberries, chicken, liver, pumpkin seeds, turkey, chicken, almonds, peanuts, dairy (6). Good sleep hygiene, stress reduction, supporting natural melatonin production and eating foods naturally rich in melatonin may help maintain optimal levels of this sleep hormone.

 

 

 

 

Summary

 

SSRI’s can deplete selenium, folate and melatonin, impacting on immune function, moods, digestion, sleep, and the ability to produce healthy new cells. If you’re not mindful with your diet, nutrient depletion can have a wide-reaching impact on your health and can result in feeling more anxious and depressed (along with other symptoms) – the very reason we started the medication in the first place!

 

I advocate a whole-foods, unprocessed diet with plenty of leafy green, beans, lentils, nuts, fruit, good quality animal protein and whole grains (if tolerated), which will go a long way in supporting your nutrient levels, especially those that may be depleted by this medication. If you are considering supplementing at all, I recommend working with a qualified nutritional therapy practitioner to support you with your individual needs, who will take into account drug-nutrient interactions and cofactors needed for nutrients to work synergistically.

 

 

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References
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  2. Cohen, S. (2011). Drug Muggers.  Rodale: USA.
  3. Tinggi, U., 2008. Selenium: Its role as antioxidant in human health. Environmental Health and Preventive Medicine, 13(2), pp.102–108.
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  5. Jones, G.D., Droz, B., Greve, P., Gottschalk, P., Poffet, D., McGrath, S.P., Seneviratne, S.I., Smith, P. and Winkel, L.H.E., 2017. Selenium deficiency risk predicted to increase under future climate change. Proceedings of the National Academy of Sciences, [online] 114(11), pp.2848–2853. Available at: <http://www.pnas.org/lookup/doi/10.1073/pnas.1611576114>.
  6. Liska, D & Quinn, S. 2004. Clinical Nutrition: A Functional Approach. 2nd Ed. The Institute for Functional Medicine: USA.
  7. Young, S.N., 2007. Folate and depression–a neglected problem. Journal of psychiatry & neuroscience : JPN, [online] 32(2), pp.80–2. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17353937%5Cnhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC1810582
  8. Crider, K.S., Bailey, L.B. and Berry, R.J., 2011. Folic acid food fortification-its history, effect, concerns, and future directions. Nutrients, 3(3), pp.370–384.
  9. Rajagopalan, P., Jahanshad, N., Stein, J.L., Hua, X., Madsen, S.K., Kohannim, O., Hibar, D.P., Toga, A.W., Jack, C.R., Saykin, A.J., Green, R.C., Weiner, M.W., Bis, J.C., Kuller, L.H., Riverol, M., Becker, J.T., Lopez, O.L. and Thompson, P.M., 2012. Commonfolate gene variant, MTHFR C677T, is associated with brain structure in two independent cohorts of people with mild cognitive impairment. NeuroImage: Clinical, [online] 1(1), pp.179–187. Available at: <http://dx.doi.org/10.1016/j.nicl.2012.09.012>.
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  11. Medic, G., Wille, M. and Hemels, M.E.H., 2017. Short- and long-term health consequences of sleep disruption. Nature and Science of Sleep, 9, pp.151–161.
  12. Claustrat, B. and Leston, J., 2015. Melatonin: Physiological effects in humans. Neurochirurgie, [online] 61(2–3), pp.77–84. Available at: <http://dx.doi.org/10.1016/j.neuchi.2015.03.002>.
  13. Brinn, N.R., Gandhi, M.A., John, S., College, F. and Ny, R., 2014. A Review of the Role of Melatonin in Irritable Bowel Syndrome. 2(12), pp.1–16.
  14. Childs, P., Rodin, I., Martin, N., Plaskett, L., Thompson, C., Allen, N., & Smythe, P. (1995). Effect of Fluoxetine on Melatonin in Patients with Seasonal Affective Disorder and Matched Controls. British Journal of Psychiatry, 166(2), 196-198. doi:10.1192/bjp.166.2.196