Dietary Precautions While Taking MAOIs

MAOIs and Dietary Restrictions

Many panic disorder sufferers are prescribed medications to treat anxiety, panic attacks, and other panic-related symptoms. Antidepressant medications may sound like they are only meant to treat depression, however, antidepressants have grown in popularity to help alleviate the symptoms of panic disorder. 

First available for United States consumers in the 1950's, monoamine oxidase inhibitors (MAOIs) are one of the earliest prescribed antidepressants. MAOIs work to impact different neurotransmitters or naturally occurring substances in the brain that regulate various body functions. In particular, MAOIs are thought to affect the neurotransmitters of serotonin, norepinephrine, and dopamine. These neurotransmitters are associated with the regulation of mood, sleep, energy, and motivation. Additionally, these neurotransmitters are responsible for balancing the fight-or-flight response which is linked to how people respond to stress and anxiety. 

Some common MAOIs include:

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

Tyramine is a compound found in many foods, beverages, and other substances. This compound has an effect on blood pressure and is regulated by the MAO enzyme. MAOIs work to restrict this enzyme, which can result in a reduction in symptoms of depression and anxiety. However, when the MAO enzyme is inhibited (such as when taking a MAOI), tyramine can reach dangerously high levels, resulting in critically high blood pressure. While taking a MAOI, it will be necessary to avoid foods and beverages high in tyramine to prevent potentially fatal high blood pressure spikes.

Protein-rich foods contain higher amounts of this compound. Additionally, tyramine content can rise in certain foods as they continue to age. Listed here are some food and beverages that are high in tyramine that you may need to avoid while taking a MAOI for panic disorder.

1
Meat Products

Chopping salami
Steven Morris Photography/Getty
  • beef liver
  • chicken liver
  • fermented sausages (pepperoni, salami)
  • luncheon meats

2
Fish Products

  • caviar
  • cured fish
  • dried or pickled herring
  • shrimp paste

3
Milk Products

  • aged cheeses
  • sour cream
  • yogurt

4
Fruits and Vegetables

  • overripe fruits
  • overripe avocados
  • fava beans
  • sauerkraut
  • canned figs
  • Italian green beans
  • snow peas
  • banana peels (not bananas themselves)

5
Alcohol

  • red wines, Chianti wine
  • beers containing yeast
  • sherry
  • vermouth

6
Miscellaneous

  • concentrated yeast products
  • brewer's yeast
  • Miso (a type of soup or sauce)
  • Soy sauce

7
Other Dietary Considerations

Tyramine is also produced in foods during the spoiling or decay process.

  • Check packaged foods for freshness. Don't consume products beyond the freshness date.
  • Cook all foods to the proper temperature.
  • Maintain cold foods at the proper temperature.
  • Don't refreeze foods that have been thawed.
  • Avoid leftovers, even if they have been refrigerated.
  • Consume cooked foods promptly, making sure proper food temperature is maintained.

Sources:

Kaplan MD, Harold I. and Sadock MD, Benjamin J. Synopsis of Psychiatry, Eleventh Edition 1998 Baltimore: Williams & Wilkins.

Silverman, Harold M. The Pill Book. 14th ed. New York, NY: Bantam Books, 2010.

8
Medications for Panic Disorder

Consult your doctor about avoiding some of these foods while taking a MAOI for panic disorder. Even though MAOIs are still used to safely and effectively treat panic disorder, the potential for dietary restrictions has made them a less popular choice.

When prescribing an antidepressant for panic disorder, many doctors often prefer Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) or Tricyclic antidepressants (TCAs). 

Your doctor may also suggest that you try an anti-anxiety medication. These medications work similarly to antidepressants in that they impact chemical messengers located in the brain. These messengers, known as neurotransmitters, send signals throughout the brain to regulate mood, sleep, and other bodily functions. Both antidepressants and anti-anxiety medications affect neurotransmitters in a way that can help improve mood, lower anxiety, and increase energy levels. Talk with your doctor to discuss which medications are right for you. 

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