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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by jangle on January 18, 2011, at 19:25:39
I suffer from dysthymia as well as social anxiety disorder and was recently prescribed Nardil.
I have the pills sitting on my table, but I'm terribly afraid to take them for fear of the severe side effects.
So I see on this diet plan
http://www.upmc.com/HealthAtoZ/patienteducation/Documents/MaoiDiet.pdfThat "fermented soybean products" are to be avoided, it says things like (miso and tofu) but then there are other sources that say to avoid anything with soybean products entirely.
Well, that includes about 90% of foods, as I'm reading ingredient labels that show just about every food I eat has soybean in some form or another, even hamburger bread!
I'd like to just make some meals that I know are safe so that I could stick to a food routine and be comfortable taking this medication, but I can't seem to feel confident about any food choice as I'm so afraid about the age/content/etc.
So I guess my question is, is that are the soybean products listed in common food items that bad or is it that I have to avoid straight soy sauce and that in small quantities as seen in baked items they're ok?
Posted by gardenergirl on January 19, 2011, at 16:09:51
In reply to Nardil MAOI diet, posted by jangle on January 18, 2011, at 19:25:39
It's good to be cautious about the diet, but there are things you can eat. For example, "autolyzed yeast extract" shows up in so many processed foods. It's not necessarily something that must be avoided at all costs. Really the yeast extracts that need to be avoided are the vegemites/marmites type things, not the spice binding additive that is autolyzed yeast extract is.
Similarly, soy products are not all bad. You want to avoid fermented or aged soybean products. Items that are listed as one of the last ingredients are usually smaller quantities than if the item is listed as a main component/ingredient.
Eating out can be tricky. I printed out a business card sized card listing the no-no's, and I would give it to the wait staff when I ordered for them to check with the cook. This almost always worked out well.
Good luck!
gg
Posted by Chairman_MAO on January 28, 2011, at 13:43:21
In reply to Nardil MAOI diet, posted by jangle on January 18, 2011, at 19:25:39
FWIW, I eat basically whatever I want with no problems. YMMV.
Posted by pedr on February 3, 2011, at 13:56:15
In reply to Re: Nardil MAOI diet, posted by Chairman_MAO on January 28, 2011, at 13:43:21
Hi,
yes it's tricky. The sources that say to avoid all soy products are outdated. If you google around (I don't have the links to hand) you will find studies that did not find *any* fermented soy products with sufficient levels of tyramine to cause trouble. Similarly there is a study that tested 50 bottled beers & 50 draft beers. It found that all 50 bottled beers were fine. Something like 47 of the draft beers were fine too. But old resources generically state that "beer contains tyramine" which whilst technically correct, is draconian and unhelpful to Nardil users.EDIT: aha, found my good links:
http://www.dr-bob.org/babble/20010804/msgs/73614.html
http://www.dr-bob.org/babble/20010814/msgs/75408.html
http://www.holisticonline.com/remedies/Depression/dep_interactions_MAOI.htmIn my view, the biggest threat is forgetting about Pseudoephedrine. It's in all sorts of OTC meds and in painkillers. For example, my Dentist was going to use it (or epinephrine, I can't remember) on me before I told him about the Nardil.
I recommend you get a Med Alert bracelet/necklace. It's a good idea in general and I find it comforting somehow. It also serves as a reminder, hanging round your neck all day :)
BTW the only Hypertensive episode I ever had was from drinking a single pint of draft lager in London. It must have been crawling with tyramine because I reacted within minutes. I cannot tell you how excruciating the pain was. And it went on for several hours. Not. Nice.
HTH,
Pete
Posted by Chairman_MAO on February 3, 2011, at 14:42:02
In reply to Re: Nardil MAOI diet, posted by pedr on February 3, 2011, at 13:56:15
Pseudoephedrine, ephedrine, PPA, etc. <-- DANGER
Psychostimulants such as d-amphetamine and d-methamphetamine are much safer. Avoid racemic psychostimulants if you can (Adderall/Vyvanse).
D-methamphetamine is the safest because it has the highest ratio of central to peripheral effect.
Beware DXM (Robitussin) and meperidine (Demerol).
Seriously. Ic you want to wear a bracelet, make sure it mentions Demerol!IIRC the treatment of choice is IV phentolamine. I've been given chlorpromazine or clonidine to carry around; doctor didn't want to use nifedipine. These days, I don't carry around anything.
It's important that you and your doctor are on the same page about this. The chance of a tyramine-induced hypertensive crisis is low but far from 0.
Dentist was probably using epinephrine.
Posted by gardenergirl on February 4, 2011, at 11:46:21
In reply to Re: Nardil MAOI diet, posted by pedr on February 3, 2011, at 13:56:15
And giblet gravy or other things made with the giblets. I had a reaction one Thanksgiving because my aunt used the broth from the giblets in the dressing.
gg
This is the end of the thread.
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