Advertisement
Research Article| Volume 20, ISSUE 5, P546-557, May 1985

A controlled clinical trial of l-tryptophan in acute mania

  • G. Chouinard
    Correspondence
    Address reprint requests to Dr. G. Chouinard, Clinical Psychopharmacology Unit, Allan Memorial Institute, 1025 Pine Avenue West, Montreal, Quebec, Canada H3A 1A1.
    Affiliations
    Clinical Psychopharmacology Unit, Allan Memorial Institute, Royal Victoria Hospital, Canada

    Department of Psychiatry, McGill University, Montreal, Canada

    Research Department, Hospital Louis-H. Lafontaine, Montreal, Quebec, Canada
    Search for articles by this author
  • S.N. Young
    Affiliations
    Laboratory of Neurochemistry, Department of Psychiatry, McGill University, Montreal, Canada
    Search for articles by this author
  • L. Annable
    Affiliations
    Clinical Psychopharmacology Unit, Allan Memorial Institute, Royal Victoria Hospital, Canada

    Department of Psychiatry, McGill University, Montreal, Canada
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      In a 2-week study, 24 newly admitted manic patients were treated for 1 week with Math Eq (12 g/day); during the second week, half the patients, chosen at random, continued to receive tryptophan, while placebo was substituted in the other half under double-blind conditions. In the open phase of the study, there was a clinically and statistically (p < 0.001) significant reduction in manic symptom scores, with little need for haloperidol prn. Patients who continued to be treated with tryptophan showed no significant change in mean scores during the second week, but those who were switched to placebo tended (p < 0.10) to show an increase in the mean scores for manic symptoms. There was a significant (p < 0.05) increase in the geometric mean of morning fasting total and free plasma tryptophan concentrations in men, but not in women. These results suggest that increasing the synthesis of 5-hydroxytryptamine has some therapeutic effect in mania.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Biological Psychiatry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Armitage P.
        Statistical Methods in Medical Research.
        Blackwell, Oxford1971
        • Baastrup P.C.
        • Hollnagel P.
        • Sorensen R.
        • et al.
        Adverse reactions in the treatment with lithium carbonate and haloperidol.
        JAMA. 1976; 236: 2645-2646
        • Beitman B.D.
        • Dunner D.L.
        l-Tryptophan in the maintenance treatment of bipolar II manic-depressive illness.
        Am J Psychiatry. 1982; 139: 1498-1499
        • Bowers M.B.
        • Heninger G.R.
        Lithium clinical effects and cerebrospinal fluid acid monoamine metabolites.
        Commun Psychopharmacol. 1977; 1: 135-145
        • Chadwick D.
        • Hallett M.
        • Harris R.
        • et al.
        Clinical, biochemical and physiological features distinguishing myoclonus responsive to 5-hydroxytryptophan, tryptophan with a monoamine oxidase inhibitor, and clonazepam.
        Brain. 1977; 100: 455-487
        • Chambers C.A.
        • Naylor G.J.
        A controlled trial of l-tryptophan in mania.
        Br J Psychiatry. 1978; 132: 555-559
        • Chouinard G.
        • Annable L.
        • Ross-Chouinard A.
        Tardive dyskinesia and supersensitivity psychosis.
        in: 39th Annual Meeting of Society of Biological Psychiatry, Los Angeles, CA1984
        • Chouinard G.
        • Young S.N.
        • Annable L.
        Antimanic effect of clonazepam.
        Biol Psychiatry. 1983; 18: 451-466
        • Chouinard G.
        • Annable L.
        • Ross-Chouinard A.
        • et al.
        Ethopropazine and benztropine in neuroleptic-induced parkinsonism.
        J Clin Psychiatry. 1979; 40: 73-80
        • Chouinard G.
        • Jones B.D.
        • Young S.N.
        • et al.
        Potentiation of lithium by tryptophan in a case of bipolar illness.
        Am J Psychiatry. 1979; 136: 719-720
        • Chouinard G.
        • Young S.N.
        • Annable L.
        • et al.
        Tryptophan-nicotinamide, imipramine and their combination in depression: A controlled study.
        Acta Psychiatr Scand. 1979; 59: 395-414
        • Chouinard G.
        • Ross-Chouinard A.
        • Annable L.
        • et al.
        Extrapyramidal Symptom Rating Scale.
        Can J Neurol Sci. 1980; 7: 233
        • Chouinard G.
        • Young S.N.
        • Bradwejn J.
        • et al.
        Tryptophan in the treatment of depression and mania.
        Adv Biol Psychiatry. 1983; 10: 47-66
        • Cohen J.
        Statistical Power Analysis for the Behavioral Sciences.
        Academic Press, Orlando, FL1977
        • Cookson J.
        • Silverstone T.
        5-Hydroxytryptamine and dopamine pathways in mania: A pilot study of fenfluramine and pimozide.
        Brit J Clin Pharmacol. 1976; 3: 942-943
        • Coppen A.
        • Prange A.J.
        • Whybrow P.C.
        • et al.
        Methysergide in mania: A controlled trial.
        Lancet. 1969; ii: 338-340
        • Court J.H.
        • Mai F.M.M.
        A double-blind intensive crossover design trial of methysergide in mania.
        Med J Austr. 1970; 2: 526-529
        • Denckla W.D.
        • Dewey H.K.
        The determination of tryptophan in plasma, liver and urine.
        J Lab Clin Med. 1967; 69: 160-169
        • Dewhurst W.G.
        Methysergide in mania.
        Nature. 1968; 219: 506-507
        • Fieve R.R.
        • Platman S.R.
        • Fleiss J.L.
        A clinical trial of methysergide and lithium in mania.
        Psychopharmacologia. 1969; 15: 425-429
        • Fyro B.
        • Peterson U.
        • Sedvall G.
        The effect of lithium treatment on manic symptoms and levels of monoamine metabolites in cerebrospinal fluid of manic depressive patients.
        Psychopharmacologia. 1975; 44: 99-103
        • Garattini S.
        • Buczko W.
        • Jori A.
        • et al.
        The mechanism of action of fenfluramine.
        Postgrad Med J. 1975; 51: 27-35
        • Grahame-Smith D.G.
        • Green A.R.
        The role of brain 5-hydroxytryptamine in the hyperactivity produced in rats by lithium and monoamine oxidase inhibitors.
        Br J Pharmacol. 1974; 52: 19-26
        • Haskovec L.
        • Soucek K.
        Trial of methysergide in mania.
        Nature. 1968; 219: 507-508
        • Joseph M.H.
        • Risby D.
        The determination of kynurenine in plasma.
        Clin Chim Acta. 1975; 63: 197-204
        • Kirkwood T.B.L.
        Geometric means and measures of dispersion.
        Biometrics. 1979; 35: 908-909
        • Lorr M.
        • Klett C.J.
        Inpatient Multidimensional Psychiatric Scale.
        Consulting Psychologists' Press, Palo Alto, CA1966
        • McCabe M.S.
        • Reich T.
        • Winokur G.
        Methysergide as a treatment for mania.
        Am J Psychiatry. 1970; 127: 354-356
        • Murphy D.L.
        • Baker M.
        • Goodwin F.K.
        • et al.
        l-Tryptophan in affective disorders: Indoleamine changes and differential clinical effects.
        Psychopharmacology. 1974; 34: 11-20
        • Murphy D.L.
        • Campbell I.C.
        • Costa J.L.
        The brain serotonergic system in the affective disorders.
        Progr Neuropsychopharmacol. 1978; 2: 1-31
        • Pearce J.B.
        Fenfluramine in mania.
        Lancet. 1973; i: 427
        • Prange A.J.
        • Wilson I.C.
        • Lynn C.W.
        • et al.
        l-Tryptophan in mania: Contribution to a permissive hypothesis of affective disorders.
        Arch Gen Psychiatry. 1974; 30: 56-62
        • Prien R.F.
        • Caffey E.M.
        • Klett C.J.
        Comparison of lithium carbonate and chlorpromazine in the treatment of mania: Report of the Veterans Administration and National Institute of Mental Health collaborative study group.
        Arch Gen Psychiatry. 1972; 26: 146-153
        • Sangdee C.
        • Franz D.M.
        Lithium-induced enhancement of central 5HT transmission induced by 5HT precursors.
        Biol Psychiatry. 1980; 15: 59-75
        • Schooler N.R.
        • Kane J.M.
        Research diagnoses for tardive dyskinesia.
        Arch Gen Psychiatry. 1982; 39: 486-487
        • Shaw D.M.
        • Tidmarsh S.F.
        • Johnson A.L.
        • et al.
        Multicompartmental analysis of amino acids: II. Tryptophan in affective disorder.
        Psychol Med. 1978; 8: 487-494
        • Shaw D.M.
        • Tidmarsh S.F.
        • Karajgi B.M.
        Tryptophan, affective disorder and stress: An hypothesis.
        J Affect Disord. 1980; 2: 321-325
        • Spitzer R.L.
        • Endicott J.
        • Robins E.
        Research Diagnostic Criteria.
        in: ed 3. Biometrics Research Division, New York State Psychiatric Institute, New York1977: 16
        • van Praag H.M.
        • Flentge F.
        • Korf J.
        • et al.
        The influence of probenecid on the metabolism of serotonin, dopamine and their precursors in man.
        Psychopharmacology. 1973; 33: 141-151
        • Young S.N.
        Monoamine precursors in the affective disorders.
        in: Advances in Human Psychopharmacology. vol 3. JAI Press, Greenwich, CT1984: 251-285
        • Young S.N.
        • Sourkes T.L.
        Antidepressant action of tryptophan.
        Lancet. 1974; ii: 897-898