Class landing · Tricyclics

Supplements and tricyclic antidepressants.

Serotonergic and anticholinergic supplements to watch alongside amitriptyline and nortriptyline.

Tricyclic antidepressants (amitriptyline, nortriptyline and others) are older antidepressants still widely used, often at low doses for nerve pain, migraine prevention and sleep. They raise serotonin and noradrenaline, and they carry anticholinergic effects such as dry mouth, constipation and drowsiness.

The serotonergic supplements (5-HTP, tryptophan, SAM-e, saffron and rhodiola) sit in the cautious tier: each can add to the serotonin effect and is worth reviewing before starting. St John’s Wort speeds up the CYP enzymes that clear these drugs and can lower their level, so it works against the medicine. Huperzine A pulls in the opposite direction to the drug’s anticholinergic action, another reason to check before combining.

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For adults over 18. This tool gives evidence-graded information, not medical advice. Always discuss changes with your GP or pharmacist, especially if you take any medication, are pregnant, breastfeeding, or have a serious health condition.

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How we decide

How we grade severity, choose what's in scope, and what we exclude.

Every call on this page is reasoned. We publish the full rubric for severity tiers, the medication inclusion logic, the evidence grades we accept, and what we deliberately leave out. About three thousand words. Worth reading once if you use this tool more than occasionally.

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The full report

A full supplement review, built around you, not a generic stack.

The free checker answers one interaction question at a time. A Distil report reviews the bigger picture: your goals, diet, medications, current supplements and any blood results you provide, then shows what appears worth keeping, changing, adding or leaving out.

what your diet already covers, so you are not adding a capsule for something food is already handling
which evidence-graded compounds are worth considering for your goals, and which were considered but left out
what to keep, change or stop from what you already take, plus the order to introduce anything new
how your medications and complete supplement stack fit together, with daily timing and a clear point for reassessment

The interaction check is one section of the full report. You also get the reasoning behind each recommendation and the evidence references used.

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Distil's interactions database is reviewed and updated every quarter. We grade evidence transparently and publish our methodology, including every database change, at /about/methodology. This tool is information, not a substitute for clinical judgement. If you take medication and supplements together, your GP or pharmacist can review your full regimen against your medical history. If you want a full personalised stack reasoned against this same database, the Distil report is the next step up.