Tryptophan depletion (TD) is an experimental procedure for studying brain serotonin function. The mood-lowering effect of TD has been demonstrated in formerly depressed patients treated with selective serotonin reuptake inhibitors (SSRIs) or monoamine oxidase inhibitors1 and in medication-free women with a history of recurrent depressive episodes.2 Typically, a little more than half of the patients experience the effect. It is not exactly clear why some patients experience the effect while others do not. Several studies have recently found that the effect may be less consistent than previously thought. Moore et al3 observed no effect on mood in fully remitted patients medicated with SSRIs. In a study4 of patients who had responded to treatment with citalopram, only 5 of 12 patients relapsed, and the effect seemed to be clinically significant in only 1 patient. In a third study,5 only 33% of 21 patients experienced a relapse. Moore et al3 suggest that their unexpected finding may be related to sample differences. In comparison with earlier studies, their patients had been in treatment longer and were less depressed. Therefore, the effect of TD may be limited to recently recovered, medicated patients.3 However, clinically significant symptom increases have been observed in euthymic patients who had not been receiving medications for at least 6months.2 Another factor that might be involved is a patient's history of suicidal ideation.6
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