title: Symptoms of depression and anxiety in anorexia nervosa: links with plasma tryptophan and serotonin metabolism.
abstract: Depressive, anxiety and obsessive symptoms frequently co-occur with anorexia nervosa (AN). The relationship between these clinical manifestations and the biological changes caused by starvation is not well understood. It has been hypothesised that reduced availability of tryptophan (TRP) could reduce serotonin activity and thus trigger these comorbid symptoms. The aim of this study, during re-feeding in individuals with AN, was to analyse covariations across measures of nutritional status, depressive and anxiety symptoms, and peripheral serotonin markers. Depressive and anxiety symptoms, nutritional status and serotonin markers--whole blood serotonin content, plasma TRP and the ratio between TRP and large neutral amino acids--were assessed for 42 AN participants at admission to inpatient treatment and after re-feeding. Biological measures were compared to those obtained in 42 non-eating disordered subjects. For those with AN, psychological, nutritional and biological parameters improved significantly during hospitalisation. Levels of serotonin markers were significantly lower in the AN group compared to the control group, at admission and at discharge. Increase in the TRP/LNAA ratio was correlated with a decrease in depressive symptoms. In addition, there was a positive correlation between serotonin levels and symptoms of both anxiety and depression at discharge. We speculate that enhanced TRP availability during re-feeding, as a result of the increase in the TRP/LNAA ratio, could restore serotonin neurotransmission and lead to a decrease in depressive symptoms. The association between serotonin and anxiety and depressive symptoms would be consistent with numerous observations indicating abnormal functioning of the serotoninergic system in AN.
authors.affiliation: Département de Psychiatrie, Institut Mutualiste Montsouris, Paris, France; Faculté de Médecine, Université Paris Descartes, Paris, France; Inserm U669, Paris, Université Paris Descartes, Paris, France. Electronic address: clairgauthier@gmail.com.
authors.forename: Claire
authors.initials: C
authors.lastname: Gauthier
authors.affiliation: Inserm U669, Paris, Université Paris Descartes, Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Hassler
authors.affiliation: Département de Psychiatrie, Institut Mutualiste Montsouris, Paris, France; Faculté de Médecine, Université Paris Descartes, Paris, France; Inserm U669, Paris, Université Paris Descartes, Paris, France.
authors.forename: Lama
authors.initials: L
authors.lastname: Mattar
authors.affiliation: APHP, Hôpital Lariboisière, Service de Biochimie et de Biologie Moléculaire, Paris, France; INSERM U942, Biomarqueurs et Insuffisance cardiaque, Hôpital Lariboisière, Paris, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Launay
authors.affiliation: APHP, Hôpital Lariboisière, Service de Biochimie et de Biologie Moléculaire, Paris, France; INSERM U942, Biomarqueurs et Insuffisance cardiaque, Hôpital Lariboisière, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Callebert
authors.affiliation: Eating Disorders Program, Douglas University Institute, Verdun, Quebec, Canada; Psychiatry Department, McGill University, Montreal, Quebec, Canada.
authors.forename: Howard
authors.initials: H
authors.lastname: Steiger
authors.affiliation: Unité de Nutrition clinique-Maladies infectieuses, Département de médecine aiguë spécialisée, Hôpital Raymond Poincarré, Garches, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Melchior
authors.affiliation: Inserm U669, Paris, Université Paris Descartes, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Falissard
authors.affiliation: Département de Psychiatrie, Institut Mutualiste Montsouris, Paris, France; Faculté de Médecine, Université Paris Descartes, Paris, France; Inserm U669, Paris, Université Paris Descartes, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Berthoz
authors.affiliation: Unité de Psychiatre, CHU Hôpital Nord, Saint-Etienne, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Mourier-Soleillant
authors.affiliation: Unité de Psychiatre, CHU Hôpital Nord, Saint-Etienne, France.
authors.forename: François
authors.initials: F
authors.lastname: Lang
authors.affiliation: Unité médico-psychologique de l'adolescent et du jeune adulte, CHU de Bordeaux, Bordeaux, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Delorme
authors.affiliation: Unité médico-psychologique de l'adolescent et du jeune adulte, CHU de Bordeaux, Bordeaux, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Pommereau
authors.affiliation: Département de pédiatrie Médicale - Psychiatrie de l'enfant et de l'adolescent, CHU de Rouen, Rouen, France.
authors.forename: Priscille
authors.initials: P
authors.lastname: Gerardin
authors.affiliation: C H S Charles Perrens, Bordeaux, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Bioulac
authors.affiliation: C H S Charles Perrens, Bordeaux, France.
authors.forename: Manuel
authors.initials: M
authors.lastname: Bouvard
authors.affiliation: Département de Psychiatrie, Institut Mutualiste Montsouris, Paris, France; Faculté de Médecine, Université Paris Descartes, Paris, France; Inserm U669, Paris, Université Paris Descartes, Paris, France. Electronic address: nathalie.godart@imm.fr.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Godart
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000097:blood* / Q000150:complications; D001007:Anxiety / Q000097:blood* / Q000150:complications; D003863:Depression / Q000097:blood* / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D009752:Nutritional Status; D012701:Serotonin / Q000378:metabolism*; D011795:Surveys and Questionnaires; D014364:Tryptophan / Q000097:blood*
chemical_list: D012701:Serotonin; D014364:Tryptophan
keywords: Anorexia nervosa; Anxiety; Depression; Malnutrition; Serotonin; Tryptophan