Dietary Precautions While Taking MAOIs

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Though they are not nearly as common as they once were, monoamine oxidase inhibitors (MAOIs) are still sometimes prescribed to treat depression or used off-label to treat Parkinson's disease.

MAOIs can also be used to treat anxiety disorders like panic disorder, social anxiety disorder, and post-traumatic stress disorder (PTSD).

If you are taking an MAOI, there are certain foods that you will need to limit or completely avoid to prevent your blood pressure from getting dangerously high (hypertensive crisis).

How MAOIs Work

Monoamine oxidase inhibitors, or MAOIs, were one of the earliest antidepressants in the United States, being first made available to consumers in the 1950s.

MAOIs are not prescribed as frequently as they once were because there are more effective medications available that have fewer side effects. However, MAOIs can be a good option for people who have not had luck with other medications.

Common MAOIs include:

  • Nardil (phenelzine)
  • Parnate (tranylcypromine)
  • Marplan (isocarboxazid)
  • Emsam (selegiline)

MAOIs work on neurotransmitters, naturally occurring substances in the brain that help regulate various bodily functions. Specifically, MAOIs seem to work on three neurotransmitters known to have an important role in the chemistry of depression:

This trio of neurotransmitters helps regulate mood, sleep, energy, and motivation. They're also responsible for balancing the fight-or-flight response, which is linked to how you respond to stress and anxiety.

MAOIs for Panic Disorder

Antidepressant medications sound like they're only designed to treat depression, but the drugs are increasingly being prescribed to treat symptoms of panic disorder and other anxiety disorders.

If you have panic disorder, you may be prescribed one or more medications (possibly including an MAOI) to alleviate anxiety, panic attacks, and other panic-related symptoms.

Reason for Food Restrictions

If you are prescribed an MAOI for depression, anxiety, or another condition, your doctor will likely talk to you about your diet. You won't be able to have some foods and drinks while you are taking an MAOI because there is a potential for a serious interaction.

Tyramine is a compound that affects your blood pressure. It's regulated and broken down by the MAO enzyme. MAOIs restrict the MAO enzyme to reduce symptoms of depression and anxiety.

However, if the MAO enzyme is inhibited, tyramine can reach dangerously high levels in your body. Elevated tyramine can cause your blood vessels to narrow, possibly leading to critically high blood pressure.

You will need to avoid foods high in tyramine while you are taking an MAOI. You will also need to continue to avoid them for two to four weeks after you stop taking an MAOI.

Foods to Avoid

Tyramine is found in certain foods, beverages, and other substances. Protein-rich foods, for example, typically contain high amounts of tyramine. Foods that are aged (such as cheese) are also high in tyramine because the content of the substance in a food or beverage increases as they age.

High Tyramine Foods and Beverages

MEAT: Beef liver, chicken liver, fermented sausages (pepperoni and salami) bacon, hot dogs, corned beef, and luncheon meats. Bouillon cubes or broth made with meat extracts. Soy-based meat alternatives.

FISH: Caviar, cured fish, dried or pickled herring, and anything that contains shrimp paste.

MILK: Aged, mature, or hard cheeses (aged cheddar, Swiss, Parmesan, blue cheese, Camembert).

PRODUCE: Overripe fruits, dried fruit, avocados, banana peels (not bananas themselves), fava beans, Italian green beans, edamame, snow peas,  and canned figs.

ALCOHOL: Certain fermented alcoholic beverages including red wines and Chianti, vermouth, and sherry. Beer that contains yeast (particularly home-brewed or tap beer).

YEASTS: Homemade yeast bread, sourdough bread. Any food made with concentrated yeast products or brewer's yeast such as miso, teriyaki, fermented tofu or bean curd, and soy sauce.

PICKLED OR FERMENTED PRODUCTS: Kimchi, sauerkraut, pickles, kefir, tofu, tempeh, kombucha.

DESSERTS: Coffee (may be OK in limited amount), soy-based ice cream, yogurt, or milk alternatives, Marmite/Vegemite.

You will also need to carefully inspect any combination of snacks and meals that may be made with the foods you need to avoid. For example, you should not eat pizza or lasagna made with cheese or meals such as a stir-fry that made with soy sauce.

Food Safety

Only eat fresh and freshly cooked foods while you are taking an MAOI as tyramine levels in food increase during the spoiling or decay process.

Here are some food safety tips to keep in mind while you are taking an MAOI.

  • Always use proper food handling, preparation, and safety practices to help prevent spoilage and food poisoning.
  • Check all packaged foods for freshness. Do not consume products beyond the freshness or expiration date.
  • Cook all foods to the proper temperature indicated for food safety.
  • Maintain and store cold foods at the proper temperature indicated for food safety.
  • Do not refreeze foods that have been thawed.
  • Avoid leftovers (even if they have been refrigerated).
  • Ensure that proper food temperature is maintained. Consume any cooked foods promptly.

It's also important to know that cooking or heating up foods and drinks that are high in tyramine will not decrease the levels.

Symptoms of Hypertensive Crisis

If your tyramine level starts to increase and your blood pressure quickly rises, you may develop symptoms of a hypertensive crisis.

Symptoms of a hypertensive crisis can include:

  • Headache (usually severe)
  • Nausea
  • Vomiting
  • Confusion
  • Vision changes or disturbances
  • Fast or irregular heart rate
  • Chest pain (may be accompanied by shortness of breath)
  • Sweating
  • Nosebleeds
  • Severe anxiety
  • Fainting

If you are taking an MAOI and develop symptoms of a hypertensive crisis (especially after eating a high-tyramine food) call 911 or go to your local emergency room.

A Word From Verywell

If your doctor prescribes an MAOI for you, ask them for a complete list of foods and beverages that you need to avoid. You will also want to ask if you need to avoid any over-the-counter or prescription medications or supplements while you are taking an MAOI.

Make sure that you know the signs of a hypertensive crisis as well as what to do if you experience symptoms before you start taking an MAOI.

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