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MAOIs and pizza: food for thought

Vol. 1, No. 8 / August 2002

I greatly appreciated the review by Jonathan Cole, MD, and J. Alexander Bodkin, MD, on the use of MAOIs (June) but would like to offer the following comments.

It is unfortunate that these potentially life-saving medications are being utilized less and less. While the authors note that excessively inclusive dietary restrictions are one reason for the MAOI’s disuse, they appear to further discourage its use by including pizza as a food to avoid. More recent experience and research 1,2 have demonstrated that commercially available pizza, as well as pizza produced without aged cheeses, is safe for consumption while taking MAOIs. In fact, the authors of the dietary instructions included with the Cole-Bodkin article are the primary researchers who reported on this food’s safety.2

Because pizza is such a popular food, it is important to not restrict patients’ consumption of it unless medically necessary.

Additionally, while Drs. Cole and Bodkin note that MAOIs are used primarily in treatment-resistant patients, it might have been useful for them to include a section on MAOI augmentation strategies, as well as the possible usefulness of prescribing these medications at dosages above their usual ranges.3

S. Shalom Feinberg, MD
Queens, NY


  1. Feinberg SS, Holzer B. The monoamine oxidase inhibitor (MAOI) diet and kosher pizza. J Clin Psychopharmacol 1997;17:226–7.
  2. Shulman KI, Walker SE. Refining the MAOI diet: tyramine content of pizzas and soy products. J Clin Psychiatry 1999;60(3):191–3.
  3. Amsterdam JD. Use of high dose tranylcypromine in resistant depression. In: Amsterdam JD, ed. Advances in Neuropsychiatry and Psychopharmacology, Volume 2, Refractory Depression. New York: Raven Press, 1991.

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