- With Mayo Clinic psychiatrist
Daniel K. Hall-Flavin, M.D.
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Daniel K. Hall-Flavin, M.D.
Daniel K. Hall-Flavin, M.D.
Dr. Daniel Hall-Flavin, board certified in general psychiatry and addiction psychiatry, is a St. Louis native looking to the Internet as a way to help people improve their health and be more active participants in their own health care by learning from Mayo Clinic's experts.
Dr. Hall-Flavin served on the faculties of Cornell University Medical College, New York Medical College and The George Washington University Medical School before joining the Mayo Clinic staff in 1996. He has special interests in adult psychiatry, addiction psychiatry, pharmacogenetics and personalized medicine. He served as medical director of the National Council on Alcoholism and Drug Dependence from 1986 to 1999, and is currently involved in translational medicine research involving the introduction of pharmacogenetic technology into the daily practice of community psychiatry.
"With the advent of pharmacogenetics and related fields and the advances in translational medicine, informed collaborative relationships between knowledgeable, capable health professionals and informed, proactive individuals and their families are more vital than ever," he said.
"I'm optimistic that our Internet health education activities will contribute to ever-improving health outcomes for all who participate and apply what is learned."
Definition (1)
- 'Clinical depression': What does that mean?
Risk factors (1)
- Junk food blues: Are depression and diet related?
Causes (4)
- Caffeine and depression: Is there a link?
- Vitamin B-12 and depression: Are they related?
- Marijuana and depression: What's the link?
- see all in Causes
Complications (2)
- Depression and anxiety: Can I have both?
- Tinnitus causes: Could my antidepressant be the culprit?
Treatments and drugs (9)
- Mild depression: Are antidepressants effective?
- After a flood, are food and medicine safe to use?
- Antidepressants and alcohol: What is the concern?
- see all in Treatments and drugs
Alternative medicine (3)
- Fish oil supplements: Can they treat depression?
- Natural remedies for depression: Are they effective?
- Do the benefits of vitamin C include improved mood?
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Question
MAOIs and diet: Is it necessary to restrict tyramine?
I just started taking MAOIs for depression. Do I really need to follow a low-tyramine diet?
Answer
from Daniel K. Hall-Flavin, M.D.
Tyramine is an amino acid that helps regulate blood pressure. It occurs naturally in the body and in certain foods. MAOIs block an enzyme called monoamine oxidase, which breaks down excess tyramine in the body. Blocking this enzyme helps with depression. But, tyramine can quickly reach dangerous levels if you eat high tyramine foods. Your body can't break them down quickly enough. This leads to a spike in blood pressure that may require emergency treatment. Signs and symptoms can include:
- Headache
- Nausea
- Vomiting
- Sweating
- Fast heartbeat
- Dilated pupils
- Rarely, brain hemorrhage or death
Some foods high in tyramine include:
- Aged cheeses
- Cured meats, such as sausage, pepperoni and salami
- Sauerkraut
- Soy sauce
- Yeast-extract spreads, such as Marmite
- Improperly stored or spoiled foods
- Broad bean (fava bean) pods
- Banana peels
- Tap (draft) beer or unpasteurized beer
- Some wines
The amount of tyramine can vary among foods due to different processing, storage and preparation methods. While you're taking MAOIs, your doctor may recommend eating only fresh foods — not leftovers or foods past their freshness dates.
One MAOI inhibitor, selegiline (Emsam) is delivered with a patch you put on your skin. With selegiline, you may not need to be as strict with the foods you eat.
Whichever type of MAOI you take, ask your doctor for a list of foods to avoid. Make sure you understand exactly what's safe for you and what isn't. Learn the emergency signs of high blood pressure and know what to do if you accidently eat or drink something with too much tyramine.
Next questionAntidepressants and weight gain: What causes it?
- Stahl SM, et al. Monoamine oxidase inhibitors: A modern guide to an unrequited class of antidepressants. CNS Spectrums. 2008;13:855.
- Rapaport, MH. Dietary restrictions and drug interactions with monoamine oxidase inhibitors: The state of the art. Journal of Clinical Psychiatry. 2007;68(suppl):42.
- Huffman JC, et al. Side effects of psychotropic medications. In: Stern TA, et al. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa.: Mosby. 2008.
- Medication guide. Emsam. U.S. Food and Drug Administration. http://www.fda.gov/downloads/Drugs/DrugSafety/ucm088589.pdf.
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