While a number of effective pharmaceutical treatments for depression have been developed, many of these drugs have undesirable or even potentially fatal side effects, leading some people to consider alternatives. SAMe, prescribed for depression in Europe for 30 years, has only recently been introduced to North America. 5-HTP has been used for over 20 years and may be as effective as some antidepressant drugs for moderate depression, according to the University of Maryland Medical Center. Both are found naturally in the human body. Although both 5-HTP and SAMe are thought to affect levels of synaptic serotonin, they are not believed to cause serotonin syndrome when used concomitantly.
Tricyclics
When combined with some drugs which increase levels of synaptic serotonin, both 5-HTP and SAMe have the potential to cause serotonin levels to rise to unhealthy levels. This condition, known as serotonin syndrome, is characterized by agitation, elevated heart rate, profuse sweating and hypertension. Although most patients recover within 24 hours, serotonin syndrome can be fatal if left untreated. For this reason, it is important to consult your doctor before taking either 5-HTP or SAMe. Tricyclics in particular are prone to producing serotonin syndrome when combined with either of these compounds. There is ample evidence that the antidepressants amitriptyline, nortryptyline and imipramine all have the potential to cause serotonin syndrome when combined with 5-HTP or SAMe.
Painkillers
SAMe, due to its anti-inflammatory and analgesic properties, is often recommended when a patient has been diagnosed with chronic pain as well as depression. This frequently occurs in diagnoses of fibromyalgia. Unfortunately, the common painkillers Tramadol, Demerol and pentazocine also act as serotonin reuptake inhibitors and can cause serotonin syndrome when combined with either SAMe or 5-HTP.
Monamine Oxidase Inhibitors
Because the effects of many pharmaceutical MAOis are irreversible for some time, they pose the most serious danger of any drugs when combined with either 5-HTP or SAMe. Under no circumstances should phenelzine, tranylcypromine or any MAO-A inhibiting drug be used within a month of starting a treatment regimen including either 5-HTP or SAMe.
Serotonin Reuptake Inhibitors
The ability of 5-HTP to produce serotonin syndrome when taken alongside a serotonin reuptake inhibitor has been well-established. This includes new generation serotonin/norepinephrine reuptake inhibitors like Effexor as well as early SSRIs such as Prozac. While more conservative medical centers such as Memorial Sloan-Kettering recommend that patients using serotonin reuptake inhibitors avoid SAMe as well, there is little grounds for this concern. Neither the Mayo Clinic nor the University of Maryland Medical Clinic lists SSRIs as sources of possible drug interactions with SAMe.
Other Interactions
Taking 5-HTP in combination with a peripheral decarboxylase inhibitor such as Carbidopa can cause an increase in the incidence of anxiety, as well as the possibility of developing a sclerodermalike condition. Neither Tramadol nor migraine medications in the triptan family such as Naratriptan, Rizatriptan, Sumatriptan or Zolmitriptan should be taken with 5-HTP, as they may also cause serotonin syndrome. Serzone may also interact negatively with 5-HTP. Sloan-Kettering warns that there has been at least one case of clomipramine causing serotonin syndrome when combined with SAMe, although the SAMe in this case was being injected intramuscularly. The University of Maryland Medical Center suggests that patients taking SAMe avoid Tramadol, Demerol, Talwin and Levadopa. They also note that over-the-counter cough syrups containing dextromethorphan may also cause serotonin syndrome when taken with SAMe. Since SAMe can lower blood glucose levels, it may increase the efficacy of some diabetes medications.
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