Explaining MAOI diet, washouts and patch options (CASC)

Station instructions (candidate)

You have 7 minutes. Explain why an MAOI is being considered after multiple failed antidepressants, what the tyramine diet means in practical language, which medicines are absolute no-list items (including tramadol and many cold remedies), and how the selegiline patch differs on diet rules at 6 mg/24 h versus higher doses. Balance hope from TRD/atypical-depression evidence with honest safety requirements. Do not guarantee cure. Do not dismiss fear. Offer written materials and follow-up.[1][2][3][6]

Marking domains

Agenda setting and empathy; accurate plain-language explanation of why MAOIs can help when other tablets have not; practical high-tyramine food teaching (not endless folklore bans); clear absolute drug bans including tramadol and dextromethorphan-containing cold remedies; selegiline patch diet nuance without claiming zero interaction risk; washout concept if switching from current serotonergic medicines; collaborative plan, pharmacy alert, crisis contacts for severe headache after restricted food.[1][2][4][5]

Model communication map

1. Open: thank her; check understanding of previous trials; name shared goals (mood recovery, work function, safety).[1]
2. Why MAOI now: several proper antidepressant pathways have not led to remission; for some people with treatment-resistant or atypical symptom patterns, MAOIs remain an evidence-supported specialist option.[1][6]
3. Diet without terror: a short list of high-risk aged/fermented/spoiled foods and draft beer — not a ban on all enjoyable eating; written card; storage matters.[2]
4. Medicine red lines: no SSRI combinations; no tramadol; careful with cold-and-flu products; always check with pharmacy/doctor first.[5][1]
5. Patch option: selegiline skin patch has trial evidence in depression; at the lowest 6 mg/24 h strength many protocols relax routine tyramine diet, but higher strengths put diet rules back on, and dangerous drug combinations still apply at every dose. Availability varies by country.[3][4]
6. Washouts: if still on a serotonergic tablet, there is a planned gap (about two weeks for many agents; longer after fluoxetine) before a classic MAOI — safety, not bureaucracy.[1]
7. Close: questions, written diet/drug list, who to call for sudden severe headache, next review, consent check.[2]

Common fails

• Saying "just avoid all cheese forever" without practical nuance or written plan.[2]
• Allowing tramadol or cold remedies "if the diet is good".[5]
• Claiming the patch has no interactions at 12 mg/24 h.[4]
• Guaranteeing remission or terrifying the patient into refusing without discussing benefits.[1]