Perhaps the most dreaded side effect in all of psychiatry is the MAOI-cheese interaction. We now understand its mechanism fairly well, namely, that most cheeses contain high amounts of the amino acid tyramine, which has the effect of increasing the release of norepinephrine (NE) from nerve terminals.
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Alicia Powell, M.D., is a psychiatrist in private practice in Jamaica Plain, Mass. Like many psychiatrists, she deals with sexual side effects of antidepressants on a daily basis.
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Dr. Pies, as an expert psychopharmacologist you’ve seen a lot of patients experiencing both therapeutic effects and side effects of medications. What do you actually say to your patients to prepare them for SSRI side effects?
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Yes, side effects can be your (and your patients’) friend. Here are several common clinical scenarios, culled from conversations with astute clinicians and from reflections on my own practice.
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Side effect expert Prakash Masand once observed that “the difference between a good clinician and a great clinician is that a great clinician is better at managing side effects.”
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Dr. Aiken is the Editor in Chief of The Carlat Psychiatry Report; director of the Mood Treatment Center in North Carolina, where he maintains a private practice combining medication and therapy along with evidence-based complementary and alternative treatments; and Assistant Professor NYU Langone Department of Psychiatry. He has worked as a research assistant at the NIMH and a sub-investigator on clinical trials, and conducts research on a shoestring budget out of his private practice. Follow him on Twitter and find him on LinkedIn.
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