Taking Nutrients Alongside an Antidepressant
Some nutrients have been studied specifically as additions to antidepressant treatment rather than as replacements for it. A systematic review in the American Journal of Psychiatry concluded that current evidence supports the adjunctive use of SAMe, methylfolate and omega-3 with antidepressants to reduce depressive symptoms. Anyone taking prescribed medication should speak to their doctor before adding anything to it.
Added to care, not used in place of it
Adjunctive use
Replacement use
What does adjunctive mean?
Adjunctive means added to an existing treatment rather than used in place of it. The distinction matters because the two are studied differently and answer different questions. A trial of a nutrient instead of an antidepressant tells you whether it can substitute for one. A trial of a nutrient added to an antidepressant, in people already taking that antidepressant, tells you whether it adds anything on top. Most of the nutrient evidence relevant here is of the second kind.
Which nutrients have been studied this way?
A systematic review and meta-analyses of adjunctive nutraceuticals in the American Journal of Psychiatry examined this question across the trial literature and concluded that current evidence supports the adjunctive use of SAMe, methylfolate, omega-3 and vitamin D with antidepressants to reduce depressive symptoms, with primarily positive results in replicated studies for those agents. [1] The 2022 WFSBP and CANMAT clinician guidelines give adjunctive omega-3 fatty acids their strongest rating for any nutrient in unipolar depression. [2] L-methylfolate was studied as an addition to an SSRI in two randomised, double-blind trials reported together in 2012, where the 15 mg daily dose showed a benefit. [3] A meta-review of thirty-three meta-analyses covering 10,951 people summarises the field as a whole. [4]
Should I stop my medication?
No. Nothing on this page is a reason to stop or change prescribed medication, and stopping an antidepressant without medical advice can cause withdrawal effects and a return of symptoms. The evidence discussed here concerns nutrients used alongside treatment, in people who continued taking their medication. Any change to prescribed medicine is a decision for the person and their doctor together.
What should I tell my doctor?
Tell them the full name and daily amount of anything you are taking or thinking of taking, including the specific nutrients and the doses, and mention every other medicine and supplement you use. Nutrients can interact with medicines, and a doctor or pharmacist can only advise properly with the whole list in front of them. This is particularly worth doing for anything affecting serotonin, and for anyone diagnosed with bipolar disorder, pregnant, nursing, or taking MAO inhibitors. [5]
Where Hedonia sits
Hedonia provides the three nutrients this literature converges on, i.e. EPA omega-3, L-methylfolate and SAMe, in one formulation. It is a medical food for the dietary management of the nutritional requirements associated with depression, intended for use under medical supervision alongside a physician-directed treatment plan. It is not a replacement for prescribed medication.
Watch this explained
[0:00] You can buy Hedonia without a prescription, so it does not need a conversation with your doctor.
[0:05] Right?
[0:06] Not quite.
[0:07] That conversation is not a formality.
[0:09] It is part of how Hedonia is meant to be used.
[0:12] So, here is why and what it should actually cover.
[0:16] First, a quick bit of context.
[0:18] In the United States, Hedonia is formulated and marketed as a medical food.
[0:23] That is a specific category of food.
[0:25] It is intended for the dietary management of a condition with distinctive nutritional requirements,
[0:30] under a doctor’s supervision.
[0:33] It is not a drug.
[0:34] It is not an ordinary dietary supplement.
[0:37] And it is not an antidepressant.
[0:39] The condition here is major depressive disorder, which brings us to the most important sentence in this video.
[0:46] Hedonia is designed to be used alongside antidepressant treatment, not instead of it.
[0:51] So, if you are taking medication for depression, keep taking it.
[0:55] Do not stop.
[0:56] Do not lower the dose.
[0:58] Do not skip days.
[0:59] Stopping an antidepressant.
[1:01] Or changing how you take it is a medical decision.
[1:04] It belongs with the doctor who prescribed it.
[1:07] Adding a medical food does not change that.
[1:09] The same applies to therapy.
[1:11] Hedonia does not replace it.
[1:13] So, why is a doctor written into the definition of a medical food in the first place?
[1:18] Partly because dietary management should sit inside a wider plan rather than alongside one.
[1:24] And partly because available without a prescription is not the same as nothing to consider.
[1:29] Nutrients are biologically active.
[1:32] That is rather the point of them.
[1:34] Being a nutrient rather than a drug does not place something outside the conversation.
[1:38] So, here is what to raise.
[1:40] Tell your doctor and your pharmacist everything you take.
[1:44] That means prescriptions, over-the-counter medicines, supplements and herbal products.
[1:50] All of it.
[1:51] Two things are worth flagging specifically.
[1:53] The first is SAMe.
[1:55] Some medicines act on serotonin.
[1:57] Many antidepressants do.
[1:59] So do certain migraine treatments and some painkillers.
[2:02] There have been reports of problems when SAMe is combined with medicines of that kind.
[2:07] The evidence is limited.
[2:08] It comes largely from individual case reports rather than trials.
[2:12] But it is a recognized caution.
[2:14] And it is precisely the sort of thing a doctor is well placed to weigh.
[2:18] The second concerns bipolar disorder.
[2:21] There have been reports of SAMe being associated with a shift towards mania or hypomania in people with bipolar disorder.
[2:28] If bipolar disorder is part of your history, that needs to be on the table before you start.
[2:34] Neither point means Hedonia is unsafe.
[2:36] It means this is not a decision to make alone.
[2:39] In practice the conversation is short.
[2:41] Bring the box or a photograph of the label.
[2:43] Say what is in it and how much.
[2:45] Say what else you take.
[2:47] Ask whether it fits with your current treatments and whether anything should be monitored.
[2:51] Then follow what you are advised.
[2:53] Now for the honest bit.
[2:55] A doctor’s involvement does not make a medical food effective.
[2:58] It makes the decision better informed.
[3:00] Those are different things.
[3:02] And it is worth keeping them apart.
[3:04] Hedonia is one nutritional part of a wider, doctor-led plan alongside whatever medication, therapy, or other medical care a person needs.
[3:13] And if symptoms worsen or thoughts of self-harm appear, that is a matter for urgent medical attention rather than a nutritional one.
[3:21] Contact your doctor or emergency services.
[3:25] Hedonia is formulated and marketed in the United States as a medical food for the dietary management of nutritional deficiencies,
[3:33] associated with depression for use under a doctor’s supervision.
[3:37] The research is linked below, so you can examine the evidence for yourself rather than simply taking our word for it.
References
- Sarris J, Murphy J, Mischoulon D, Papakostas GI, Fava M, Berk M, Ng CH. Adjunctive nutraceuticals for depression: a systematic review and meta-analyses. Am J Psychiatry. 2016;173(6):575-587. PMID 27113121. PubMed
- Sarris J, Ravindran A, Yatham LN, Marx W, Rucklidge JJ, McIntyre RS, et al. Clinician guidelines for the treatment of psychiatric disorders with nutraceuticals and phytoceuticals: the WFSBP and CANMAT Taskforce. World J Biol Psychiatry. 2022;23(6):424-455. PMID 35311615. PubMed
- Papakostas GI, Shelton RC, Zajecka JM, Etemad B, Rickels K, Clain A, et al. L-methylfolate as adjunctive therapy for SSRI-resistant major depression: results of two randomized, double-blind, parallel-sequential trials. Am J Psychiatry. 2012;169(12):1267-1274. PMID 23212058. PubMed
- Firth J, Teasdale SB, Allott K, Siskind D, Marx W, Cotter J, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta-analyses of randomized controlled trials. World Psychiatry. 2019;18(3):308-324. Open access
- National Center for Complementary and Integrative Health. 8 Things To Know About Depression and Complementary Health Approaches. National Institutes of Health. NCCIH