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Cheese syndrome is the name of a condition that is commonly associated with the usage of monoamine oxidase inhibitors (MAOIs), a class of anti-depressants. It is caused by a buildup of tyramine, an amino acid that is involved in blood pressure regulation.

The name of the syndrome is derived from the story of the British pharmacist who first noted the effect. His wife, who was using an MAOI, complained of headaches every time they had eaten cheese, which is particularly rich in tyramine.

MAOIs work by decreasing the action of the enzyme monoamine oxidase, which destroys neurotransmitters like serotonin. Increasing the serotonin concentration in the brain ultimately helps people with clinical depression. But it turned out the enzyme was also responsible for the breakdown of tyramine, a compound that causes severe discomfort or even death if it builds up to too high a concentration.

The connection drawn by the pharmacist explained why many people had been complaining of headaches while using the medicine, but also why some had died of brain haemorrhages while on the drug. The latter effect had caused MAOIs to be taken off the market for a while, even after the cheese connection was made.

Nowadays, MAOIs are prescribed again, but patients are instructed to watch their diet. Liver, fava beans, red wine (particularly Chianti), sausages, nuts, and cheese should not be combined with this particular class of anti-depressants. The first three items are familiar to Dr Hannibal Lecter, the fictional psychiatrist and serial killer. Hence his most famous line: "I ate his liver, with some fava beans, and a nice Chianti," which is Lecter's way of implying he has no need for MAOI's or any other antidepressants. Not surprisingly, Lector enjoys his work and his curious hobby.

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It is not easy to avoid all items on the list of forbidden foods. Some are not obvious. For example, one patient carefully avoided liver, fava beans, red wine, cheese,and nuts, but had a severe reaction after eating a Tandoori mixed grill, which consisted of chicken, shrimp,lamb, and a small chunk of sausage. The sausage did the damage. The patient called his psychiatrist from the restaurant,; he advised him to take nifedipine and report to the nearby Stanford Emergency Room. The triage nurse took his blood pressure, which was alarmingly high, and advised him to wait until a room and a doctor were available. About two hours (!) later, the patient was taken to a room and his blood pressure was measured again: it was nearly normal. The headache responded to an injection of Toradol, an injectable NSAID. (Morphine or Demerol/meperidine would have somewhat rather better for the pain, but it would have made it inadvisable to drive home.)

The patient explained to the attending physician that his doctor had prescribed nifedipine, and that he always carried a few doses with him and the doctor had advised him to take it before leaving the restaurant. This explained the timing of drop in blood pressure. By coincidence, the attending physician was an old medical-school friend of the patient's psychiatrist, so the emergency ended collegially, with a humorous allusion to McGill University Medical School.