Dietary Precautions While Taking MAOIs

Though they are not nearly as common as they once were, monoamine oxidase inhibitors (MAOIs) are still sometimes prescribed to treat depression or used off-label to treat Parkinson's disease.

MAOIs can also be used to treat anxiety disorders like panic disorder, social anxiety disorder, and post-traumatic stress disorder (PTSD). If you are taking an MAOI, there are certain foods that you will need to limit or completely avoid to prevent your blood pressure from getting dangerously high (hypertensive crisis).

How MAOIs Work

Monoamine oxidase inhibitors, or MAOIs, were one of the earliest antidepressants in the United States, being first made available to consumers in the 1950s. MAOIs are not prescribed as frequently as they once were because there are more effective medications available that have fewer side effects. However, MAOIs can be a good option for people who have not had luck with other medications.

Common MAOIs include:

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

MAOIs work on neurotransmitters, naturally occurring substances in the brain that help regulate various bodily functions. Specifically, MAOIs seem to work on three neurotransmitters known to have an important role in the chemistry of depression:

• Dopamine
• Norepinephrine
• Serotonin

This trio of neurotransmitters helps regulate mood, sleep, energy, and motivation. They're also responsible for balancing the fight-or-flight response, which is linked to how you respond to stress and anxiety.

MAOIs for Panic Disorder

Antidepressant medications sound like they're only designed to treat depression, but the drugs are increasingly being prescribed to treat symptoms of panic disorder and other anxiety disorders.

If you have panic disorder, you may be prescribed one or more medications (possibly including an MAOI) to alleviate anxiety, panic attacks, and other panic-related symptoms.

Reason for Food Restrictions

If you are prescribed an MAOI for depression, anxiety, or another condition, your doctor will likely talk to you about your diet. You won't be able to have some foods and drinks while you are taking an MAOI because there is a potential for a serious interaction.

Tyramine is a compound that affects your blood pressure. It's regulated and broken down by the MAO enzyme. MAOIs restrict the MAO enzyme to reduce symptoms of depression and anxiety. However, if the MAO enzyme is inhibited, tyramine can reach dangerously high levels in your body. Elevated tyramine can cause your blood vessels to narrow, possibly leading to critically high blood pressure.

Foods to Avoid with MAOIs

Tyramine is found in certain foods, beverages, and other substances. Protein-rich foods, for example, typically contain high amounts of tyramine. Foods that are aged (such as cheese) are also high in tyramine because the content of the substance in a food or beverage increases as they age.

You will also need to carefully inspect any combination of snacks and meals that may be made with the foods you need to avoid. For example, you should not eat pizza or lasagna made with cheese or meals such as a stir-fry that made with soy sauce.

The Importance of Food Safety

Only eat fresh and freshly cooked foods while you are taking an MAOI as tyramine levels in food increase during the spoiling or decay process.

Here are some food safety tips to keep in mind while you are taking an MAOI.

• Always use proper food handling, preparation, and safety practices to help prevent spoilage and food poisoning.
• Avoid leftovers (even if they have been refrigerated).
• Check all packaged foods for freshness. Do not consume products beyond the freshness or expiration date.
• Cook all foods to the proper temperature indicated for food safety.
• Do not refreeze foods that have been thawed.
• Ensure that proper food temperature is maintained. Consume any cooked foods promptly.
• Maintain and store cold foods at the proper temperature indicated for food safety.

Symptoms of Hypertensive Crisis

If your tyramine level starts to increase and your blood pressure quickly rises, you may develop symptoms of a hypertensive crisis.

Symptoms of a hypertensive crisis can include:

• Chest pain (may be accompanied by shortness of breath)
• Confusion
• Fainting
• Fast or irregular heart rate
• Headache (usually severe)
• Nausea
• Nosebleeds
• Severe anxiety
• Sweating
• Vision changes or disturbances
• Vomiting

A Word From Verywell

If your doctor prescribes an MAOI for you, ask them for a complete list of foods and beverages that you need to avoid. You will also want to ask if you need to avoid any over-the-counter or prescription medications or supplements while you are taking an MAOI.

Make sure that you know the signs of a hypertensive crisis as well as what to do if you experience symptoms before you start taking an MAOI.