Medication Management

Nutrients Psychiatric Medications Can Deplete, and What to Test

By Dr. Stacey Forbes, DNP, APRN, PMHNP-BC · Updated October 12, 2026

Some psychiatric medications do change nutrient and mineral levels, but far fewer than online depletion charts suggest. The best-documented effects are written into the drug labels: valproate and folate-related anemia and bone thinning, carbamazepine and low sodium, lithium and the thyroid and calcium, SSRIs and sodium in older adults, and antipsychotics and metabolic changes. Other claims rest on thin evidence. This guide separates the two, explains which labs are reasonable for which medication, and when replacing a nutrient makes sense.

Well established versus marketing: how to read the claims

Search “medications that deplete nutrients” and you will find long charts linking almost every prescription to a supplement you can buy. Some of those links are real. Many come from a single small study, a theoretical mechanism, or a product page.

A 2018 review in the journal Pharmaceutics looked at drug-nutrient interactions across commonly prescribed medicines and concluded that the research is quite limited, that most interactions need better-quality trials before their clinical importance is clear, and that widespread supplementation is not currently recommended. That is a useful anchor. It does not mean depletion is imaginary; it means the evidence varies by drug and nutrient.

On this page we use a simple grading:

• Established: the effect appears in the FDA-approved prescribing information or in consistent clinical guidance.
• Possible: observational studies point the same way, but the size and importance are uncertain.
• Unproven: mostly mechanism or marketing; not a reason to test or supplement on its own.

For how nutrient shortfalls themselves can look like anxiety or depression, see our guide to nutrient deficiencies that mimic anxiety and depression. This page is about what the medications do.

Valproate and carbamazepine: folate, bone and sodium

Valproate (Depakote) and carbamazepine (Tegretol) are anticonvulsants also used as mood stabilizers. Both have nutrient-related effects listed in their labels.

Valproate

The Depakote label lists anemia, including macrocytic anemia with or without folate deficiency, among reported reactions. It also lists fractures, decreased bone mineral density, osteopenia and osteoporosis, along with decreased carnitine concentrations and low sodium. For anyone who could become pregnant, folate matters for another reason: the label explains that valproate can cause neural tube defects and that folic acid before conception and in early pregnancy lowers neural tube defect risk in the general population. That is a conversation to have with your prescriber before starting, not after.

Carbamazepine

The Tegretol label warns that carbamazepine can lower sodium, often through a hormone imbalance called SIADH, with higher risk in older adults and people on diuretics. It also notes reports of decreased plasma calcium and osteoporosis.

What about vitamin D?

Older anticonvulsants have long been associated in research with lower vitamin D and weaker bones, and the bone findings in both labels fit that picture. The evidence for routine vitamin D testing in everyone on these drugs is mostly observational, so we treat it as possible: worth checking if you have been on them for years, have other bone risk factors, or get little sun. Our article on low vitamin D and B12 and mental health explains the symptoms that overlap with mood problems.

Lithium: thyroid, calcium and kidneys

Lithium does not so much deplete a nutrient as change how glands handle minerals and hormones, and the label is direct about it.

• Thyroid (established). Lithium is concentrated in the thyroid and can inhibit thyroid hormone production, which can lead to hypothyroidism. The label calls for regular thyroid monitoring. Low thyroid can look like depression, fatigue and weight gain, so it is worth catching early. Our page on thyroid health and mood explains why.
• Calcium (established). Long-term lithium is associated with overactive parathyroid glands and high calcium, and the label asks prescribers to monitor serum calcium.
• Kidneys and sodium (established). The label describes lithium-related chronic kidney disease with long-term use and recommends checking kidney function. Lithium levels also depend on salt and fluid balance, which is why dehydration and certain blood pressure medicines matter.

None of these is a reason to fear lithium. It remains one of the best-studied mood stabilizers. They are reasons to keep up with the scheduled blood work described in our guide to lab monitoring for psychiatric medications.

SSRIs and sodium in older adults

Low sodium, called hyponatremia, is the best-documented mineral effect of SSRIs. The citalopram label explains that it usually comes from SIADH, that elderly patients, people taking diuretics and those who are volume-depleted are at greater risk, and that early symptoms include headache, difficulty concentrating, memory problems, confusion, weakness and unsteadiness that can lead to falls.

Those symptoms are easy to blame on age, depression or the medication “not working”. For an older adult starting or increasing an SSRI or SNRI, especially one also taking a water pill, a sodium check is a reasonable, inexpensive precaution. We cover this in more depth in our guide to psychiatric medication for older adults.

Antipsychotics: the metabolic picture

Antipsychotics, including those used as add-on treatment for depression, can raise weight, blood sugar and blood fats. That is not a nutrient depletion in the classic sense, but it is the most clinically important “nutrition-adjacent” effect in psychiatry. A New York State prescriber education summary, adapted from the American Diabetes Association and American Psychiatric Association consensus, rates clozapine and olanzapine as having the strongest weight and metabolic effects, with others ranging from moderate to minimal.

The response is monitoring plus lifestyle support, not a supplement. Our guides to antipsychotics as add-on treatment and weight gain on psychiatric medication cover options in detail.

Metformin and B12

If metformin is on your medication list, for diabetes, prediabetes or medication-related weight gain, vitamin B12 is relevant. The 2018 Pharmaceutics review found consistently lower B12 levels in people taking metformin and concluded the evidence is sufficient to recommend periodic B12 assessment. Low B12 can cause fatigue, numbness and low mood, so it is worth ruling out.

Claims with weak evidence

Some popular depletion claims attached to psychiatric drugs do not have strong support. Examples include the idea that every antidepressant drains CoQ10, that all mood stabilizers require a broad “replacement stack”, or that a symptom on a medication is automatically a nutrient problem. We grade these as unproven.

That does not mean ignoring them. If you feel worse on a medication, the useful questions are: Is this a known side effect? Is the dose right? Is there an actual deficiency on a lab test? Is something else going on, such as poor sleep, thyroid change or a new medication? Our article on why an antidepressant may stop working walks through that broader list.

Taking extra supplements “just in case” also has costs: more pills, more interactions to track, and occasionally real harm. See our guide to supplement and medication interactions before adding anything.

Which labs are reasonable, by medication

Testing should follow what you take and your own risks. A reasonable starting framework, to discuss with your prescriber:

Willow & Stone also offers advanced lab testing such as micronutrient panels when a broader look is warranted, but these are chosen for a reason, not ordered by default. If a deficiency turns up, Dr. Stacey Forbes will usually start with diet and a single targeted supplement, recheck, and adjust, in keeping with our integrative approach to medication management.

Common Questions

Sources & Further Reading

• Mohn ES et al. — Evidence of Drug–Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update (Pharmaceutics, 2018)
• DailyMed — Depakote (divalproex sodium) prescribing information
• DailyMed — Tegretol (carbamazepine) prescribing information
• DailyMed — Lithium carbonate prescribing information
• DailyMed — Celexa (citalopram) prescribing information
• New York State Medicaid Prescriber Education Program — Metabolic Monitoring of Antipsychotic Medications (2024)

This article is general education, not advice for your situation. Do not start, stop, or change a medication or supplement without talking to the clinician who prescribes it.