title: Gastrointestinal distress to serotonergic challenge: a risk marker for emotional disorder?
abstract: 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.
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. campojv@msx.upmc.edu
authors.forename: John V
authors.initials: JV
authors.lastname: Campo
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Dahl
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Williamson
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.forename: James M
authors.initials: JM
authors.lastname: Perel
authors.forename: Neal D
authors.initials: ND
authors.lastname: Ryan
mesh_terms: 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
chemical_list: D006916:5-Hydroxytryptophan