Posted by Elizabeth on June 1, 2001, at 0:33:46
In reply to Re: Tricyclics » Elizabeth, posted by Elizashae on May 31, 2001, at 21:29:05
> Any ideas of which MAOIs are tolerated better? What are some of the more popular ones? I don't know really much about them except a certain diet has to be followed. I feel better when I go to talk with my therapist if I have a bit of an idea what to ask about...and know a little myself..
The number of foods that need to be avoided is much smaller than was once thought. A group of researchers at the University of Toronto has made some headway in determining what foods may interact dangerously with MAOIs. The main foods that pose a risk are the most aged cheeses (e.g., cheddar, Stilton, bleu); tap/draft beer and a couple of obscure foreign (Irish and Czech) bottled beers; fava (broad) bean pods; banana peels; and certain yeast or protein extracts such as Bovril and Marmite.
As a rule, protein-containing foods (e.g., meat, fish, milk, yogurt) should be avoided if they are aged or possibly spoiled, or if they may have been stored improperly.
There is still controversy regarding the safety of soy products (soy sauce, tofu, soy milk, etc.) and sauerkraut; until the issue is resolved, these foods are probably best avoided as well. Because liver seems to have been associated with a number of reactions, I believe it should be avoided as well. Certain foods from the Far East, notably miso soup, have also been implicated in interactions; this, too, is up in the air.
There are also some drugs that need to be avoided, including serotonergic antidepressants (SSRIs, clomipramine, Effexor, etc.), the opioid analgesics Demerol (meperidine or pethidine) and Ultram (tramadol), and certain over-the-counter cough and cold or diet drugs (those containing psuedoephedrine, ephedrine (or "ma huang"), phenylpropanolamine, or dextromethorphan). It is risky to combine MAOIs with amphetamine-like stimulants, but some people have done it successfully with careful monitoring.
This list isn't exhaustive but it covers the basics. If you have a question about a particular food, I may be able to answer it. Here are some references:
Shulman KI, Walker SE. Refining the MAOI diet: tyramine content of pizzas and soy products. J Clin Psychiatry. 1999 Mar;60(3):191-3.
Shulman KI, Tailor SA, Walker SE, Gardner DM. Tap (draft) beer and monoamine oxidase inhibitor dietary restrictions. Can J Psychiatry. 1997 Apr;42(3):310-2.
Walker SE, Shulman KI, Tailor SA, Gardner D. Tyramine content of previously restricted foods in monoamine oxidase inhibitor diets. J Clin Psychopharmacol. 1996 Oct;16(5):383-8.
Gardner DM, Shulman KI, Walker SE, Tailor SA. The making of a user friendly MAOI diet. J Clin Psychiatry. 1996 Mar;57(3):99-104.
Sullivan EA, Shulman KI. Diet and monoamine oxidase inhibitors: a re-examination. Can J Psychiatry. 1984 Dec;29(8):707-11.
You should also know that, even if you do accidentally ingest something you shouldn't have, the resulting hypertension is easily detected and completely treatable.
There are three irreversible, nonselective MAOIs that are in common use: Nardil (phenelzine), Marplan (isocarboxazid), and Parnate (tranylcypromine).
The most common side effects of all three of these MAOIs are orthostatic hypotension (lowered blood pressure upon standing up, especially when you get up too quickly or when you first get up in the morning) and insomnia (I experienced this as a reduced *need* for sleep -- I slept little but did not feel tired).
They can also cause anticholinergic side effects such as constipation, tachycardia (rapid heartbeat), and dry mouth. Anticholinergic side effects of MAOIs (if any) tend to be milder than those associated with the tricyclics, and are mainly annoying rather than dangerous.
MAOIs suppress REM sleep (this is also believed to be an aminergic/anticholinergic effect), resulting in decreased dream recollection. For this reason they have been used in the treatment of narcolepsy, posttraumatic stress disorder, and REM sleep parasomnias as well as depression.
They can cause sexual dysfunction (similar to that seen with SSRIs); Nardil seems to be more likely to cause these side effects than does Parnate.
As with all antidepressants, MAOIs can trigger mania; it is believed that they are less likely to induce mania than are tricyclics, and that MAOI-induced mania is less likely to be dysphoric than TCA-induced mania.
Abrupt discontinuation of MAOIs can result in severe depression, REM sleep rebound, and even psychosis, and should be avoided if at all possible.
Nardil and Marplan (the hydrazine-type MAOIs) have similar side effect and safety profiles; Nardil is the better studied of the two. In addition to the side effects listed above, they are known for causing weight gain and/or carbohydrate cravings. They are considered to be contraindicated for diabetics. They carry a minute risk of liver toxicity, so patients with compromised liver function should use them with caution if at all.
Parnate is chemically similar to amphetamine (as are several antidepressants of various classes). Unsurprisingly, it can be very activating, especially at first. There is also a possibility of spontaneous elevations in blood pressure; these are usually not great enough to pose a risk, but individuals with preexisting hypertension should use Parnate only with extreme caution.
I hope this information reassures you. All drugs have risks, but the risks of MAOIs are often far less than the risks of untreated or undertreated depression.
-elizabeth
poster:Elizabeth
thread:64764
URL: http://www.dr-bob.org/babble/20010530/msgs/64979.html