‘Much ado about nothing’: MAOIs

Published 1/2/2017 http://dx.doi.org/10.1017/S1092852916000651

‘Timendi causa est nescire’

My recent editorial in CNS Spectrums (1) discusses the discrepancy between the published literature substantiating their benefits and the current lack of use of MAOIs.

It draws attention to recent data and encourages doctors to consider these drugs earlier in the illness-course of patients and clarifies the over-emphasised concerns of:

 1) the misperception that there are frequent drug interactions

2) the risk of ingesting excessive tyramine (Tyr).

I argue that the ability to manage MAOIs should be in the repertoire of all psychiatrists and that MAOIs are most certainly not “outmoded and dangerous drugs”.

I discuss the two main mistaken ideas:

1) the misperception that there are frequent drug interactions

2) that there is a major risk of ingesting excessive tyramine (Tyr).

Modern diets have greatly reduced levels of tyramine

Current diet guides about Tyramine in foods contain much misinformation because the modern data concerning Tyr are in food science journals, which doctors are unaware of. (See my detailed monograph).

The key change is in food production techniques, especially over the last decade or two, with the near-universal adoption of non-decarboxylating starter cultures, which do not produce any Tyr. Those are now used by almost all producers of cheeses, salamis and soy sauces etc. and in consequence modern diets have greatly reduced levels of Tyr. This greatly reduces the risk of hypertensive reactions.

As Seneca said ‘Timendi causa est nescire’ (The cause of fear is ignorance).

References

1.         Gillman, PK, “Much ado about nothing”: Monoamine oxidase inhibitors, drug interactions and dietary tyramine. CNS Spectr, 2017: p. Editorial [in press].