Symptoms of depression and anxiety in anorexia nervosa: links with plasma tryptophan and serotonin metabolism

Psychoneuroendocrinology. 2014 Jan:39:170-178. doi: 10.1016/j.psyneuen.2013.09.009. Epub 2013 Sep 17.


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.

Keywords: Anorexia nervosa; Anxiety; Depression; Malnutrition; Serotonin; Tryptophan.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anorexia Nervosa / blood*
  • Anorexia Nervosa / complications
  • Anxiety / blood*
  • Anxiety / complications
  • Depression / blood*
  • Depression / complications
  • Female
  • Humans
  • Male
  • Nutritional Status
  • Serotonin / metabolism*
  • Surveys and Questionnaires
  • Tryptophan / blood*


  • Serotonin
  • Tryptophan