Monoamine oxidase inhibitors (MAOIs) can be highly effective therapeutic agents for depression; however, they tend to be underutilized in clinical practice. This trend has been driven by concern and misconception about dietary and drug interactions and side effects, as well as declining physician experience with these medications.
The body’s capacity to handle dietary tyramine is greatly reduced whilst talking an MAOI. High levels of tyramine can cause blood vessels to narrow, which can lead to very high blood pressure, a severe headache, and possibly bleeding, causing a condition known as hypertensive crisis. Because of the potential dangers of a hypertensive crisis from a tyramine reaction in patients taking MAOIs, certain mythology has grown around how much tyramine is in various foods and which dietary restrictions are necessary. However, fewer foods than previously assumed have problematically high tyramine levels. Tyramine concentrations for ordinary foods depend on storage time and storage conditions. Foods that are close to spoiling, are aged (like cheese), or have been stored for a long time have higher levels of tyramine than fresh foods do.
Some Common Myths:
- The diet is difficult: people cannot have cheese or red wine
- MAOIs have many dangerous interactions with other drugs
- One cannot give an anaesthetic
- It is difficult to swap to and from other drugs
- One cannot combine them with tricyclic antidepressants (TCAs)
- They have a lot of side effects
- MAOIs cause hypertension/should not be given to hypertensive patients
- Tyramine reactions need urgent treatment
- Patients should be given nifedipine sublingually
- Adrenaline cannot be used
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Recent advances have been made to help clarify these drugs' pharmacology and help clinicians familiarize themselves with the properties of and indications for prescribing MAOIs. Dr. P. Ken Gillman has published a comprehensive review on the dietary tyramine and drug interactions relevant to MAOIs, while also addressing common mythology mentioned above.
Click here to read Dr. Gillman’s full monograph on MAOIs.