Dietary Precautions While Taking MAOIs

MAOIs and Dietary Restrictions

Though not as common as they once were, MAOIs are still prescribed for depression and panic disorder. When taking these medications, there are certain high-protein and aged foods that you should avoid. This will prevent harmful spikes in your blood pressure and it's important to consider these dietary restrictions.

What Are MAOIs?

Many people dealing with panic disorder are prescribed medications to treat anxiety, panic attacks, and other panic-related symptoms.

Antidepressant medications may sound like they are only designed to treat depression. However, antidepressants have increasingly been used to help alleviate the symptoms of panic disorder. 

First available to United States consumers in the 1950s, monoamine oxidase inhibitors (MAOIs) were one of the earliest antidepressants prescribed. 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 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. 

Common MAOIs include:

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

Why Food Restrictions Are Necessary With MAOIs

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. This can result 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 blood pressure spikes.

Foods to Avoid When Taking a MAOI

Protein-rich foods contain higher amounts of tyramine. Additionally, tyramine content can rise in certain foods as they continue to age. There are a few foods and beverages that are high in tyramine that you may need to avoid while taking a MAOI.

  • Meat Products. Foods to avoid include beef liver, chicken liver, fermented sausages like pepperoni and salami, and luncheon meats.
  • Fish Products. Try to refrain from eating caviar, cured fish, dried or pickled herring, and anything that contains shrimp paste.
  • Milk Products. Aged cheeses and other dairy products like sour cream and yogurt are on the list of foods to avoid.
  • Fruits and Vegetables. High-protein produce is also a concern. This includes overripe fruits and avocados, as well as banana peels (not the bananas themselves). Also, try not to eat fava beans, Italian green beans, or snow peas. It's best to stay away from sauerkraut and canned figs as well.
  • Alcohol. Certain fermented alcoholic beverages should be left out of your diet as well. This includes red wines and Chianti, vermouth, and sherry. A beer that contains yeast should also be avoided.
  • Yeasted foods. It's recommended that you avoid foods that contain concentrated yeast products and brewer's yeast. Included in this group are items like miso and soy sauce.

Other Dietary Considerations

Tyramine is also produced in foods during the spoiling or decay process. It's important that you eat only the freshest and freshly cooked foods and use proper food safety practices.

  • Check packaged foods for freshness and 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.

Medications for Panic Disorder

Consult your doctor about avoiding some of these foods while taking a MAOI. 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 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. 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. 

Sources:

Kaplan MD, Harold I, Sadock MD, Benjamin J. Synopsis of Psychiatry. 11th ed. Baltimore: Williams & Wilkins; 2014.

Silverman, Harold M. The Pill Book. 15th ed. New York, NY: Bantam Books, 2012.

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