Cerebrospinal fluid monoamine metabolite levels and lethality of suicide attempts in patients with bipolar disorder: a prospective study
Leo Sher, M.D.
Our research work, “A prospective study of the association of cerebrospinal fluid monoamine metabolite levels with lethality of suicide attempts in patients with bipolar disorder” was published 15 years ago in the October 2006 issue of Bipolar Disorders (1). We examined the relation between CSF 5-hydroxyindolacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) levels and maximum lethality of suicide attempts at baseline and during a 2-year follow up.
Demographic and clinical parameters of bipolar depressed patients were examined and recorded. Lumbar punctures were performed and CSF 5-HIAA, HVA, and MHPG were assayed by high-performance liquid chromatography with electrochemical detection. Following discharge, patients were evaluated after 3 months, 1 year, and 2 years. Subjects received treatment as usual in the community. Each follow-up interview included an in-depth assessment of suicidal behavior during the intervening time period.
Bipolar patients who attempted suicide during the follow-up period had higher aggression and hostility scale scores compared to bipolar subjects who did not make a suicide attempt during the follow-up period. CSF 5-HIAA, HVA, and MHPG levels were negatively correlated with the maximum lethality of suicide attempts during the 2-year follow-up period.
Our finding was the first observation that CSF monoamine metabolite levels may be predictors of lethality of suicide attempts in patients with bipolar disorder. The serotonergic, dopaminergic, and noradrenergic systems are involved in the neurobiology of bipolar disorder. Therefore, CSF 5-HIAA, HVA, and MHPG levels may reflect pathophysiological processes in bipolar disorder.
- Sher L, Carballo JJ, Grunebaum MF, Burke AK, Zalsman G, Huang YY, Mann JJ, Oquendo MA. A prospective study of the association of cerebrospinal fluid monoamine metabolite levels with lethality of suicide attempts in patients with bipolar disorder. Bipolar Disord. 2006 Oct;8(5 Pt 2):543-50. doi: 10.1111/j.1399-5618.2006.00319.x.