Anti-depression/serotonin
Cochrane Database Syst Rev 2002;(1):CD003198
Tryptophan and 5-hydroxytryptophan for depression (cochrane review).
Shaw K, Turner J, Del M.
School of Population Health, University of Queensland, Public Health Building, Herston Rd, Herston, Queensland, AUSTRALIA, 4006.
[email protected]
BACKGROUND: 5 Hydroxytryptophan (5-HTP) and tryptophan are so-called natural alternatives to traditional antidepressants, used to treat unipolar depression and dysthymia. OBJECTIVES: To determine whether 5-HTP and tryptophan are more efective than placebo, and whether they are safe to use to treat depressive disorders in adults. SEARCH STRATEGY: Trials were searched in computerized general (Medline, Psychlit, and Embase) and specialized databases (Cochrane Controlled Clinical Trials Register, Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trial Register); by checking reference lists of relevant articles; by handsearching relevant specialist journals; and by contacting relevant authors where appropriate. Publications in all languages were sought. SELECTION CRITERIA: Trials were included if they were randomized, included patients with unipolar depression or dysthymia, compared preparations of 5-HTP or tryptophan with placebo, and included clinical outcomes assessed by scales assessing depressive symptoms. DATA COLLECTION AND ANALYSIS: Data was extracted independently by the three reviewers, onto data collection forms. Inclusion criteria were applied to all potential studies independently and a coefficient of agreement (Kappa) was calculated for them. Disagreement was resolved by reaching consensus. Trial quality was scored according to risk of bias. Analysis for 5-HTP and tryptophan were combined due to the small number of included trials. MAIN RESULTS: 108 trials were located using the specified search strategy. Of these, only two trials, involving a total of 64 patients, were of sufficient quality to meet inclusion criteria. The available evidence suggests these substances were better than placebo at alleviating depression (Peto Odds Ratio 4.10; 95% confidence interval 1.28-13.15; RD 0.36; NNT 2.78). However, the evidence was of insufficient quality to be conclusive. REVIEWER'S CONCLUSIONS: A large number of studies appear to address the research questions, but few are of sufficient quality to be reliable. Available evidence does suggest these substances are better than placebo at alleviating depression. Further studies are needed to evaluate the efficacy and safety of 5-HTP and tryptophan before their widespread use can be recommended. The possible association between these substances and the potentially fatal Eosinophilia-Myalgia Syndrome has not been elucidated. Because alternative antidepresants exist which have been proven to be effective and safe the clinical usefulness of 5-HTP and tryptophan is limited at present.
Eur Neuropsychopharmacol 1996 May;6(2):103-10
Behavioral, neuroendocrine and biochemical effects of different doses of 5-HTP in panic disorder.
van Vliet IM, Slaap BR, Westenberg HG, Den Boer JA.
Department of Psychiatry, Academic Hospital Utrecht, The Netherlands.
To investigate the role of serotonin (5-HT) in the pathophysiology of panic disorder (PD) a challenge test with L-5-hydroxytryptophan (5-HTP) was conducted. Seven patients suffering from PD and seven healthy controls received an i.v. challenge with 10 mg, 20 mg and 40 mg 5-HTP and placebo in random order on four different occasions. Before, during and until 2 h after 5-HTP administration anxious and depressive symptomatology was assessed. In addition, plasma levels of 5-HTP, cortisol, and 5-HIAA were measured at several timepoints. During and after infusion of placebo or any of the different dosages of 5-HTP, none of the patients or controls experienced a panic attack or showed an increase in anxiety or depressive symptoms. There was a dose-related increase in side effects, like nausea, dizziness and fatigue. Only infusion with 40 mg 5-HTP led to an increase in plasma cortisol in both patients and controls. The observed increase in plasma cortisol level was higher for patients compared to controls only at 30 min after infusion. In conclusion, stimulation of the serotonergic neuronal system by three different dosages of 5-HTP did not induce panic or anxiety in PD patients and healthy controls. The 5-HT hypersensitivity hypothesis of PD could not be confirmed in the present study.
J Clin Psychopharmacol 1987 Jun;7(3):127-37
5-Hydroxytryptophan: a review of its antidepressant efficacy and adverse effects.
Byerley WF, Judd LL, Reimherr FW, Grosser BI.
Alterations in serotonin metabolism may be an important factor in the etiology and treatment of depression. In this regard, 5-hydroxytryptophan (5-HTP), a serotonin precursor, has been given to patients with depression. Although a review of these studies suggests that 5-HTP possesses antidepressant properties, additional trials are clearly indicated. Following a discussion of the pharmacology of 5-HTP, the authors highlight adverse effects associated with its administration to depressed patients, neurologic subjects, and normal individuals. Relatively few adverse effects are associated with its use in the treatment of depressed patients.
Some on hunger/portion size in rats:
Pharmacol Biochem Behav 1979 Oct;11(4):431-7
Serotonergic influences on food intake: effect of 5-hydroxytryptophan on parameters of feeding behaviour in deprived and free-feeding rats.
Blundell JE, Latham CJ.
Three experiments were carried out to examine the effect of the serotonin precursor, 5-hydroxytryptophan, upon food intake and the micro-structure of eating in deprived rats, and on the pattern of meal taking in free-feeding animals. The study also investigated the capacity of a peripheral decarboxylase inhibitor (MK-486) to antagonise the effect of 5-HTP in order to identify a central or peripheral mode of action. In deprived rats 5-HTP brought about a dose related inhibition of food intake which was midly antagonised by MK-486. A detailed analysis of the behavioural changes occurring during eating showed that the inhibition of food intake by 5-HTP was reflected in a reduced number of eating bouts and a slower rate of eating. MK-486 did not antagonise the effect of 5-HTP on eating rate. In free-feeding rats whose food comsumption was continuously monitored for 24-hr periods, 5-HTP gave rise to reduction in meal size and a slowing of the intra-meal rate of eating. These findings are in keeping with the effects of other serotonergic manipulations on the patterns of feeding in rats.
Chin J Physiol 1995;38(4):235-40
Serotonergic mechanisms involved in the suppression of feeding by 5-HTP in rats.
Ju CY, Tsai CT.
Department of Biology, National Changhua University of Education, Taiwan, Republic of China.
The effect of 5-hydroxytryptophan (5-HTP), the serotonin precursor, on food intake in rats was investigated in this study. 5-HTP (100 mg/kg, i.p.) reduced food intake by 68.9% of control level. The anorectic effect of 5-HTP was antagonized by cyproheptadine (CYP, 4 mg/kg, i.p.), a serotonin receptor blockade. However, the anorectic effect of 5-HTP was also antagonized by propranolol (PROP 1mg/kg, i.p.) and sulpiride (SULP, 20 mg/kg, i.p.), while Pinodol (PIN 2mg/kg, i.p.) and Haloperidol (HAL 0.5 mg/kg, i.p) did not affect the suppressive effect of 5-HTP on food intake by 5-HTP. These results indicates that the anorectic action of 5-HTP was mediated by the serotonergic mechanism through 5-HT1 and 5-HT2 receptors.
J Pharm Pharmacol 1975 Jan;27(1):31-7
The effect of 5-hydroxytryptophan on food intake and on the anorexic action of amphetamine and fenfluramine.
Blundell JE, Leshem MB.
5-Hydroxytryptophan (5-HTP), amphetamine and fenfluramine suppressed food intake in normal rats and in aminals with lesions of the lateral hypothalamus. The anorexic effect of amphetamine was reduced in lesioned animals compared with controls while the effect of 5-HTP like that of fenfluramine was increased. When administered in conjunction with anorexic drugs, 5-HTP markedly potentiated the anorexic effect of amphetamine in both control and lesioned animals. However, 5-HTP potentiated fenfluramine anorexia only in lesioned rats. These findings provide further evidence for the role of 5-hydroxytryptamine (5-HT,in the anorexic effect of fenfluramine, and suggest that a 5-HT mechanism, inhibitory for feeding, produces particulary severe suppression of food intake in rats with lateral hypothalamic lesions.