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Tryptophan Depletion in Patients With Obsessive-Compulsive Disorder Who Respond to Serotonin Reuptake Inhibitors

Linda C. Barr, MD; Wayne K. Goodman, MD; Christopher J. McDougle, MD; Pedro L. Delgado, MD; George R. Heninger, MD; Dennis S. Charney, MD; Lawrence H. Price, MD
Arch Gen Psychiatry. 1994;51(4):309-317. doi:10.1001/archpsyc.1994.03950040053007.
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Methods:  The effects of short-term tryptophan depletion were examined in 15 patients with DSM-III-R obsessive-compulsive disorder who had demonstrated symptom reduction following treatment with serotonin reuptake inhibitors. Patients received a 24-hour, low-tryptophan (160-mg/d) diet followed the next morning by a drink of 15 amino acids. A double-blind, placebo-controlled crossover design was used.

Results:  The diet and the amino acid drink reduced free plasma tryptophan levels by a mean of 84% 5 hours later. Short-term tryptophan depletion did not significantly change mean ratings of obsessions and compulsions. In contrast, mean depression ratings were significantly increased with tryptophan depletion compared with the control (tryptophan-supplemented) testing.

Conclusion:  Maintenance of serotonin reuptake inhibitor—induced improvement of obsessive and compulsive symptoms, unlike remission of depressive symptoms, may not depend on ongoing short-term availability of serotonin.

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