Leo Sher, M.D.

Our research paper, “Lower cerebrospinal fluid homovanillic acid levels in depressed suicide attempters” was published 15 years ago in the January 2006 issue of the Journal of Affective Disorders (1).

Depressed suicide attempters constitute a heterogenous group and important differences may exist between depressed suicide attempters with or without Axis II disorders. Including both Axis II and non-Axis II subjects in prior studies could obscure the relationship between dopamine and suicidal behavior in patients with major depression. Therefore, we compared demographic and clinical parameters, and cerebrospinal fluid (CSF) homovanillic acid (HVA) levels in depressed suicide attempters without comorbid Axis II disorders, depressed non-attempters without comorbid Axis II disorders, and normal controls.

Thirty-one depressed subjects with a history of a suicide attempt, 27 depressed subjects without a history of a suicide attempt, and 50 healthy controls were included in the study. A suicide attempt was defined as a self-destructive act committed with some intent to end one’s life. Subjects with comorbid Axis II disorders were excluded. Demographic and clinical parameters, and CSF HVA levels were examined.

The two depressed groups did not differ with regard to depression, aggression, hopelessness, and total hostility scale scores. Depressed suicide attempters had higher current suicidal ideation scores compared to depressed non-attempters. Depressed suicide attempters had lower CSF HVA levels compared to depressed non-attempters and to controls. There was no difference in CSF HVA levels between depressed non-attempters and controls.

CSF HVA appears to be a biologic marker of suicidal behavior in depressed patients. The results of our study indicate that dopaminergic abnormalities are associated with suicidality but not with depression. The variability in the rates of comorbid Axis II disorders and in the prevalence of suicide attempters in different patient populations may affect both clinical and biological results of studies of mood disorders.

Reference

1. Sher L, Mann JJ, Traskman-Bendz L, Winchel R, Huang YY, Fertuck E, Stanley BH. Lower cerebrospinal fluid homovanillic acid levels in depressed suicide attempters. J Affect Disord. 2006 Jan;90(1):83-9. doi: 10.1016/j.jad.2005.10.002. Epub 2005 Nov 28.