Gastrointestinal distress to serotonergic challenge: a risk marker for emotional disorder?
OBJECTIVE
Serotonin is an important mediator of gut sensation and motility. The authors' aim was to determine whether inadvertent gastrointestinal (GI) distress to serotonergic challenge predicted future major depressive and/or anxiety disorders in exposed children.


METHODS
l-5-hydroxytryptophan was administered to 119 prepubertal children free of psychiatric disorder as part of a psychobiological cohort study initially designed to examine familial loading for mood disorder as the exposure of interest. Subjects were followed longitudinally with standardized psychiatric interviews to identify new-onset mood and anxiety disorders over 90.3 +/- 29.2 months, with the average assessment interval being 16.6 +/- 6.2 months. Reports of GI distress in a subgroup during serotonergic challenge led the authors to examine GI distress to infusion as an exposure post hoc and to perform survival analysis using major depressive and/or anxiety disorders as the outcomes of interest.


RESULTS
GI distress to serotonergic challenge was experienced by 23 subjects, with 7 (30.4%) developing an emotional disorder during follow-up in comparison to 12 (10.4%) of 96 nondistressed subjects. The distressed group was at significantly greater risk of subsequent major depression and/or anxiety (p =.026), even after controlling for family history of psychiatric disorder.


CONCLUSIONS
GI distress to serotonergic challenge in childhood is associated with heightened risk for subsequent major depressive and/or anxiety disorders. Studies of serotonergic neurotransmission may aid our understanding of nonrandom associations between functional GI symptoms and emotional symptoms and disorders.
Campo
John V
JV
Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. campojv@msx.upmc.edu
Dahl
Ronald E
RE
Williamson
Douglas E
DE
Birmaher
Boris
B
Perel
James M
JM
Ryan
Neal D
ND
D006916:5-Hydroxytryptophan; D000342:Affective Symptoms / Q000209:etiology / Q000503:physiopathology; D001008:Anxiety Disorders / Q000209:etiology* / Q000503:physiopathology; D002648:Child; D015331:Cohort Studies; D003866:Depressive Disorder / Q000209:etiology* / Q000503:physiopathology; D004064:Digestive System / Q000187:drug effects*; D004068:Digestive System Physiological Phenomena; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012307:Risk Factors
D006916:5-Hydroxytryptophan