Identification and management of psychiatric medication-induced nutrient depletion

This article reviews the evidence for drug-nutrient (DN) interactions associated with the chronic use of commonly prescribed psychiatric medications and suggests management strategies.

Nutrient deficiencies due to DN interactions pose a risk for poorer patient outcomes. However, DN interaction studies and guidelines on preventing and managing DN abnormalities are lacking, with limited information for healthcare providers and patients to use as a resource. DN interactions can be caused by chronic use of psychiatric medications. Carbamazepine (CBZ), valproic acid (VPA), tricyclic antidepressants (TCAs), antipsychotics, and lithium can cause various vitamin B deficiencies. Calcium and/or vitamin D levels can be decreased by CBZ, VPA, antidepressants (ie, TCAs and selective serotonin reuptake inhibitors), and antipsychotics. VPA and clozapine can cause selenium deficiency. VPA may also lower carnitine and zinc levels, while VPA and CBZ can decrease vitamin E levels. Lastly, coenzyme Q10 levels can be reduced by TCA use. Strategies for the detection and treatment of these deficiencies are provided in the article.

Although widespread supplementation is not recommended, identifying at-risk individuals taking psychiatric medications for evaluation and, if needed, treatment can improve their nutrient status. The summary evidence provided can assist pharmacists in guiding recommendations for patient care.