Monoamine Antidepressant (MAOIs) Food Restrictions

Young woman serving customer at cheese counter
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Biochemically, the brain hormones that play a crucial role in depression and depressive episodes are monoamines. As part of the regulatory cycle in the body, these hormones are routinely cleaned out by an enzyme called monoamine oxidase (MAO). MAOI antidepressants inhibit the action of MAO, thus allowing more of the monoamine neurotransmitters to remain active and relieving depression.

The problem is that there is another monoamine, tyramine, which is involved not with depression but with blood pressure.

Normally the MAO enzyme also cleans tyramine out of the body, but if a MAOI is taken, MAO is blocked from controlling tyramine levels as well as levels of the neurotransmitters associated with depression. If too much tyramine is present, blood pressure goes up, a condition known as hypertension. If the tyramine level rises dramatically, it can cause a dangerous, possibly fatal spike in blood pressure, called a hypertensive crisis.​​

The tyramine connection was discovered by a British pharmacist whose wife was taking a MAOI. He noticed that every time they had a meal with cheese, she would get a severe headache. Cheese, especially aged cheese, contains quite a bit of tyramine. For this reason, persons taking MAOI antidepressants are cautioned to avoid foods that are rich in tyramine.

Foods to Avoid

  • Aged cheeses, some processed cheeses (cottage cheese, cream cheese, pot cheese and ricotta cheese are allowed)
  • Chianti, vermouth, sherry, red wines, tap beer, nonalcoholic beer, and wine
  • Broad (fava) beans
  • Sauerkraut
  • Italian green beans
  • Snow pea pods
  • Soy products, especially soy sauce and tofu
  • Aged or cured meats
  • Caviar
  • Liver
  • Concentrated yeast extract, brewer's yeast, yeast supplements, yeast paste (marmite), miso (commercially leavened products with baker's yeast are allowed)
  • Acidophilus and products with acidophilus
  • Any food that is not fresh, overripe, close to expiration date

Some sources suggest limiting chocolate, caffeinated beverages, yogurt, sour cream, avocados, raspberries and packaged soups. A 1999 study published in the Journal of Clinical Psychiatry concluded that major chain pizzas are safe, but "caution must be exercised if ordering pizzas from smaller outlets or gourmet pizzas known to contain aged cheeses." The sources do not agree, so check with your doctor or pharmacist if you have questions.

Sources Monoamine Oxidase Inhibitors.

Gardner D.M., Shulman K.I., Walker S.E., Tailor S.A. (1996). "The making of a user-friendly MAOI diet." Journal of Clinical Psychiatry

Mayo Clinic. (2004). MAOI diet: Restrict foods high in tyramine.

Shulman K.I., Walker S.E. (1999). "Refining the MAOI diet: tyramine content of pizzas and soy products." Journal of Clinical Psychiatry.

University of Pittsburgh Medical Center. (2003). MAOI Diet Facts.

Wikipedia Cheese Syndrome.