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Like the TCAs, antidepressants of the MAOI class raise the levels of crucial neurotransmitters, but they do so in a different way, by inhibiting the action of an enzyme called monoamine oxidase. This enzyme breaks down certain compounds in the blood. By keeping monoamine oxidase from doing its job, the drug allows higher levels of certain neurotransmitters to circulate.

Studies show that two MAOIs, phenelzine and isocarboxazid, effectively reduce or eliminate bingeing. The dosages are the same as those used in treating depression. Drugs of this class pose a somewhat greater risk of side effects, such as lower blood pressure, agitation, or sleep disturbances, than do the TCAs.

There’s another problem with MAOIs. Because they interfere with enzyme action, they affect the body’s ability to break down an amino acid called tyramine. Too much tyramine floating around in the bloodstream can cause problems related to high blood pressure, such as excruciating headaches, internal bleeding and even death.

Certain foods contain high amounts of tyramine. The list includes cheeses, wines, beers, pickled herring, liver, yeast extract (including brewer’s yeast), salami, pepperoni, bologna, yogurt, and fava beans. A patient should only take an MAOI if she understands the risk involved and agrees not to eat any foods containing tyramine.

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