{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:18:41Z","timestamp":1790738321591,"version":"4.1.0"},"reference-count":50,"publisher":"Royal College of Psychiatrists","issue":"2","license":[{"start":{"date-parts":[[2018,1,2]],"date-time":"2018-01-02T00:00:00Z","timestamp":1514851200000},"content-version":"unspecified","delay-in-days":6545,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Psychiatry"],"published-print":{"date-parts":[[2000,2]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Uncertainties remain about the role of serotonin in the aetiology and treatment of panic disorder.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To investigate the effect of reducing brain serotonin function on anxiety at rest, and following 5% CO<jats:sub>2<\/jats:sub> provocation in normal controls and patients with panic disorder.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Twenty drug-free patients with DSM\u2013III\u2013R panic disorder and 19 controls received a tryptophan-free amino acid drink on one occasion and a control drink on the other in a double-blind, balanced protocol. 5% CO<jats:sub>2<\/jats:sub> was given as a panic challenge after 270 minutes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Plasma tryptophan fell by more than 80% both patients and controls after the tryptophan-free drink. Tryptophan depletion did not alter resting anxiety. In patients alone, tryptophan depletion caused a greater anxiogenic response and an increased rate of panic attacks (9 <jats:italic>v<\/jats:italic>. 2, <jats:italic>P<\/jats:italic>&lt;0.05) after 5% CO<jats:sub>2<\/jats:sub> challenge. No normal volunteers panicked.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Serotonin may directly modulate panic anxiety in patients with panic disorder. 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