Answer: Cheese and wine contain tyramine, an amino acid that could interact with MAOIs to produce high blood pressure.
Monoamine oxidase inhibitors such as Ensam are commonly prescribed to decrease the symptoms of depression. These drugs inhibit the enzyme that breaks down monoamines such as dopamine and serotonin, resulting in elevated monoamine signaling in the synapse. This can increase mood after chronic exposure, usually after a few weeks.
Foods such as cheese and wine contain the amino acid tyramine. In the body, tyramine causes the release of norepinephrine, which acts at the alpha receptors to cause vasoconstriction. Normally, monoamine oxidase in the liver will break down tyramine rapidly.
People who are taking MAOIs will have an elevated blood concentration of tyramine since the amino acid will not be broken down. As a result, they may experience more norepinephrine release, and consequently, increased constriction of blood vessels. This decrease in blood vessel diameter results in elevated blood pressure, which may lead to stroke in some patients. This change in the circulatory system is called a hypertensive crisis.
In addition to high blood pressure, other physical symptoms of a hypertensive crisis include headache and shortness of breath. Mental symptoms of hypertensive crisis include confusion and seizure, all of which may be very dangerous.
In addition to cheese and wines, there are other foods to be avoided because of their high concentration of tyramine, including many meats (especially liver and cured meats like hot dogs and sausages), fermented vegetables (tofu, kimchi, and sauerkraut for example), chocolate, and caffeinated drinks.
Some medications should also be avoided. Although selective serotonin reuptake inhibitors (SSRIs) such as escitalopram (Lexapro) and setraline (Zoloft) have generally better safety profiles and may also be prescribed for depression, they should not be taken at the same time as MAOIs. The enzyme monoamine oxidase is responsible for breaking down serotonin as well. Inhibiting both the breakdown and the reuptake of serotonin can lead to too much serotonin, which may produce a clinical condition called “serotonin syndrome.”
The Food and Drug Administration in the US currently has approved four different MAOI drugs for the treatment of depression:
Isocarboxazid (Marplan)
Selegiline (Emsam)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Moclobemide is a reversible MAOI that may allow eating cheese while taking the drug.
Because of these potentially deadly side effects and more, MAOIs have often been largely replaced by other classes of medicines to treat depression. More recently, ketamine has been approved as a fast acting antidepressant.
More information regarding the interactions of cheese and monoamine oxidase inhibitors can be found at in this article, Hypertensive crisis and cheese published by T. S. Sathyanarayana Rao and Vikram K. Yeragani
