Tryptophan Depletion Reverses the Therapeutic Effect of Selective Serotonin Reuptake Inhibitors in Social Anxiety Disorder

S.V. Argyropoulos, Sean Hood, M. Adrover, C.J. Bell, A.S. Rich, J.R. Nash, N.C. Rich, H.J. Witchel, D.J. Nutt

    Research output: Contribution to journalArticle

    73 Citations (Scopus)

    Abstract

    Background: Tryptophan depletion studies have suggested that central serotonin (5-hydroxytryptamine, 5-HT) function mediates the therapeutic effect of selective serotonin reuptake inhibitors (SSRIs) in depression and panic disorder, The present study tested the hypothesis that temporary reduction in central 5-HT transmission, through acute tryptophan depletion, could reverse the therapeutic effect of the SSRIs in social anxiety disorder (SAD) patients.Methods: Fourteen patients with SAD who showed sustained clinical improvement with SSRI treatment underwent tryptophan depletion in a double-blind, placebo-controlled, crossover design, over 2 days 1 week apart. At the peak time of depletion, the participants also underwent three behavioral challenges: autobiographical script, verbal task, and neutral script. Psychological outcome was assessed with the Spielberger State Anxiety Inventory (STAI) Form Y-1 and visual analog scales (VAS) measuring anxiety, depression, and somatic symptoms.Results: Anxiety was significantly increased on the depletion day compared with the control day, both oil the STAI Form Y-1 and composite VAS score. Furthermore, there was a significant depletion X time interaction, explained mainly by the anxiogenic effect of the autobiographical script. In contrast, the verbal and the neutral tasks failed to differentiate between depletion and placebo.Conclusions: Tryptophan depletion induced significant increase of anxiety in treated SAD patients, which was more prominent during the recital of all autobiographical script. This finding supports the notion that SSRIs improve social anxiety by increasing 5-HT availability. The autobiographical script seems to be a more robust challenge test for SAD than the stressful verbal task.
    Original languageEnglish
    Pages (from-to)503-509
    JournalBiological Psychiatry
    Volume56
    Issue number7
    DOIs
    Publication statusPublished - 2004

    Fingerprint Dive into the research topics of 'Tryptophan Depletion Reverses the Therapeutic Effect of Selective Serotonin Reuptake Inhibitors in Social Anxiety Disorder'. Together they form a unique fingerprint.

  • Cite this

    Argyropoulos, S. V., Hood, S., Adrover, M., Bell, C. J., Rich, A. S., Nash, J. R., Rich, N. C., Witchel, H. J., & Nutt, D. J. (2004). Tryptophan Depletion Reverses the Therapeutic Effect of Selective Serotonin Reuptake Inhibitors in Social Anxiety Disorder. Biological Psychiatry, 56(7), 503-509. https://doi.org/10.1016/j.biopsych.2004.07.006