17 November 2020
Zooming in on Micros: Mental health, RDIs, Supps & more…
Last article, I spoke about the basic functions of micronutrients, common deficiencies and their role in physical health. If you’re just tuning in now, I’m going to redirect you to here, otherwise this isn’t going to make a whole lot of sense… To kick of this article, we are going to start with (an introduction to)…
Last article, I spoke about the basic functions of micronutrients, common deficiencies and their role in physical health. If you’re just tuning in now, I’m going to redirect you to here, otherwise this isn’t going to make a whole lot of sense…
To kick of this article, we are going to start with (an introduction to) the role played by micronutrients in mental health.
Micronutrients and psychological health
The first thing to recognise here is that physical and psychological health are not two separate entities, in reality, they’re two sides of the same coin. Your mental wellbeing is the conscious meta-physical manifestation of unconscious physical processes at the level of the brain, and these physical processes can and will be directly and indirectly effected by the state of the body.
Essential in the brain’s energetic processes — and hence your mental health — is once again, mitochondrial proficiency. They have to work damn hard for this glucose guzzling organ! The brain is so metabolically active, that it accounts for approximately 20-25% of your Basal metabolic rate.
With this knowledge, we’ve already arrived at a key point: that the brain it likely to be the place which displays any negative effects due to inadequate nutrients — such as in the form of mental fatigue.
What separates this centre of consciousness — and the remainder of the central nervous system — from the rest of the body, however, is neurotransmitters. The synthesis and reuptake of neurotransmitters partially relies on micronutrient cofactors and co-enzymes. Serotonin, GABA, dopamine, norepinephrine, essentially all the chemicals that make you feel mentally sound, stem, in part, from micronutrients such as magnesium, zinc and B-vitamins.
This is important point number two: you’ve gotta supply the goods to feel the goods.
For these reasons, it’s not hard to find research that strongly links poor diet to the onset of clinically diagnosed mental health conditions such as depression, anxiety disorders, ADHD and suicide (1-8). And, to that point, when poor diets are resolved to become more wholesome, and varied, there is often significant relief of symptoms, and in some cases, total relief (9). Of course, these outcomes can’t be attribute to micronutrients alone. Essential fats, amino acids and other bioactive components such as phytochemicals, play a massive role alongside micronutrients.
What has really interested me, and what actually prompted me to write this article, is the emerging research of micronutrient supplementation on aiding in the battle against psychiatric conditions, via both single micronutrient and broad-spectrum formulas. Considering these cases are more specific to micronutrients, and with the rise of depression and anxiety in Australia — 20% total & 30% of females ages 15-24 (10) — I thought it be worth a detailed account of these results. Not only that, it starts to lead in questions about the efficacy of RDI’s and supplementation.
Starting with the single nutrient interventions into mental health, we need to understand that it’s always going to be unknown whether a single micronutrient is required or whether groups of nutrients are better. But, given what’s know about human physiology and its need to balance between nutrients, a broad-spectrum approach (featuring synergists) would make more sense — though, some monotherapies have been very successful.
Zinc, for example has been shown to be effective in improving depression, especially in conjunction with an antidepressant (11). As for anxiety, one study comparing the mineral status of 38 chronically anxious participants (diagnosed with General Anxiety Disorder) and 16 participants without GAD, found that those who had anxiety had slightly higher levels of copper and lower zinc, and that symptoms were significantly relieved with zinc supplementation (12).
A quick add in on the potential physiology behind this study:
Remember that zinc and copper are antagonists, and, in true antagonistic fashion, they fight for absorption. Well actually, it’s more that zinc gets in coppers way. Whether the reverse relationship occurs is somewhat controversial. Copper, when utilised, is involved in the synthesis of the neurotransmitter’s adrenaline and noradrenaline which are known as your “fight or flight” hormones, occasionally inducing feelings of anxiety depending on emotional state. Zinc, on the other hand is partly responsible for the main calming neurotransmitter GABA. It’s been shown in rats that when there’s too much copper, GABA production is blocked but this hasn’t really been shown in humans (13, 14). It’s more likely that these participants just ate stuff all zinc, were commonly eating zinc inhibitors alongside zinc containing foods or had a genetically wired zinc prohibitors.
Extra factoid: People often take ZMA before sleep which makes some sense because zinc can lead to GABA and magnesium and B-6 are the precursors to the serotonin-melatonin pathway, however, neither the zinc nor magnesium used in typical ZMA products are well absorbed, so you’re better off creating your own version. More on this later.
Many other single nutrient studies have also shown some positive effects on depression such as Vitamin D (15)and folate (B-vitamin) (16)and magnesium (17), but I believe they’re a drop in the ocean of human physiology, so to speak, and the bottleneck may simply be moved onto the next metabolic stage.
The next question is, do a broad-spectrum of vitamins and mineral fair better in the optimisation of human physiology, and thus mental health?
Leading the charge in this regard is Julia Rucklidge and her team from the University of Canterbury.
In a 2013 systematic review, Julia and Bonnie J Kaplan reviewed broad-spectrum micronutrient formulas for the treatment of psychiatric symptoms (18). This included, mood, bipolar disorder, ADHD, Autism spectrum disorder (ASD), anxiety and stress, antisocial behaviours and substances abuse. To qualify for review, the formulas had to consist of at least four vitamins or minerals, and they didn’t discount formulas that included some amino acids or herbal additives. Forty-seven (of 738) studies met the inclusion criteria, of which 25 were double-blind randomized control trials (RCT’s) which is important to note because they are the gold standard research method. It was a real free for all in terms of psychiatric conditions and micronutrient formula but it’s the first of its kind and the results are quite amazing.
The one big downside that must be mentioned is that barely any studies reviewed diet before beginning the research. It could just be that everyone from these studies had mental illness borne partially out of poor diet quality and that subsection of the study’s population saw relief. I, however, find this to be doubtful given the large sample sizes, countries in the study and when the results are combined with the research I’ll present later. It’s also somewhat non-concerning because the formulas that got the best results in this review used products that extended well beyond the RDA recommendations. One product was called EMPowerplus and it contained 36-ingredients, 30 of which are vitamins and minerals.
Now a quick brief of the results…
All seven trials on using EMPowerplus for the treatment of bipolar (lasting between 6-24 months) showed improvement in symptoms and less need for medication. Just so you’re aware, these were 15-pill day protocols from a supplement that you can’t find at your local Chemist Warehouse.
One small drawback was that none of these studies were RCT’s which is understandable given the costly timeframes, but the volume of studies at the very least says something about the efficacy and sets a good platform for more rigorous testing. Since this review, another trial of 60 adults with major depressive disorder showed greater reductions when participants received a B-complex formula, compared with placebo (19)
The research regarding mood did include RCT’s and the results were mixed, however, they did include “healthy’ subjects, the timeframes were short, and the formulas were less complete. All factors which no doubt influenced results. Nevertheless, many did still show a significant benefit.
Five RCT’s for anxiety, four of which for double-blind placebo randomised controlled trials, used high dose B-vitamins and all five reported improvements. When using a larger variety of micronutrients (27-29 ingredients) at around the RDA, all but one showed significant benefit in reducing anxiety. All studies on substance abuse and anti-social behaviours even showed significant benefit, most of which were double-blind. Crazy, right?
All four studies on ADHD, ranging from 4-16 weeks showed significant improvement in symptoms and so to all three studies on ASD, ranging from 3 months to 2 years. EMPowerplus (or similar) featuring heavily in both. For ADHD there was only one double-blind placebo randomised controlled trial. However, since that trial, Julia has conducted multiple studies of just that kind (20, 21). Once again, these are powerful 15 pills per day treatments using EMPowerplus, above the RDA’s. In one of these follow up trials, the participants showed less hyperactivity, impulsivity and depression and after 1 year, the group that continued using micronutrients maintained or showed improvements, and the group that stopped or returned back to ADHD medication had a worsening of symptoms (20).
Within the review, there was even preliminary research of the reduction of PTSD using high dose B-vitamins following the Christchurch New Zealand earthquakes in 2010-2011, one of these studies where in participants that also had ADHD. Since then, these results have been replicated after devasting flooding in Alberta Canada, with the broad-spectrum approach showing the greatest improvements (22).
This research is a clear demonstration of how feeding the brain everything is needs (the constituents for effective energy and neurotransmitter production) can help manage psychological health for many sufferers of mental illness. It’s important to note, however, that the benefits aren’t universal and as previously stated, it may just be serving those who previously had poor diet rather than those with unfortunate genetic dispositions.
While emerging research is revealing this strong link between mitochondrial dysfunction in ADHD, bipolar disorder, depression, anxiety and ASD (23-27). I just can’t speak to the genetic side of things; however, it should be made clear that pre-programmed errors in metabolism can only be worsened by poor micronutrient status, and that high dose broad spectrum micronutrients, may still bring about some positive effects.
Many questions sprang to mind after reading this review as well as other work published by Julia Rucklidge. Most questions related to: why some people responded so well to the higher than RDI treatment?
One answer that kept popping up was that it could be poor digestive and absorptive capabilities. It’s always important to note that nutrient intake is not a perfect predictor of nutrient availability and, therefore, the old adage of “You are what you eat” would be better stated as “You are what you absorb.”
Furthermore, it has long been known that chronic psychological (or physical) stress will significantly impact the composition of the microbiota, leading to dysbiosis (28, 29). The microbiome, if you didn’t know, is an ecosystem (mostly bacteria) that reside in your GI tract and their main purpose is to digest food and extract the nutrients that we need — and, in some cases, make nutrients for us. A loss of diversity in gut bacteria (dysbiosis) will, therefore, alter what we can absorb from our food.
Overtime, dysbiosis will also injure the mucosal barrier and increase the permeability between our intestines and systemic systems (aka bloodstream and lymphatic system), by slowly chipping away at what used to be tight “gatekeeping” junctions between intestinal (epithelial) cells. From that point, macromolecules such as bacteria can translocate and cause systemic inflammation via an immune response (30)(or more like autoimmune).
In such unfortunate cases, it’s always hard to know what came first, pre-disposed GI problems or a self-induced condition through poor diet and lifestyle. Without intervention though, wherever it started from, this problem (just like anything got to do with stress) has a way of compounding itself.
It seems destined, that once gut problems arise, errors in energy metabolism will occur and that maybe “supersaturation” of essential vitamins and minerals may be the only way to get enough through the intestinal lining and increase endogenous stocks — hence the positive effects. Of course, dieting interventions won’t win this battle of their own back, lifestyle factors such as your ability to cope with stress also need to be corrected.
RDIs: Good Enough?
This brings me to the grand question, which I’ve been building to through both articles: Are the recommend daily intakes (RDI’s) for micronutrients up to scratch?
To answer this question, I’m going to summarise a brilliant review article by David Benton from the university of Swansea (31), however, if you’re interested in this topic, I suggest you glaze over it yourself*.
(*I’m not going to reference articles that are discussed within this review. You’ll need to check it out for yourself. )
It’s wonderfully written and packed full of interesting research on the effects of micronutrients on cognition in healthy adults and school kids (fluid vs crystallized intelligence) and mood, all of which showed positives signs and all most of which pre-dated Julia Rucklidge’s work. If you’re disappointed that I haven’t touched on cognition, read this article!
First, before we can get an idea of whether the RDI’s are adequate, we need to understand what the RDI’s were designed for.
For the scientists involved, creating the recommend daily values for each nutrient through population-based research was a painstaking process — to say the least. And, due to this draining and expensive style of research, the “need” that was met by researchers was for participants to be free from disease (within the study timeframe), anything fancier such as optimising cognition was out of the question.
This highlights that they wereneverput in place to optimise physiological function. Nutrients often showed a variety of physiological effects at different levels of intake, yet once the burden of disease was taken care of, the set value became somewhat arbitrary. Some nutrients even showed beneficial or therapeutic effects, but unfortunately, such dosages surpassed their definition of “requirements.”
The answer of “we don’t know” was also unacceptable because law required that recommended daily values be labelled in proportion to the food product, so in many cases, due to time pressure, the results were nothing more than a best guess…
David’s main argument is that because the brain is by far the most metabolically active organ, constantly requiring an influx of glucose and cofactors from micronutrients, it would show the first signs of deficiency. Those deficiencies would show up as things such as inattentiveness and mental lethargy to begin with which could then spiral more towards anxiety, depression and anger. However, when establishing the nutrient reference values, no psychological or behavioural parameters where studied, therefore RDI’s are invalid when taking psychological well-being into account.
Through biological assay (which tests the concentration of a substance in humans or other living organisms) Benton was able to show that levels of thiamine (B1) significantly above the average RDI, compared with placebo, improved feelings of happiness after 3 months in women who already had, by RDI’s definition, a suitable amount to avoid deficiency. In fact, multiple studies on thiamine, have shown this!
In another one of Benton’s studies, he gave healthy subjects ten times the RDI’s for nine vitamins, or a placebo, for one year. The females reported better mental health and feeling more agreeable and composed. The males reported being more agreeable and this was in subjects, who through biological assay, were judged to be adequately nourished prior to the study with the slight exception of B2 and B6.
To put it plainly, we set the RDI’s a while back in a pretty half-as*ed manner (relative to how we could study them now), with no consideration into mental wellbeing and now they’re our standard nutritional metric in monitoring nutrient intake.
The consensus amongst leading researchers is this field is that optimisation of physical and mental health lies somewhere just prior to the upper limit for many, if not all nutrients.
Physical health may have been mostly covered (although unlucky not to be optimised) by our current parameters but mental health is all but unknown. However, given the research I’ve presented so far, I’d say the RDI’s aren’t sufficient for enough of the population’s mental — especially given the grounds under which these recommendations where developed. And supplementation may boost many already healthy people need or even “nutritional medicine” for those facing psychological difficulty.
If you’ve made it this far, you’re probably very enthused about getting your hands on a broad-spectrum supplement, and hopefully eating a more varied and nutritious diet. But, you’re also almost certainly confused at what to go for. A single nutrient option like zinc? A “complete” multivitamin like centrum? A b-vitamin mix? Well, that’s what I’m here to help answer, and in fact, I’ve created a check list of sorts for you to use. But first, we simply have to return back to the topic of bioavailability to find out why you’re better off avoiding the common brands.
I’ve already touched on the fact that just through diet alone, anti-absorbers exist (an example from the previous article was oxalates and iron) but the realm of multivitamin/multimineral supplementation is twice as complex…
A solid definition of bioavailability is also hard to pin down. For prescription drugs, it’s typically considered to be the quantity of an administered substance that gets into circulation and is not metabolised before it can exert a biological effect. Too often people will consider absorption without putting a thought toward utilisation which is always the end goal. Bioequivalence is also another term worth noting because for some nutrients, for example folate, have multiple nutrient sources with different chemical structures, meaning equal amounts doesn’t mean equal absorption or biological effect. (It’s the heme iron vs non-heme iron issue. And, Vitamin A has the same problem… plant-based vitamin A (Beta carotene) is next to negligible compared to animal-based sources).
There are two inhibitor categories to absorption and utilisation. One is host factors such as the dysbiosis example I gave earlier, and the other is product factors such as the chemical ingredient source as well as bindings, coatings, surfactants and excipients that effect the completeness or rate of release.
1. Host factors
If a person is low on iron and you ingest a large amount of red meat or sardines, there body will be very effective at taking on board all they iron it can. Conversely, this homeostatic mechanism will work inversely if iron stocks are already high. You’ve got enough, why take much on more?
Factored into this is the load per mealof a nutrient. Studies on calcium and folate have shown that the larger the load, the more absorption and utilisation is impacted (32, 33). This may be part of the reason why the 15 pill per day protocols were so profound – doses were spread out across that day.
This is also why the “balanced meal” approach — meaning that you have a little bit of protein, fats and carbs per meal from wholesome sources — is such effective advice; it keeps nutrient load moderate and consistent, allowing for maximal saturation throughout the day. Water soluble vitamins and some minerals are the most sensitive to being excreted so spreading out a b-vitamin and/or mineral multi is important.
Then, just to re-mention it, there’s intestinal health impacting absorption, which is paradoxically solved, in part, by a healthy diet. Some people also get an unlucky genetic draw, making some nutrients undesirable to the body. Lastly, once you hit old age, the less absorptive capabilities you possess.
2. Product factors
One of the biggest product faux pasthat I see is the adage of multiple antagonists. It’s just plain silly. Instead you want to find a formula that looks to enhances synergisms between nutrients.
To be fair, however, creating a stacked multivitamin without having any antagonist issues is a puzzle that seems unsolvable. Some companies, though, are better than other because the ratios between these antagonists allow both to see the light of utilisation. I’ll mention these companies at the end.
Then most importantly: Do they have all the ingredients that you’d want? Do they have the nutrients that people are commonly deficient in?Or, if you’re looking for something more specialised like a bone mix or an iron mix, Do they have the cofactors?
Next, we have the chosen chemical ingredient.
Have you ever noted how, when shopping for a vitamin or mineral such as magnesium, there’s about 10 different forms to choose from? There’s magnesium… chloride, citrate, glycinate (or bisglycinate), malate, oxide, sulfate, taurate and threonate.
Well, guess what… Each one differs in bioavailability!
I’ve always found that, when looking to buy a supplement, looking online for which chemical form has the greatest absorptive capabilities is the easiest way to go.
Hint: it’s often then ones attached to an amino acid like glycinate or organic salts such as citrate, chelates and phosphates. Inorganic salts such as oxides, chlorides, and sulphates tend to limit uptake and cause GI distress.
Hint 2: You sometimes have to be careful of enantiomers. An example is R-Alpha-lipoid acid which is the one the body can utilise versus dl-alpha lipoic acid which is basically a useless fake. If you see an extra letter, and the common ones are D and L, at the start of a nutrient, once again, look up which ones actually work.
Excipients such as binders, disintegrating agents and lubricants are something I know little about, but I do know they are responsible for the rate of release and often are purposefully put there to create a slow release from. Alongside excipients, fillers, coatings and surfactants, often put their to maintain pill structure or dampen the bad taste have also been shown to change the bioavailability of many micronutrients (34). This is why capsulated multi’s are a good idea.
Don’t trust what you see…
Unfortunately, the same kind of rigorous testing doesn’t apply to multivitamin/multimineral supplements as it does for prescription drugs. Manufacturers determine both the types and levels of vitamins and minerals. Take a swing at which form of a nutrient a company is most likely to use? Factor in that most companies only care about their bottom line, and, because the greater public is unaware of product bioavailability differences, they don’t need to worry about much else. Companies like centrum, not only have very small amounts of micronutrient, but there’s no consideration into nutrient form and nutrient-nutrient interactions.
Not only this, overreporting of nutrients is also a common occurrence (34).
With bioavailability out of the way, I can now sum up the key points for micronutrient consumption, factoring in everything that’s been spoken about thus far.
- Always look to improve your diet first. This the healthiest and most cost effect strategy there is. Not only will this maximise your micronutrition from diet, but it will also keep calories to an acceptable level, and, it’s the only reliable place to get phytochemicals (supplementation cannot effectively cover this area yet). The aim should be to fill your diet with 80-90% wholesome foods — preferably 100% but we aren’t robots. To be wholesome, the diet must be varied and consistent across meals. Do this first, see how you feel and then consider supplementation, but I dare say most of you will still benefit from it anyhow. Supplementation should not be used as the lazy persons insurance for eating a poor diet, however, if you’re not going to change your tune with eating, go for it, I guess.
- If you’re overweight/obese, have mental health conditions or any other conditions that may imply mitochondrial dysfunction, once again, first look to diet (after seeking advice of course). However, I think these are cases where supplementation can be suitably added straight away. Micronutrients won’t work magic, but they will likely lead to some improvements, especially in conjunctions with a change in lifestyle factors. Plus the downside is minimal.
- Athletes should consider supplementation given the high metabolic demands of sport.
- When looking to fix something specific such as osteoporosis or anaemia, look for synergistic formulas i.e. calcium, magnesium, Vitamin D and phosphorus for osteoporosis and iron with vitamin C and some b-vitamins for anaemia. (Also do more exercise, especially resistance training for osteoporosis as a lifestyle change as well as eating in a calorie surplus for optimal growth if it’s due to being underweight).
- Buy formulas that are synergistic, in correct ratios and use bioavailable forms of each nutrient. The two brands that I know that account for this are Life Extensionand Thorne Research. I would recommend the Life Extension mix without copper or Thorne’s Advanced nutrients or Basic nutrients V. Thorne also has a multi that is specifically for athletes. They are expensive relative to what you’d but at your local chemist but that’s because they factor in what’s require for a decent multi. They are 8 pill per day servings, however, I would start with 5-6 and take 2 with each meal to spread out the doses. Make sure each meal contains some fat for enhanced absorption of fat-soluble vitamins.
- It seems that iron absorption is the most interfered with when paired with other nutrients. So, don’t buy multis that have iron in them, especially if that’s the deficiency you’re wanting to fix. Always take iron supplements on its own and with the necessary cofactors. The forms of iron you’re looking for are ferrous ascorbate, ferrous gluconate or ferrous bisglycinate.
- Due to age related malabsorption and a reduced endogenous antioxidant system, the elderly should take a broad spectrum multi.
- If you’re anxious or depressed and don’t want to spend much money, you can try some of the single nutrients option I spoke about such as zinc, magnesium or even B-vitamin mixes. Be sure to look up bioavailable forms of zinc and magnesium.
- If you’re an office worker or you spend a lot of time indoors, take vitamin D. This is a micronutrient that you’re not going to get from diet very effectively. I would recommend 1,000UI per day at minimum. Higher might be better and it is tolerated well.
- Supplement with a broad spectrum multi when in a moderate to large calorie deficit.
- If you’re taking a prescription medication look to the extras section under drug interactions for further guidance.
My final say.
A lot of the research I’ve presented is considered to be “a good start” rather than something concrete and I don’t want anyone to go away thinking I’ve illuminated a magic bullet. Each piece of research is promising but none of it is anything akin to a eureka!moment. Optimisation of mental or even physical health through micronutrient consumption is an extremely challenging thing to measure for any researcher given the genetic and environmental variances between humans resulting in numerous confounding variables.
Humans also struggle to objectively rate how they’re feeling retrospectively, and many trials ask to do just that, and a few are without placebos. There’s also the lack of regulation in what constitute and broad-spectrum formula, nor is there a consensus what should be the standard dosages if there was to be one.
Lastly, these studies don’t go through the same trials that a prescription painkiller, for example would, not even close. Why fund research for nutrients? Isn’t it something we know everything about? This may change in the future but for now, gold standard trialling is confined to small sample sizes and short trial durations until it proves itself to be worthy of more.
With that said, when it comes to health optimisation, what the research begins to state is that heading north of the RDI’s is likely the correct direction to travel, and, to reach that place will likely require supplementation of some sort, especially given our current food environment. Exactly how far beyond is uncertain, but there’s considerable space between the upper limit and the current RDI’s.
You may think it’s an overly expensive purchase but contrast that with all the unnecessary purchases you’ve made that are anything but an investment in your health and future. This one may not be tangible, but it is healthy one and it may just be a potentiator of healthier decisions to come — a variable that is likely underestimated.
At the very least, if there’s one thing you should do after reading this, it’s to top up your diet with plenty of fruit and veg of all different colours, make the majority of your remaining carbs whole grain, have some dairy, some leans meats, seafood and poultry, and then, and only then if you’re able to afford it, a decent multi. And the more you restrict your options, whether that be for ethical or experimental reasons the more straightforward this decision should come.
Blood tests and symptomology.
There’s a common issue when it comes to analysing symptoms of a nutrient deficiency and that is the commonality between symptoms. Fatigue can arise from a deficiency of magnesium, iron, B12, Vitamin D and more. Muscle weakness, headaches and dizziness all have long lists as well.
Some are more exclusive such as diarrhea and zinc deficiencies or magnesium and high blood pressure, but, once again, there could be many other reasons for these outcomes.
This is where blood tests can help and if you’ve got probable cause (i.e. a symptom), a thorough doctor and healthcare, you can get these for free. They’ll test for the most likely suspects such as Iron and vitamin D as well as any others that are common for that gender or after assessing diet. Blood tests should be a quarterly to half yearly habit in any case, you know, just to see if you’re going to live for the foreseeable future. When you do that, get whatever nutrients you can for free.
Testing for some micronutrients that people are uncommonly deficient in will likely cost you. It’s better in this case to come back to assessing symptoms, lifestyle and diet. For this, you’ll likely need help, and this is where it is handy to consult with a nutritionist or dietician. I think it’s handy to be in contact with one anyway because you may think your tired from work and stress, and that’s no doubt apart of the problem, however you may be totally unaware that you’ve got next to no magnesium or B12 in your diet.
This is more of public service announcement:
Many prescription drugs interact with nutrient absorption OR can aid in depleting current nutrient stocks!
There’re a few common ones that I have been able to get from this paper, and there’s more in there if you’re interest.
- Contraceptives – May decrease vitamin B-6 & B-12
- Nicotine (smokers) – May decrease vitamin B-3
This websitealso has a list for psychiatric drugs and the nutrients they deplete but I can’t really speak to the validity of this website.
It’s a good idea to supplement with what you may be missing.
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