What Foods Should You Avoid If You Have Serotonin Syndrome?

November 24, 2025 •

4 min read

Serotonin syndrome, a rare but potentially dangerous condition, can sometimes be triggered or exacerbated by drug-food interactions. Understanding what foods you should avoid if you have serotonin syndrome is a crucial step for managing your health and preventing a severe reaction, particularly if you are on specific medications.

Quick Summary

This article details which foods to avoid for serotonin syndrome, focusing primarily on high-tyramine items that pose a risk for those taking MAOI antidepressants. Safe fresh food alternatives are also discussed.

Key Points

Avoid High-Tyramine Foods: Individuals on MAOIs must avoid aged cheeses, cured meats, fermented soy, and tap beer to prevent a hypertensive crisis.
Choose Freshness: Prioritize fresh, unprocessed foods like fresh meat, poultry, fish, and produce to minimize tyramine buildup.
Mind Other Ingredients: Be cautious of high-histamine foods (with drugs like Linezolid), excessive chocolate, and especially tryptophan supplements.
Consult a Doctor: Always talk to your healthcare provider or pharmacist about all medications and supplements to understand potential dietary interactions.
Practice Safe Food Handling: To reduce tyramine formation, eat foods fresh and store leftovers properly in the freezer or refrigerator immediately.
Beware of Certain Supplements: Herbal supplements like St. John's wort can dangerously increase serotonin levels when combined with other serotonergic medications.

Serotonin syndrome is caused by an excess of serotonin activity in the central nervous system, and while it is often the result of combining certain medications, diet can play a significant role for individuals on monoamine oxidase inhibitors (MAOIs). MAOIs prevent the body from breaking down monoamines, including tyramine and norepinephrine, which can cause a dangerously high spike in blood pressure known as a hypertensive crisis if high-tyramine foods are consumed. This makes a restricted diet a necessary and vital part of treatment for those on MAOIs. Food alone is highly unlikely to cause serotonin syndrome but can act as a potentiator alongside serotonergic drugs.

High-Tyramine Foods to Avoid with MAOIs

For those on MAOIs, a strict diet that avoids or severely limits tyramine is essential. Tyramine is a natural compound that forms from the breakdown of the amino acid tyrosine, especially in aged, fermented, and spoiled foods. Cooking does not reduce tyramine levels.

Aged and Fermented Cheeses

This is one of the most well-known food groups to avoid due to high tyramine content. Aged cheeses that should be excluded from the diet include:

Cheddar
Blue cheese
Brie
Camembert
Gorgonzola
Muenster
Feta
Swiss and Parmesan

Cured, Fermented, and Aged Meats

Processed meats and those past their prime can also contain high levels of tyramine. It is best to eat fresh meat, poultry, and fish. Foods to avoid include:

Salami and pepperoni
Aged or cured sausages
Cured or smoked fish
Dried or pickled fish
Meat extracts and gravies
Liver, especially if aged or stored improperly

Fermented Soy Products

Soy products that have been fermented can accumulate significant levels of tyramine and should be avoided.

Soy sauce
Miso soup and miso paste
Fermented tofu and bean curd
Tempeh

Certain Beverages

Some drinks contain tyramine or other compounds that can cause issues when combined with MAOIs or other serotonergic drugs.

Tap or home-brewed beer
Red wine, especially Chianti and vermouth
Sherry
Certain liqueurs
Kombucha
Excessive amounts of caffeine, found in coffee, tea, and energy drinks, can increase agitation and impact serotonin regulation.

Fruits and Vegetables

While most fresh fruits and vegetables are safe, some should be approached with caution, especially when overripe or fermented.

Overripe fruits, such as bananas and avocados
Fava or broad bean pods
Pickled vegetables like sauerkraut and kimchi
Fermented olives

Comparison of Tyramine Content in Foods

When navigating a low-tyramine diet, understanding which items fall into high, moderate, or safe categories can be helpful.


Food Category	High-Tyramine (Avoid)	Moderate-Tyramine (Use Caution)	Low-Tyramine (Generally Safe)
Cheeses	Aged cheddar, blue cheese, Gorgonzola, aged Swiss	Mozzarella, fresh parmesan, havarti, brie	Cream cheese, cottage cheese, ricotta
Meats	Salami, pepperoni, aged sausages, cured fish	Fresh sausages (limited), canned or pre-packaged meats with nitrates	Fresh poultry, fresh beef, most fresh fish
Beverages	Tap beer, red wine, vermouth, sherry	Bottled beer, most wines (in moderation)	Water, most juices, decaffeinated coffee, milk
Fermented Goods	Soy sauce, miso, sauerkraut, tempeh	Yogurt, sour cream, fermented dairy (limited)	Fresh vegetables, unfermented soy milk
Fruits/Veggies	Overripe fruits, fava bean pods	Avocados (limited), raspberries	Most fresh fruits and vegetables

Other Dietary Interactions to Note

Beyond tyramine, other food-based compounds can interact with certain medications that increase serotonin.

High-Histamine Foods: For those taking specific medications like Linezolid that inhibit histamine breakdown, avoiding high-histamine foods is also important. This includes tuna, mackerel, spinach, and fermented items.
Chocolate: Chocolate contains small amounts of serotonin and other compounds. In large quantities, especially alongside serotonergic medications, it may contribute to the risk of serotonin syndrome.
Tryptophan Supplements: While foods rich in tryptophan, like turkey, are generally not an issue, taking concentrated tryptophan supplements can significantly increase serotonin levels and pose a risk, particularly when combined with serotonergic drugs.

Conclusion: A Proactive Approach to Diet and Medication

Managing your diet is a critical and potentially life-saving aspect of treatment when at risk for serotonin syndrome, especially while on MAOI medication. Prioritizing fresh, unprocessed foods is the simplest way to reduce risk. However, it is always essential to work directly with your healthcare provider to understand specific dietary interactions with your prescribed medications. Do not make any changes to your diet or medication regimen without consulting a doctor first. For more in-depth information on MAOIs and dietary precautions, you can reference reliable medical sources.

How to Avoid Tyramine Contamination

To further minimize risk, proper food storage is key. Always eat the freshest food possible, ideally within 48 hours of purchase. Immediately refrigerate or freeze any leftovers. Thawing food at room temperature should be avoided as it promotes tyramine formation. Canned or frozen items should be consumed soon after opening. When dining out, be mindful that you don’t know how fresh ingredients are and exercise caution with sauces and dressings.

Beyond Diet: Other Serotonergic Agents

Dietary management is just one piece of the puzzle. St. John's wort, an herbal supplement, is a known contributor to serotonin syndrome and should be avoided by anyone taking serotonergic medication. Certain over-the-counter cough and cold medicines containing dextromethorphan can also interact dangerously with MAOIs. Always inform your doctor and pharmacist of all medications and supplements you are taking to prevent harmful interactions.

What to Do in Case of Exposure

If you accidentally consume a high-risk food while on an MAOI and experience symptoms such as high fever, confusion, agitation, or a rapid heart rate, seek immediate medical attention. Mild symptoms might resolve quickly, but a hypertensive crisis is a medical emergency that requires prompt treatment. Being prepared and aware of the risks is the best defense.

Frequently Asked Questions

Serotonin syndrome from food alone is highly unlikely. It is primarily caused by combining multiple serotonergic medications, but certain high-tyramine or high-histamine foods can trigger a reaction, especially in individuals taking MAOIs or other specific drugs.

Consuming high-tyramine foods while on an MAOI can cause a dangerous spike in blood pressure, known as a hypertensive crisis, potentially leading to severe symptoms like headache, palpitations, and rapid heart rate.

Not all cheeses are off-limits. Aged and fermented cheeses like aged cheddar, blue cheese, and Gorgonzola are high in tyramine and should be avoided. Fresh cheeses such as cottage cheese, ricotta, and cream cheese are generally safe.

Overripe bananas, particularly the peels, contain higher levels of tyramine and should be avoided. A fresh, unripe banana in moderation is less likely to cause an issue, but it's best to be cautious, especially with an overripe fruit.

No, fermented soy products like soy sauce, miso, and tempeh are high in tyramine and should be avoided by individuals at risk of serotonin syndrome, particularly those on MAOIs.

Some medications, like Linezolid, can inhibit the body's ability to break down histamine. In such cases, consuming excess amounts of high-histamine foods, such as certain fish and fermented items, can also increase the risk of serotonin syndrome.

Yes. Herbal supplements such as St. John's wort and dietary supplements like 5-HTP or concentrated tryptophan should be avoided, as they directly increase serotonin levels and pose a significant risk when combined with serotonergic medications.