L-tryptophan augmentation of light therapy in patients with seasonal affective disorder

Objective: Up to one-third of patients with seasonal affective disorder (SAD) do not have full response to light therapy. Given the evidence for serotonergic dysregulation in SAD, we examined the possible role of I-tryptophan as an augmentation strategy for nonresponders and partial responders to light therapy. Method: Eligible drug-free patients meeting DSM-IV criteria for SAD were treated for 2 weeks using a standard morning light therapy regimen (10 000 lux cool-white fluorescent light for 30 minutes). Partial and nonresponders were treated for 2 weeks with open-label l-tryptophan (1 g 3 times daily) while light therapy was continued. Ratings at baseline and follow-up included the 29-item Structured Interview Guide for the Hamilton Depression Rating Scale, SAD version (SIGH-SAD) and the Clinical Global Impression (CGI) scale. Results: Sixteen patients began the I-tryptophan augmentation phase. Two patients discontinued medications within 3 days because of side effects. In the 14 patients completing treatment, the addition of l-tryptophan resulted in significant reduction of mean depression scores. Nine of 14 patients (64%) showed very good clinical responses to combined treatment and minimal side effects. Conclusion: This open-label study suggests that l-tryptophan may be an effective augmentation strategy for those patients with SAD who show limited or poor response to bright light therapy. Further placebo-controlled studies are warranted to demonstrate efficacy.