MAOI;S and foods that CAN INTEFERE WITH THE WAY THEY WORK.

[Nik]

Also applies to Linezolid (antibiotic)

(Virtual pat on the back)

[bobbin]

He reckoned that if there had been placebo controlled trials the MAOIs wouldn't have done any better than the placebo, but then there is a fairly marked placebo effect from all anti-depressants.

MAOIs can be remarkably effective for severe depression in some cases, including patients who have not responded to anything else. There have been quite a few placebo-controlled trials. Phenelzine (Nardil) and tranylcypromine (Parnate) are substantially different from one another. A poor response to one does not imply that the other will be ineffective. The adverse effects are also quite different. Moclobemide is not very useful. Some of the early trials of phenelzine which showed poor efficacy used sub-therapeutic doses. Response is very variable and there is no 'standard dose'. Phenelzine is usually effective at 45-75mg per day in divided doses but 90mg can be necessary. Tranylcypromine often requires 30-60mg in divided doses but higher doses can be used in selected patients if tolerated eg. 80mg per day. Overall, tranylcypromine is thought to be somewhat better tolerated than phenelzine. It causes less ankle oedema and much less weight gain. Phenelzine is generally preferred for severe anxiety disorders because there is much more evidence of efficacy. Tranylcypromine is used more often than phenelzine for severe depressive illness by the older generation of psychiatrists in North America, who have the most experience of using it. Isocarboxazid (formerly Marplan) is a bit like a less potent version of phenelzine.

MAOIs are difficult to prescribe, but they retain a place in treatment because for some patients nothing else works - their mechanism of action is different to other antidepressants. Phenelzine is one of the most effective treatments for severe social phobia and related anxiety disorders. SSRIs are not really comparable. SSRIs are often (but not always) better tolerated than MAOIs but there is little point in continuing to prescribe them to patients who find them ineffective.

[bobbin]

MAOIs work as they say, Mono Amine Oxidase Inhibitor. They slow the break down of 5HT. Tryptophan is a precursor of 5 Hydroxy Tryptophan and foods rich in this can cause problems..... Cheese and Chocolate.
Tryptophan mixed into Cadburys drinking chocolate was marketed as an anti-depressant.
I used to sell Isocarboxazide (Marplan).
johnep

Some cheeses are high in tyramine, which can cause hypertension when combined with MAOIs. I don't think cheese contains much tryptophan. The tryptophan content of foods isn't usually much of a problem compared with the tyramine content.

Among the various cheeses, tyramine content is very different. The sort of 'American' cheese often used on pizzas generally contains little tyramine. Very mature 'strong' and aged cheeses generally contain quite a lot.

A practical MAOI diet has been developed by Sunnybrook Health Centre in Toronto. Some of the early restrictive diets contained a lot of foods which are actually safe. The main foods to avoid are.....

No aged, hard cheeses
No air-dried sausages, cured hams, etc.
No soy sauce
Red wine, tap beer only in very limited quantities. Many alcoholic drinks (eg. vodka) contain no tyramine.
No meat that could be spoiled
No Marmite or yeast extracts

Most of all, no medications without checking an appropriate source for interactions. Stockley's is pretty much the only useful textbook when it comes to MAOI interactions. There is no reason to avoid small amounts of caffeine. Paracetamol and ibuprofen are fine. Vasoconstrictors/decongestants are a big no-no.

[johnep]

Um, yes on looking back does seem as though I danced around a bit. However, mainly due to the fact I was selling ingredients rather than finished products. As a marketing man, I was always looking for new business ideas. Also, when selling a project to a potential customer, I had to know about his/her business as well. They would take me for a tour round the factory. When leaving, I tried to go out via the warehouse so I could see who was currently supplying. My agent in Dublin, now a multi millionaire, sold to the food industry. His rep would go round the bakeries with a cake and sell the ingredients. I did the same with vitamin products for Roche and vegetable extracts for Bush Boake Allen. Peppermint foot lotion or cucumber cream anyone? I covered Food, cosmetic, Pharma and animal feed industries.
johnep