Just Starting MAOI

Hi All,

New here, but not new to depression/anxiety. Suffered for many years with some form of cyclothymia or bipolar 2 since my teens (just turned 40). Have tried just about every med possible, including combinations. Also, I eat very clean, do CrossFit, am sober, work the 12 steps, have strong faith, go to therapy weekly, did vitamin IVs, massage therapy, yoga, meditation.....you name it, I have done it. This depression (and I call it depression because the mania is minimal and occurs maybe once every couple of years) is stubborn and completely out of my control.

At this point, the doctor suggested trying Nardil, which I have agreed to do. He also suggested ECT, which I am not opposed to. I have two kiddos aged 9 and 11, and I am willing to do everything in my power to be the best momma I can possibly be for them. I picked up my prescription today and my anxiety has kicked in full throttle because, of course, I have googled the side-effects and possible interactions and am convinced I will accidentally ingest blue cheese and die!

So, my question is really to those of you who have been on an MAOI and more specifically about the food restrictions. I read the terms "aged cheese". Is that all blue cheese? Is that all cheddar cheese? I'm having trouble finding more specific information. Also, "smoked meat". So, for example there are BBQ places, that smoke their meat. That does not appear to be an aged process but it is smoked. Are those processes totally different? I realize I am probably totally over complicating this, but I tried to ask the pharmacist and was unable to communicate properly with her due to language barrier. Oh also, soy sauce was on the list. Is that out in all amounts?

Would love some feedback from experienced MAOI users. And also would be thrilled to hear some success stories. It breaks my heart to think about living life with this heavy blanket of depression over me. Never being able to fully engage in life, knowing the real me is trapped inside. Never knowing when it will lift, or when it will come back. I know you guys know exactly what I am talking about.

FYI: I am also on Topamax 100mg 2x/day and Seroquel 50mg at night

Thank you in advance

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Hi Cindy, welcome to Psych Central. I applaud your lifestyle changes like yoga, massage and meditation. I am sorry you are finding restrictions on foods. It seems like soy sauce and blue cheese may be fermented products. I would talk to your doc and get a list of all foods you cannot have.

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Psych Central - Search results for MAOI

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I've been on MAOIs in the past and you do need to be careful when eating certain cheeses. The word "aged" is key since processed cheeses and mozzarella are usually fine. I had a reaction after eating pasta with a vodka sauce that was made with fresh Parmesan cheese and it freaked me (and my pdoc) out. The flavor of Parmesan cheese gets stronger as it ages, so that's the distinction. And yes, blue cheese, goat or feta should be avoided. I doubt you'd have it accidentally since they are strong, distinct flavors and usually mentioned in the description of a dish. Processed Parmesan cheese like Kraft is find, it's the fresh variety of Parmesan that you should avoid (which is more commonly used in Italian restaurants). You do need to be more mindful of what you consume but I didn't find it as overwhelming as it sounds. Just always pay attention to ingredients when cooking or eating out and don't be afraid to ask questions if you're unsure. I always said I had an allergy to aged cheese and yeast and people would always check if I had questions. You also need to be careful with yeast and if you drink beer can't have beer on tap, only from a bottle. There is usually a standard list your pdoc will give you (or can find online) of items to restrict or avoid. Your doctor can also talk to you about what items pose more or less risk in general. I found many things on the list were foods that I never ate anyway, so most of it did not affect my lifestyle. I found Nardil extremely effective for depression- the best med out there in my experience. I had to change due to side effects (nothing to do with the reaction I had to cheese) but others do very well. My father took Nardil for 30 years and felt it saved his life and had no problem with the dietary restrictions.

Hello and welcome to Psych Central Cindy!!! It's nice to meet you. You have joined a community of warm and caring members who will want to offer you support and advice. Yours is welcome as well.

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I look forward to seeing you around!!!

I'm now 2 weeks on a MAOI. I don't feel any different. I don't eat meat and I don't eat much cheees. But I did eat some Old Cheese in these past weeks. I don't know what kind of reaction is can give, but I didn't had any.

It can give a hypertensive headache which happens when your blood pressure rises too quickly. If you go to the ER they'd give you a pill to quickly lower your blood pressure. You won't miss the reaction when it happens, it hurts and you feel very very strange. The older the cheese is, the drier it is; I guess it also contains more tyrosine as it ages which is what causes the reaction. So some cheese might be old but not old enough to cause a problem but since there's no way to know how old cheese is, doctors tell patients to avoid it.

Yikes. I don't want to get that kind of reaction. Maybe the cheese I had didn't contain much tyrosine.

Hi all. Thank you for the responses. I am about a week in and so far so good. On 15mg Nardil 2x/day.

I have avoided aged cheese - so blue cheese. I assume feta is in the same category, and Gorgonzola as well.

Also, soy sauce. I went to my favorite Japanese restaurant thinking I just wouldn't put soy sauce on my food and when I mentioned I couldn't have soy sauce, that resulted in me getting my salad with no dressing, and not being able to have the ginger dressing that I typically cover my food in! So sad! I did read somewhere that it was ok to have soy, but no more than 1/4 cup. Anyone know if there is any truth to that?

Are aged cheeses ok in any amount? There is a big difference, I suspect, between eating a chunk of blue cheese and a tablespoon of blue cheese dressing.

Otherwise, I haven't had any side effects from the medication which is great. My mood and energy are good.

Thanks again

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I had some feta cheese in small amounts but after I had the reaction from eating the ages Parmesan, I avoided all aged cheeses after that. A tablespoon of blue cheese dressing may be fine but you should really talk to your pdoc to be sure. Some of the literature says to even avoid pizza but my doctor said one or two pieces were fine, jus not to eat too much more. I did occasionally eat soy sauces in Chinese food and never had a reaction. Small amounts like 1/4 cup aren't a big deal, but a lot should be avoided. Red wine is another one that's debated - Merlot or Cabernet are ok, but do not drink Chianti, even in small amounts. Again, I'd talk to your doctor and get the list of foods to avoid - every doctor is different in their comfort level when it comes to telling patients which stuff on the list might be fine in small amounts. Sone are very conservative while others will tell you that some things are ok to eat in small amounts, etc. Sometimes patients have to figure out themselves what they can have by trying things in very, very small amounts and see how you feel. A reaction can be a headache that ends quickly to one that lasts for days to one that can be more dangerous, but it's important to pay attention to how you feel and if you notice feeling strange to avoid that food.

Nardil is a total blockbuster med, from the people I have talked to.. it's as effective or better than amphetamines for mood. If you can follow the tyramine restrictions it's really worth it. It's surprising to me that you found a psych that will prescribe it, but good on them for doing it.

The 'panic' about the tyramine restrictions is really not that big of a deal.. just like the bupropion seizure myth. It's the same rate (bupropion) as Prozac. I've (I VERY STRONGLY DO NOT RECOMMEND THIS) taken 2700mg of bupropion for experimental reasons with no problems.

I would really urge you not to have ECT. It causes structural damage and major memory loss.

Thanks again all. I have survived so far . Vvector - I am finding that, yes, I am somewhat fortunate to have found a pdoc willing to prescribe. I can tell you it is not without many years of effort. Much effort has gone into trying the other medication, and into cleaning up my life. As I understand it, this med would not be prescribed to an alcoholic, so with four years of strong sobriety under my belt, maybe this is finally a chance at some relief.

It has been a little over two weeks on 15mg 2x/day and I will go back this week for a dosage change I suspect. I feel pretty good - definitely no depression, but maybe a little bit on the manic/obsessive side (but just a little bit). It's so hard to observe yourself from the inside). But I have such a good support system and I check in with my friends who I trust and I am able to use them as a mirror. So, I think I'm pretty stable at the moment.

In terms of food, I have definitely eaten things by mistake in these past two weeks. Some hidden cheeses, and then I was eating a potato salad that had pickles and it dawned on me that pickles might be a no and I googled it and indeed, they were a no. I have had a few headaches, but the most noticeable change has been some kind of indigestion or heartburn. I have never ever had that. So, that is brand new, and I have to imagine due to the med, but not terrible.

There really is a ton of conflicting information out there. If you google pickles specifically you will see that they are on the no list. But on the basic list, I don't think they are listed. I did talk to my pdoc. He is about a thousand years old, but so awesome. He just gave me the basics, and maybe for good reason. The aged cheeses, smoked meats, alcohol. So, maybe it really is as simple as that and I am over-complicating it.

Thanks all

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soy sauce is quite high in tyramine. japanese soy sauce contains about 1 mg per cc, or about 5 mg /tsp. under 6 mg is usually considered safe. try some chinese foods with no soy or ask the chef is it has hi soy content waiters generally not reliable

Hi All, wanted to give an update!

I have been on Nardil since I posted, with great results. Depression has been wiped except for one small episode which was actually only noticeable by catching the distorted thinking. There was no desire to stay in bed, no physical, outward display of depression (which is my "tell" so actually made it hard to know I was in depression). I did start Lamictal to make sure moods stay balanced, but I have never, ever been on an anti-depressant that worked as well as this one.

There is a bit of a tendency to go manic, or even OCD, but it almost seems optional - if that makes sense. Like I can make the decision to work all night, or not.

The really interesting change, is that my emotions are beginning to pour our. Typically, I kept a pretty strong wall of detachment up, but now I am emotional, able to cry. I cry a lot, but in a good way! Lol. More empathetic, kinder, genuinely loving. I don't need to shield myself from everyone and their energy anymore because it doesn't wreck me like it used to.

I will say that I also am four years sober, three years into a very passionate Christian walk (I was an atheist), and so those changes, along with this medication, life is just opening up for me in a great way.

The food issues are no big deal, but I did get a cold and it turned into a sinus infection and there is *nothing* you can take. So, that was a big rough - ended up on anti-biotics.

Life is much improved - super grateful.

Thank you friends.

XO

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I'm glad you're doing better.

This is really terrific news, Cindy! It's so good to hear that things are going well for people.

What you said about the respiratory infection made me wonder if you can take plain guaifenesin (Mucinex) - it's just a mucus thinner, but I have found it helpful when I've had respiratory infections. Mucinex comes in several formulations, but the basic one is only guaifenesin.

Congrats on such a significant improvement!!