a tale of 3 cities, the maastricht masters & the tryptophan depletion story professor sean hood...
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A Tale of 3 Cities, the Maastricht Masters &
the Tryptophan Depletion story
Professor Sean HoodConsultant Psychiatrist
University of Western AustraliaPerth, Australia
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Servier + Pfizer Support
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City # 1: Bristol
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Tryptophan Depletion in Social Anxiety Disorder.
Dr Sean Hood
Presented at The European Certificate in Anxiety and Mood Disorders, Santa Margherita Ligure, 2000
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Tryptophan Depletion: Serotonin & Anxiety
Study Protocol Overview
Recruitment
Patient fails to respond to standard open treatment (by CGI-I score):
Routine outpatient care
Exclusion Criteria met: Routine outpatient care
Post-Study Follow-upScreening Day
Exclusion Criteria met: Routine outpatient care
Day 1 Day 2Standard open treatment3/12+ SSRI
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Tryptophan Depletion: Serotonin & Anxiety
SAnD TD: Protocol
Amino acid drink
0 +1 +2 +3 +4 +5 +6 +7
TRP Levels
TRPLevels
TRPLevels
Time (hrs)
TRPLevels
#3:#3:NeutralNeutralScriptScript
#2:#2:VerbalVerbalTaskTask
#1: Autobiographical
Script
(fasting)
Qu. +2 hr Qu. +4 hr
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• Subjects: n=14 SSRI-remitted SAnD (CGI 1 or 2)
• Challenge: Autobiog. Script,Verbal Task, N.
task• Measures:
SSAI,VAS,LSAS,SPINCVS
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• Subjects: n=14 SSRI-remitted SAnD (CGI 1 or 2)
• Challenge: Autobiog. Script,Verbal Task, N.
task• Measures:
SSAI,VAS,LSAS,SPINCVS
• Results: ATD
Total [TRP] over time (+/- SD)
0 1 2 3 4 5 6 7 80
10
20
30
40TRP DepletedNormal TRP
** (Wilcoxon z=-3.297, p<0.001)
** (Wilcoxon z=-3.181,p<0.001)
Time (hours)
To
tal
[TR
P]
(m
ols
/L)
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Baseline 4 Hours A Script Verbal N Script 20
30
40
50
Depletion
Control
Figure 2: Spielberger State Anxiety Inventory (STAI form Y-1) score across thesessions. A Script: autobiographical script; Verbal: verbal stressful task; N Script:
neutral script. a: Wilcoxon z = -1.995, p = 0.046; b: Wilcoxon: z = -2.279; p =
0.023; c: Wilcoxon z = -2.199; p = 0.028.
ac
b
Session
SS
AI
sco
re
0 Baseline 4 Hours A Script Verbal N Script 0
5
10
15
20
Depletion
Control
Figure 1: Visual Analogue Scales composite score across the sessions.A Script: autobiographical script; Verbal: verbal stressful task; N Script: neutral
script; a: Wilcoxon z = -2.043; p = 0.041.
a
Session
VA
S s
core
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City # 2: Maastricht
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2004 Summer Conference of the British Association for Psychopharmacology. Harrogate, UK.
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Acute Tryptophan Depletion in 5 clinical anxiety disorders:
PD, SAnD, PTSD, GAD & OCD
NeurotalkJune 27th, 2010
Singapore
Professor Sean HoodConsultant Psychiatrist
University of Western AustraliaPerth, Australia
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5 Clinical Anxiety Disorders
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Acute Tryptophan Depletion:Serotonin & Anxiety
• Acutely Depleting Serotonin Sx– (SSRI-remitted Depression)– SSRI-remitted SAnD (Social Anxiety)– SSRI-remitted PD (Panic)– CBT-remitted PD (Panic)– SSRI-remitted PTSD
• Acutely Depleting Serotonin NO Sx– SSRI-remitted GAD (Generalised Anxiety)– SSRI-remitted OCD (Obsessive Compulsive)
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ATD in Anxiety Summary
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City # 3: Perth
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Serotonin – HPA
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Serotonin – HPA
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5HT & Hypertension & Stress(N) Volunteer Studies completed
Study ATD 35% CO2 SSRICompleted Pre-1: ATD Vols
(Shufflebotham et al. 2006)
Pre-2: CO2 Vols (Shufflebotham et al. 2009)
Pre-3: ATD CO2 Vols (Hood et al. 2006)
Pre-4: ATD CO2 SSRI Vols(Hince et al. 2010)
(3 weeks)
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5HT & Hypertension & Stress(N) Volunteer Studies over Past 5 Years
Significant Outcome Measures for Normal Volunteers
Study Psychological Cardiovascular EndocrinePre-1: ATD Vols (Shufflebotham, Hood, Hendry, Hince, Morris, Nutt, Probert, & Potokar 2006)
Nil: ATD Nil: ATD -
Pre-2: CO2 Vols (Shufflebotham, Wetherell, Hince, Hood, Lightman, Nutt, Probert, & Potokar 2009)
CO2 anxiety CO2 BP CO2 Cortisol
Pre-3: ATD CO2 Vols (Hood, Hince, Robinson, Cirillo, Christmas, & Kaye 2006)
Nil: ATD CO2 anxietyNil: ATD x CO2
ATD BP (trend)CO2 BPNil: ATD x CO2
ATD CortisolCO2 CortisolNil: ATD x CO2
Pre-4: ATD CO2 SSRI Vols(Hince, Menon, Shadianloo, & Hood 2010)
Nil: ATDCO2 anxietyNil: 3 wk SSRINil: ATD x CO2Nil: ATD x 3 wk SSRICO2 x 3 wk SSRI anxiety
Nil: ATDCO2 BPNil: 3 wk SSRI Nil: ATD x CO2Nil: ATD x 3 wk SSRINil: CO2 x 3 wk SSRI
-
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Serotonin – Cardiovascular
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5HT & Hypertension & StressDavies, Hood et al. J Clin Psychopharm.
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P & H: Autonomic Dysfunction
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P & H: Autonomic Dysfunction
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Networking
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P & H: Autonomic Dysfunction
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From Rags to Riches in 10 years:
How the Maastricht Masters made me fantastically successful.
Professor Sean HoodConsultant PsychiatristUniversity of Western AustraliaPerth, Australia