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The treatment of depression in general practice: a comparison of L-tryptophan, amitriptyline, and a combination of L-tryptophan and amitriptyline with placebo

Published online by Cambridge University Press:  09 July 2009

Joan Thomson ,
H. Rankin ,
G. W. Ashcroft ,
Celia M. Yates ,
Judith K. McQueen  and
S. W. Cummings
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Synopsis

One hundred and fifteen patients from 5 general practices participated in a 12-week, double-blind study comparing L-tryptophan, amitriptyline, L-tryptophan–amitriptyline combination and placebo in the treatment of depression. Analysis of total score on the Hamilton Depression Scale and a global rating of depression showed that all 3 active treatments were more effective than placebo. Significantly more patients were withdrawn as treatment failures in the placebo group compared with the active treatment groups. Side-effects necessitated withdrawal of more patients from the amitriptyline group than from the other active tratment groups, but this difference was not significant. Plasma amitriptyline and nortriptyline levels were similar in the difference was not significant. Plasma amitriptyline and nortriptyline and biochemical profiles did not alter significantly in any group, but mean heart rate was significantly increased in patients receiving amitriptyline. There was no change in free or total plasma tryptophan concentration with treatment or on remission of symptoms.

Type
Research Article
Information
Psychological Medicine , Volume 12 , Issue 4 , November 1982 , pp. 741 - 751
Copyright
Copyright © Cambridge University Press 1982

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References

Aylward, M. (1973). Plasma tryptophan levels and mental depression in postmenopausal subjects: effects of oral piperazine oestrone sulphate. International Research Communications System 1, 30.Google Scholar
Bartlett, J. R., Bridges, P. K., Curzon, G., Gillman, P. K., Hunt, A., Kantamaneni, B. D. & Patel, J. (1981). Effect of tryptophan infusion on plasma, CSF, and brain tryptophan in man. British Journal of Clinical Pharmacology 12 (2), 277–278.Google Scholar
Blashki, T. G., Mowbray, R. & Davies, B. (1971). Controlled trial of amitriptyline in general practice. British Medical Journal i, 133–138.CrossRefGoogle Scholar
Braithwaite, R. A. & Widdop, B. (1971). A specific gas-chromatographic method for the measurement of steady-state plasma levels of amitriptyline and nortriptyline in patients. Clinica chemica acta 35, 461–472.CrossRefGoogle ScholarPubMed
Braithwaite, R. A., Goulding, R. & Thean, G. et al. (1972). Plasma concentration of amitriptyline and clinical response. Lancet i, 1297–1300.CrossRefGoogle Scholar
Bunney, W. E. Jr, Brodie, H. K. H., Murphy, D. L. & Goodwin, F. K. (1971). Studies of alpha-methyl-para-tyrosine, L-dopa, and L-tryptophan in depression and mania. American Journal of Psychiatry 127, 872–881.CrossRefGoogle ScholarPubMed
Carroll, B. J., Mowbray, R. M. & Davis, B. (1970). Sequential comparison of L-tryptophan with ECT in severe depression. Lancet i, 967–969.CrossRefGoogle Scholar
Chouinard, G., Young, S. N., Annable, L. & Sourkes, T. L. (1979). Tryptophan-nicotinamide, imipramine and their combination in depression. A controlled study. Acta psychiatrica scandanavica 59, 395–414.CrossRefGoogle ScholarPubMed
Coppen, A., Shaw, D. M., Herzberg, B. & Maggs, R. (1967). Tryptophan in the treatment of depression. Lancet ii, 1178–1180.Google Scholar
Coppen, A., Whybrow, P. C., Noguera, R., Maggs, R. & Prange, A. J. (1972). The comparative antidepressant value of L-tryptophan and imipramine with and without attempted potentiation by liothyro-nine. Archives of General Psychiatry 26, 234–241.CrossRefGoogle Scholar
Coppen, A., Eccleston, E. G. & Peet, M. (1973). Total and free tryptophan concentration in plasma of depressive patients. Lancet ii, 60–63.CrossRefGoogle Scholar
Coppen, A., Ghose, K. & Montgomery, S. et al. (1978). Amitriptyline plasma concentration and clinical effect. Lancet i, 63–66.CrossRefGoogle Scholar
Curzon, G. (1979). Relationships between plasma, CSF, and brain tryptophan. Journal of Neural Transmission Suppl. 15, 81–92.Google Scholar
Duncan, D. B. (1955). Multiple range and multiple Ftests. Biometrics 03, 1–42.Google Scholar
Dunner, D. L. & Fieve, R. R. (1975). Affective disorder: studies with amine precursors. American Journal of Psychiatry 132, 180–183.Google Scholar
Green, A. R., Aronson, J. K., Curzon, G. & Woods, H. F. (1980). Metabolism of an oral tryptophan load. I. Effects of dose and pre-treatment with tryptophan. British Journal of Clinical Pharmacology 10, 603–610.Google Scholar
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.Google Scholar
Herrington, R. N., Bruce, A., Johnstone, E. C. & Lader, M. H. (1974). Comparative trial of L-tryptophan and ECT in severe depressive illness. Lancet ii, 731–734.CrossRefGoogle Scholar
Herrington, R. N., Bruce, A., Johnstone, E. C. & Lader, M. H. (1976). Comparative trial of L-tryptophan and amitriptyline in depressive illness. Psychological Medicine 6, 673–678.CrossRefGoogle ScholarPubMed
Hess, S. M. & Udenfriend, S. (1959). A fluorimetric procedure for the estimation of tryptamine in tissues. Journal of Pharmacology and Experimental Therapeutics 127, 175–177.Google Scholar
Jensen, K., Fruensgaard, K. & Ahlfors, U.-G. et al. (1975). Tryptophan/imipramine in depression. Lancet ii, 920.CrossRefGoogle Scholar
Johnson, D. A. W. (1973). Treatment of depression in general practice. British Medical Journal ii, 18–20.CrossRefGoogle Scholar
Kupfer, D. J., Hanin, I. & Spiker, D. (1978). Amitriptyline plasma levels and clinical response in primary depression. Communications in Psychopharmacology 2, 441–450.Google Scholar
Lopez-Ibor, Alino J. J., Ayuso Gutierrez, J. L. & Montejo Iglesias, M. L. (1973). Tryptophan and amitriptyline in the treatment of depression. A double blind study. International Pharmacopsychiatry 8, 145–151.CrossRefGoogle Scholar
McNenamy, R. H. & Oncley, J. L. (1958). The specific binding of L-tryptophan to serum albumin. Journal of Biological Chemistry 233, 1436–1447.CrossRefGoogle Scholar
Mantel, N. & Haenszel, W. (1959). Statistical aspects of the analysis of data from retrospective studies of disease. Journal of the National Cancer Institute 22. 719–748.Google ScholarPubMed
Mendels, J., Stinnett, J. K.. Burns, D. & Frazer, A. (1975). Amine precursors and depression. Archives of General Psychiatry 32. 22–30.CrossRefGoogle ScholarPubMed
Montgomery, S., McAuley, R., Rani, S. J., Montgomery, D. B., Braithwaite, R. & Dawling, S. (1979). Amitriptyline plasma concentration and clinical response. British Medical Journal i 230–231.CrossRefGoogle Scholar
Murphy, D. L., Baker, M., Goodwin, F. K.. Miller, J., Kotin, J. & Bunney, W. E. Jr (1974). L-Tryptophan in affective disorders. Indolearnine changes and differential clinical effects. Psychopharmacologia, 34, 11–20.CrossRefGoogle ScholarPubMed
Murphy, J. E., Donald, J. F. & Molla, A. L. (1976). Mianserin in the treatment of depression in general practice. Practitioner 217, 135–138.Google ScholarPubMed
Niskanen, P., Huttunen, M., Tamminen, T. & Jaaskelainen, J. (1976). The daily rhythm of plasma tryptophan and tyrosine in depression. British Journal of Psychiatry 128. 67–73.CrossRefGoogle ScholarPubMed
Peet, M., Moody, J. P., Worrall, E. P., Walker, P. & Naylor, G. J. (1976). Plasma Iryptophan concentration in depression and mania. British Journal of Psychiatry 128. 255–258.Google Scholar
Porter, A. M. W. (1970). Depressive illness in a general practice. A demographic study and a controlled trial of imipramine. British Medical Journal i, 773–778.CrossRefGoogle Scholar
Rao, B. & Broadhurst, A. D. (1976). Tryptophan and depression. British Medical Journal i, 460.CrossRefGoogle Scholar
Rickels, K., Gordon, P. E., Jenkins, B. W., Perloff, M., Sachs, T. & Stepansky, W. (1970). Drug treatment in depressive illness (amitriptyline and chlordiazepoxide in two neurotic populations). Diseases of the Nervous System 31, 30–42.Google Scholar
Riley, G. J. & Shaw, D. M. (1976). Total and non-bound tryptophan in unipolar illness. Lancet ii, 1249.CrossRefGoogle Scholar
S.A.S. User's Guide (1979 edition), S.A.S. Institute Inc.: Cary, North Carolina.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1977). Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders (3rd edn). New York State Psychiatric Institute: New York.Google Scholar
Wålinder, J., Skott, A., Carlsson, A., Nagy, A. & Roos, B.-E. (1976). Potentiation of the antidepressant action of clomipramine by tryptophan. Archives of General Psychiatry 33, 1384–1389.CrossRefGoogle ScholarPubMed
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974). Measurement and Classification of Psychiatric Symptoms. Cambridge University Press: Cambridge.Google Scholar
Ziegler, V. E., Cox, B. T. & Taylor, J. R. (1976). Amitriptyline plasma levels and therapeutic response. Clinical Pharmacology and Therapeutics 19, 795–801.Google Scholar