02-05-2019, 11:02 PM
hxxps://www.healthline.com/health/depression/what-are-mao-inhibitors#monoamine-oxidase
Tyramine and foods to avoid
One downside to MAOIs is that they come with dietary restrictions because of the elevated tyramine levels in the blood.
When this class of drug first entered the market, no one knew about the concerns over tyramine and blood pressure. This caused a wave of deaths that prompted further research. Now we know that certain foods contain excess tyramine, and these should be avoided when taking MAOIs.
The more food ages, the more concentrated the levels of tyramine become. This is true for aged meats, cheeses, and even leftovers in your fridge. Foods with dangerously high levels of tyramine include:
soy sauce and other fermented soy products
sauerkraut
salami and other aged or cured meats
Other foods that contain high levels of tyramine are:
aged cheeses, such as Brie, cheddar, Gouda, Parmesan, Swiss, and blue cheese
alcohol, especially chianti, vermouth, and beers
fava beans
raisins, dates, and other dried fruits
tofu
all nuts
Get more information about tyramine-free diets.
Other precautions
Besides blood pressure problems, people taking MAOIs should also beware of a condition called serotonin syndrome. Symptoms can include:
confusion
fever
irregular or rapid heartbeat
dilated pupils
occasional unconsciousness
The condition can manifest if a person on MAOIs takes other antidepressants or the herbal supplement St. John’s wort.
To avoid serotonin syndrome, people taking MAOIs shouldn’t take anything for two weeks when ending MAOI treatment and starting another.
Types of MAOIs
These days, MAOIs are rarely the first choice of prescription medication to treat depression. However, the U.S. Food and Drug Administration (FDA) — the regulating agency of all prescription medication — has approved the following MAOIs:
isocarboxazid (Marplan): can take three to six weeks to fully take effect
phenelzine (Nardil): can take up to four weeks to fully work
tranylcypromine (Parnate): can take up to 3 weeks to achieve its desired effects
Selegiline
Selegiline (Emsam, Atapryl, Carbex, Eldepryl, Zelapar) is a newer type of MAOI. It works by selectively blocking monoamine oxidase B (MAO-B). This reduces the breakdown of dopamine and phenethylamine and means there are no dietary restrictions. It’s available in patch form. Learn about other medications used to treat depression.
Aside from depression, selegiline is also prescribed for early onset Parkinson’s disease and dementia.
Side effects of MAOIs
MAOIs carry more side effects than other antidepressants, which is why they’re often the last drug prescribed to treat depression. Some side effects of MAOIs include:
fatigue
muscle aches
nervousness
insomnia
reduced libido
erectile dysfunction (ED)
dizziness
lightheadedness
diarrhea
dry mouth
high blood pressure
tingling of the skin
difficulty urinating
weight gain
MAOIs and suicide risk
The FDA requires a warning on antidepressants that they may increase the risk of suicide in children and young adults. While MAOIs are rarely prescribed for children, all people beginning any kind of antidepressant therapy should be watched for changes in mood, mindset, or attitude. Successful antidepressant treatments should lower suicide risk by increasing mood.
However, you should consult your doctor before you stop taking MAOIs or any other prescribed medication.
The takeaway
MAOIs are only one type of medication used to treat depression. Like most antidepressants, they may not be right for everyone and take weeks of use to reach their full effect. However, when used in combination with other therapies and lifestyle changes, they can be highly effective at combating depression symptoms. Talk to your doctor for more information to see if MAOI therapy suits your lifestyle.
HEALTHLINE PARTNER SOLUTIONS
Are you or a loved one living with depression?
Find new treatment options from clinical trials currently enrolling near you.
Medically reviewed by Alan Carter, PharmD on September 5, 2017 — Written by Brian Krans
related stories
What Medications Help Treat Depression?
The Dangers of Abruptly Stopping Antidepressants
Combination Therapies for Depression
Tyramine and foods to avoid
One downside to MAOIs is that they come with dietary restrictions because of the elevated tyramine levels in the blood.
When this class of drug first entered the market, no one knew about the concerns over tyramine and blood pressure. This caused a wave of deaths that prompted further research. Now we know that certain foods contain excess tyramine, and these should be avoided when taking MAOIs.
The more food ages, the more concentrated the levels of tyramine become. This is true for aged meats, cheeses, and even leftovers in your fridge. Foods with dangerously high levels of tyramine include:
soy sauce and other fermented soy products
sauerkraut
salami and other aged or cured meats
Other foods that contain high levels of tyramine are:
aged cheeses, such as Brie, cheddar, Gouda, Parmesan, Swiss, and blue cheese
alcohol, especially chianti, vermouth, and beers
fava beans
raisins, dates, and other dried fruits
tofu
all nuts
Get more information about tyramine-free diets.
Other precautions
Besides blood pressure problems, people taking MAOIs should also beware of a condition called serotonin syndrome. Symptoms can include:
confusion
fever
irregular or rapid heartbeat
dilated pupils
occasional unconsciousness
The condition can manifest if a person on MAOIs takes other antidepressants or the herbal supplement St. John’s wort.
To avoid serotonin syndrome, people taking MAOIs shouldn’t take anything for two weeks when ending MAOI treatment and starting another.
Types of MAOIs
These days, MAOIs are rarely the first choice of prescription medication to treat depression. However, the U.S. Food and Drug Administration (FDA) — the regulating agency of all prescription medication — has approved the following MAOIs:
isocarboxazid (Marplan): can take three to six weeks to fully take effect
phenelzine (Nardil): can take up to four weeks to fully work
tranylcypromine (Parnate): can take up to 3 weeks to achieve its desired effects
Selegiline
Selegiline (Emsam, Atapryl, Carbex, Eldepryl, Zelapar) is a newer type of MAOI. It works by selectively blocking monoamine oxidase B (MAO-B). This reduces the breakdown of dopamine and phenethylamine and means there are no dietary restrictions. It’s available in patch form. Learn about other medications used to treat depression.
Aside from depression, selegiline is also prescribed for early onset Parkinson’s disease and dementia.
Side effects of MAOIs
MAOIs carry more side effects than other antidepressants, which is why they’re often the last drug prescribed to treat depression. Some side effects of MAOIs include:
fatigue
muscle aches
nervousness
insomnia
reduced libido
erectile dysfunction (ED)
dizziness
lightheadedness
diarrhea
dry mouth
high blood pressure
tingling of the skin
difficulty urinating
weight gain
MAOIs and suicide risk
The FDA requires a warning on antidepressants that they may increase the risk of suicide in children and young adults. While MAOIs are rarely prescribed for children, all people beginning any kind of antidepressant therapy should be watched for changes in mood, mindset, or attitude. Successful antidepressant treatments should lower suicide risk by increasing mood.
However, you should consult your doctor before you stop taking MAOIs or any other prescribed medication.
The takeaway
MAOIs are only one type of medication used to treat depression. Like most antidepressants, they may not be right for everyone and take weeks of use to reach their full effect. However, when used in combination with other therapies and lifestyle changes, they can be highly effective at combating depression symptoms. Talk to your doctor for more information to see if MAOI therapy suits your lifestyle.
HEALTHLINE PARTNER SOLUTIONS
Are you or a loved one living with depression?
Find new treatment options from clinical trials currently enrolling near you.
Medically reviewed by Alan Carter, PharmD on September 5, 2017 — Written by Brian Krans
related stories
What Medications Help Treat Depression?
The Dangers of Abruptly Stopping Antidepressants
Combination Therapies for Depression
It is Well with My Soul