The foods to avoid are banana skins, broad beans, cheese (particularly mature cheese), some red wines, beer, mature protein foods such as fish and meat which are cured and meat, vegetable and yeast extracts, chocolate, yogurt, sour cream, strawberries and avocado.
Stimulant drugs such as adrenalin, present in the local anaesthetic used by dentists, and the bronchodilator drugs used in treating asthma, also need to be avoided.
The more commonly used tricyclic anti-depressants do not have this reaction and dietary control is unnecessary.
I remember treating a woman for depression with one of these agents. She complained of a severe headache, and had all the symptoms and some signs of a sub-arachnoid haemorrhage — a type of bleeding around the brain. I arranged for a specialist to see her and she was thoroughly examined. We were puzzled by the negative findings.
That same week we received a report from the makers of the drug stating that this side effect had been reported by research workers after the drug had been widely used.
I questioned my patient again and found that she had had a large meal of macaroni cheese on the evening she developed the symptoms.
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