Leo Sher, M.D.

Our research paper, “CSF monoamine metabolites and lethality of suicide attempts in depressed patients with alcohol dependence” was published 15 years ago in the January 2007 issue of European Neuropsychopharmacology (1). In this study, we investigated the relationship of cerebrospinal fluid (CSF) 5-hydroxyindolacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) levels to lethality of suicide attempts in drug free patients with comorbid alcoholism and major depression.

All subjects met DSM-IV criteria for a current major depressive episode, alcohol dependence and had made a previous suicide attempt. Participants were free from medications known to affect brain serotonin, dopamine, or norepinephrine systems for a minimum of 14 days. The drug-free interval was longer for drugs with a long half-life (6 weeks for fluoxetine and 4 weeks for oral antipsychotics).The Beck Lethality Scale was used to evaluate degree of medical damage. Study participants with medical lethality scores ≥4 were classified as high-lethality suicide attempters, participants with medical lethality scores <4 were regarded as low-lethality attempters. The classification between low-lethality and high-lethality attempters was based on lifetime history.

There were 16 low-and 16 high-lethality suicide attempters. There was no difference between the two groups with regard to the demographic characteristics or psychiatric measures. We found that CSF 5-HIAA levels were lower in high-lethality attempters compared to low-lethality attempters. There were no group differences in the CSF HVA or MHPG levels. Controlling for age and gender did not change the results for CSF 5-HIAA. The difference in the CSF HVA and CSF MHPG levels remained non-significant after the adjustment for age and gender. The results of this study indicate that lethality of suicidal behavior in depressed patients with alcoholism is related to serotonergic activity.

Reference

1. Sher L, Oquendo MA, Grunebaum MF, Burke AK, Huang YY, Mann JJ. CSF monoamine metabolites and lethality of suicide attempts in depressed patients with alcohol dependence. Eur Neuropsychopharmacol. 2007 Jan;17(1):12-5. doi: 10.1016/j.euroneuro.2006.04.011. Epub 2006 Jun 8.