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Tryptophan as a Link between Psychopathology and Somatic States

From Department of Biological Psychiatry (S.R., J.C.B., J.A.D.B., J.K.), Department of Laboratory Medicine (I.P.K., M.R.F.), Department of Medical Oncology (P.H.B.W., E.G.E.D.V.), University Hospital Groningen, The Netherlands

Address reprint requests to: S. Russo, MD, University Hospital Groningen, Division of Biological Psychiatry, Hanzeplein 1, Box 30.001, 9700 RB Groningen, The Netherlands. Email: s.r.russo{at}acggn.azg.nl

Received for publication February 14, 2002; revision received September 30, 2003.

OBJECTIVE: Several somatic illnesses are associated with psychiatric comorbidity. Evidence is provided that availability of the essential amino acid tryptophan, which is the precursor of serotonin, may cause this phenomenon.

METHODS: We performed a database search to find relevant articles published between 1966 and 2002. For our search strategy, we combined several diseases from the categories hormonal, gastrointestinal, and inflammatory with the search terms "tryptophan" and "serotonin."

RESULTS: The catabolism of tryptophan is stimulated under the influence of stress, hormones and inflammation by the induction of the enzymes tryptophan pyrrolase (in the liver) and IDO (ubiquitous). Because of the reduction in blood levels of tryptophan under these circumstances the formation of cerebral serotonin is decreased.

CONCLUSIONS: It is argued that the coupling of peripheral tryptophan levels and cerebral serotonin levels has physiological significance. The clinical implications and therapeutic consequences of changes in tryptophan and consequently serotonin metabolism are discussed.

Key Words: tryptophan, • serotonin, • review, • psychiatry, • somatic, • depression.

Abbreviations: TRP = tryptophan;; 5-HT = 5-hydroxytryptamine;; BBB = blood-brain barrier;; 5-HIAA = 5-hydroxyindoleacetic acid;; 5-HTP = 5-hydroxytryptophan;; CSF = cerebrospinal fluid;; IDO = indoleamine 2,3 dioxygenase;; NMDA = N-methyl-D-aspartate;; CNS = central nervous system;; SSRI = serotonin-specific reuptake inhibitor.

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