What your Dr forgot to tell you about your medications: anti-depressants, statins, and methotrexate
Updated: Jan 28, 2020
Let me first say there are some great Drs out there who don't forget to mention the nutritional impact of the medications they prescribe, and some who even prescribe the necessary vitamins to combat these. But I'm often shocked when patients come with a long list of ailments that started when they were prescribed a new drug and they have not realised their complaints are listed side effects.
Let's look at three common drugs that affect nutrient uptake.
1. SSRIs and SNRIs - prescribed for depression, these medications can be very helpful for some sections of the population suffering mood disorders, but did you know they can block the uptake of folate, a key nutrient to support mood balance and sleep! Folate also supports methylation which in turn impacts inflammation, microbial balance, detoxification, hormonal balance and more. Studies have clearly shown that taking folate alongside anti-depressants improves their efficacy. It would make sense for Drs to mention the benefits of taking B vitamins on mood balance and response to anti-depressants, when they prescribe them. Indeed B complex vitamins are helpful as adjunct therapy in depression. DO NOT take other 'natural' antidepressant therapies however, when taking prescribed meds. Nutraceuticals commonly used for depression, including St John's wort and 5-HTP, negatively interact with anti-depressant therapies. Seek the advice of a qualified health professional.
2. Statins - These drugs are used to control cholesterol levels and reduce cardio-vascular disease risk. Although evidence has been mixed regarding their effect on the brain, they have also been associated with cognitive decline in enough studies to warrant an FDA warning. A review of the literature concluded, "...statin-induced cognitive decline does exist, needs to be better recognized and requires more studies of prevention and treatment." It has been hypothesised that one of the key issues leading to neurological effects of statins, is the blocking of CoQ10 by statin drugs. Since CoQ10 is a potent neuro-protector and also essential to heart health, it could make sense for doctors to prescribe it as an adjunct to statin therapy. Unfortunately the evidence is still mixed for the use of supplements of CoQ10 in preventing statin side effects, perhaps because of wide variations in doses, quality, and types used in the trials (as well as a lack of trials for vitamins in general). There is little doubt however, that CoQ10 supplementation is useful in treating cardiovascular disease and may help reduce statin side effects. Fortunately many doctors do agree and about 50% of the time I find GPs have mentioned this to their patients taking statins.
3. Methotrexate - This is commonly prescribed for autoimmune disease, especially rheumatoid arthritis and psoriasis. Because it is known to block the uptake of folate, it is always prescribed alongside folate therapy. Usually this involves taking methotrexate on one day of the week and folic acid on all the other days. What many Drs fail to mention is that some people are genetically predisposed to responding badly to methotrexate due to genetic issues already blocking the uptake of folate. Studies show patients with MTHFR mutations (About 10-30% of the population) are more likely to suffer from liver damage on this drug. Studies also suggest that genetic considerations should be part of routine clinical practice when prescribing methotrexate. Unfortunately I have never heard of an Australian doctor taking this into account when prescribing this drug. Moreover, the folic acid prescribed as an adjunct to methotrexate therapy may be toxic to those with folate pathway genetic variations.
These are just a few of the many drug/nutrient interactions that can occur with prescribed medications and nutraceuticals. If you are taking any pharmaceutical drugs, NEVER self prescribe nutraceuticals (supplements), especially herbal ones, without the advice of a pharmacist or qualified health professional. At the same time, seeking advice about how to combat the side effects of drug therapies with targeted nutraceuticals seems prudent when so many drugs do impact normal nutrient uptake.