Plasma and CSF GABA in affective illness

CSF and plasma GABA was measured in patients with bipolar affective illness and matched controls. There was no correlation between CSF and plasma GABA in 10 pairs of simultaneously obtained samples. Plasma GABA was significantly lower in a group of 10 euthymic medication-free bipolar patients compared to 41 normal volunteers (P less than .02). This finding was replicated in a second study involving 6 patients and 10 normal volunteers. Twin studies showed a high correlation between members of 11 monozygotic twin pairs (P less than .008). Diurnal variation was minimal, but bimonthly sampling over one year revealed somewhat higher values in the late summer compared to late winter.

Cerebrospinal fluid gamma-aminobutyric acid and homovanillic acid in depressive disorders

gamma-Aminobutyric acid (GABA) and homovanillic acid (HVA) levels were determined in the lumbar cerebrospinal fluid (CSF) of hospitalized patients suffering from depression and in a control group. Both mean CSF GABA and HVA levels in the patients with depression were significantly lower than those of the control group (p less than 0.05, p less than 0.01, respectively). No positive correlation was found between the changes in CSF GABA and HVA levels in the patients with depression. The Hamilton Rating score in these depressed patients, age, and sex showed no correlation to CSF GABA levels. It is suggested that decreased activity in the central GABAergic and dopaminergic system may be involved in the pathogenesis of depression.

Altered neuropeptide concentrations in cerebrospinal fluid of psychiatric patients

Immunoreactive somatostatin, bombesin, and cholecystokinin were measured in cerebrospinal fluid of normal subjects and patients with anorexia nervosa, depression, mania, and schizophrenia. Somatostatin-like immunoreactivity was decreased in anorexic and depressed patients. Bombesin-like immunoreactivity tended to be decreased in schizophrenics. Cholecystokinin-like immunoreactivity did not differ between groups. These data suggest a possible function for neuropeptides in regulation of human behavior.

CSF beta-endorphin-immunoreactivity in normal, schizophrenic, depressed, manic and anorexic subjects

beta-Endorphin immunoreactivity was measured in cerebrospinal fluid of 75 medication-free subjects: normal, depressed, schizophrenic, and anorexic. No significant differences in beta-endorphin immunoreactivity were found. Affinity extraction chromatography revealed beta-lipotropin and beta-endorphin, but no apparent precursors.

Endogenous opioid activity and beta-endorphin immunoreactivity in CSF of psychiatric patients and normal volunteers

The authors measured total opioid activity by radioreceptor assay in the CSF of 41 normal subjects and 89 unmedicated psychiatric patients, including schizophrenic, schizoaffective, depressed, and manic diagnostic groups. Schizophrenic men had significantly lower levels of opioid activity than the normal men, although these levels did not significantly differ from levels of other male patients. The authors observed higher opioid activity during mania than during depression in paired samples for 4 manic-depressive patients. beta-Endorphin immunoreactivity in a subsample of the same subjects was no different in the patient group than in the normal group, suggesting that the differences in CSF opioid activity between schizophrenic men and normal patients may be related to opioids other than beta-endorphin.

CSF GABA in normal subjects and patients with depression, schizophrenia, mania, and anorexia nervosa

The authors examined the CSF GABA of 87 subjects: 29 normal control subjects, 11 patients with schizophrenia, 26 with depression, 6 with mania, and 15 with anorexia nervosa. Depressed patients had significantly lower CSF GABA levels than did normal subjects. This finding suggests that GABA may have a direct or indirect association with depressive affective disorders.

Symptom patterns in unipolar and bipolar depression correlating with monoamine metabolites in the cerebrospinal fluid: II. Suicide

Suicidality scores from the Schedule for Affective Disorders and Schizophrenia on 21 unipolar and 12 bipolar depressives were correlated with monoamine metabolites in the cerebrospinal fluid using multiple regression analyses. The single item of Suicidal Tendencies Worst Week correlated highly significantly and negatively with 3-methoxy-4-hydroxyphenylglycol (MHPG) and only to a very slight degree with 5-hydroxyindoleacetic acid (5HIAA). Seriousness of Intent of Worst Suicide Attempt earlier in life correlated significantly and negatively with both MHPG and 5HIAA. Subjective Anger was positively and Overt Anger negatively associated with thoughts of suicide. The results support earlier reports that depressives with low 5HIAA are prone to violent suicides, but also point to the equal, if not even greater involvement of MHPG and noradrenergic neuronal systems in carrying out a wish for death.

Symptom patterns in unipolar and bipolar depression correlating with monoamine metabolites in the cerebrospinal fluid: I. General patterns

The symptom scores on the Schedule for Affective Disorders and Schizophrenia (SADS) of 21 unipolar and 12 bipolar depressive patients diagnosed with Research Diagnostic Criteria (RDC) were correlated with the monoamine metabolites homovanillic acid (HVA), 3-methoxy-4-hydroxyphenylglycol (MHPG), and 5-hydroxyindoleacetic acid (5HIAA) in the cerebrospinal fluid (CSF). For the unipolar group, multiple regression analyses revealed strong multiple correlations (from r = 0.92 to 0.97) to the effect that high- and low-HVA, high- and low-MHPG, and high- and low-5HIAA syndromes, respectively, could be isolated. The bipolars were too few for the same analyses to work well, but there is evidence for the high- and low-monoamine syndromes to be characterized by differential symptomatology in bipolar and unipolar patients. Through the comparison of monoamine metabolite values predicted from a total of 18 SADS symptom items with the true CSF values, a computer program was able to classify 20 of the 21 unipolar and all the 12 bipolars correctly. The results are consistent with a hypothesis of the pathoplastic role of individually set (genetically determined?) brain monoamine homeostases in shaping the profile of an affective episode.

Lack of effect of carbamazepine on gamma-aminobutyric acid in cerebrospinal fluid

Carbamazepine was administered to nine patients with manic-depressive illness at doses ranging from 600 to 1600 mg per day, achieving blood levels between 6 and 11 microgram per milliliter. Compared to medication-free values, GABA levels in the cerebrospinal fluid (CSF) were not significantly altered by an average of 30 days' treatment with carbamazepine. These preliminary data do not support a major effect of carbamazepine on brain GABA as reflected in CSF as a mechanism for its anticonvulsant or psychotropic effects.

Amino acid concentrations in cerebrospinal fluid: effects of aging, depression, and probenecid

Cerebrospinal fluid (CSF) amino acid concentrations were measured in six Bipolar I, eight Bipolar II, eight Unipolar, and four other and control patients. All but four were also studied after administration of probenecid. Fourteen amino acids showed significant correlations of concentrations with age of subjects. Significant diagnostic group differences were found for five amino acids; only that of tyrosine persisted after taking subject's age into account. Following probenecid administration, there were statistically significant changes in CSF concentration of several amino acids, but these changes were small and likely indicative of diurnal changes.

CSF monoamine metabolites in child and adult psychiatric patients. A developmental perspective

Concentrations of acid metabolites of dopamine and serotonin were measured in lumbar CSF of a diagnostically heterogeneous group of 154 psychiatric patients following oral probenecid loading. The patients ranged in age from 2 to 67 years old. No patients had received psychoactive medications for at least two weeks prior to the lumbar puncture. Children had higher mean CSF homovenillic acid (HVA) levels, higher mean CSF HVA-probenecid ratios, higher CSF HVA-log probenecid ratios, and lower mean CSF probenecid levels than adults. Age was negatively correlated with CSF HVA level and with CSF HVA-probenecid ratio. These correlations were more pronounced in male patients than in female patients.

GABA levels in CSF of patients with psychiatric disorders

The authors measured gamma-aminobutyric acid (GABA) levels in the lumbar CSF of patients with depression, with psychosis, or undergoing evaluation for a neurologic disorder. GABA levels in the CSF from depressed patients were significantly decreased compared with neurologic control patients. CSF GABA levels in psychotic patients were not different from those in neurologic patients, although the data suggested a decrease in CSF GABA levels in patients with schizoaffective disorder.

Monoamine metabolites in cerebrospinal fluid of depressive subgroups

Lumbar punctures were performed on 69 patients who met Research Diagnostic Criteria (RDC) for major affective disorder, while they were drug-free and depressed. None of the patients met RDC for alcoholism. Cerebrospinal fluid 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) were measured by fluorometry and 3-methoxy-4-hydroxyphenylglycol (MHPG) by gas chromatography. Family histories were ascertained by systematic interviews of patients and their relatives, and diagnoses were made by family history diagnostic criteria (Andreasen et al., 1977). Depressed patients with alcoholism in a first degree relative had significantly lower levels of 5-HIAA and MHPG than patients without a family history of alcoholism (p < 0.05). No difference in HVA levels was found. The metabolite differences remained significant when the influence of sex ratio was considered. These results are in agreement with previous work linking alcoholism to abnormal serotonin metabolism. They provide further biochemical evidence of distinct genetic subtypes of affective disorder along lines suggested by Winokur (1979a, 1979b), and illustrate the usefulness of the family history method in defining patient subgroups.

Interactions between central monoaminergic systems: dopamine-serotonin

Concentration of dopamine and serotonin metabolites (HVA and 5-HIAA) in the CSF was evaluated before and after pharmacological treatment in 19 patients with different neuropsychiatric diseases. In every case a reciprocal modification of the two metabolites occurred after treatment. The result supports the hypothesis of a functional balance between the monoaminergic systems in the central nervous system.

CSF calcium: clinical correlates in affective illness and schizophrenia

In a study of electrolytes in lumbar cerebrospinal fluid (csf) from psychiatric patients, the authors found a positive correlation between calcium concentration and symptom severity in hospitalized depressed patients. CSF calcium levels tended to decrease as patients improved. In four rapidly cycling patients, CSF calcium was higher during depression than during mania. Mean CSF calcium for the depressed patients as a group was not significantly different from neurological controls or other psychiatric patients. Symptom remission from acute psychosis in schizophrenic patients was accompanied by a significant increase in CSF calcium concentration. These findings are discussed in relationship to calcium-induced alterations in neuronal and physiological excitability.

Cerebrospinal fluid norepinephrine in affective illness

The authors measured cerebrospinal fluid norepinephrine concentrations in manic, depressive, and neurological control patients with and without probenecid administration. Baseline and probenecid norepinephrine values were significantly higher in manic than in depressed patients, who did not differ significantly from the neurological patients. Depressed patients with high levels of anxiety had higher levels of norepinephrine than those with low anxiety. These data suggest that alterations in mood or motor activity may be associated with changes in central norepinephrine metabolism in man.

Effects of a dopamine agonist piribedil in depressed patients: relationship of pretreatment homovanillic acid to antidepressant response

Piribedil, a compound that stimulates dopamine receptors in a relatively specific fashion, was administered to 11 hospitalized depressed patients. The dopamine agonist significantly decreased rapid eye movement (REM) sleep and percent REM sleep and increased REM latency. Piribedil decreased the probenecid-induced accumulation of the dopamine metabolite homovanillic acid (HVA) in CSF. A range of mild to moderate antidepressant effects was noted; one patient worsened and one developed recurrent manic episodes. The degree of improvement in depression was negatively correlated with pretreatment values of HVA in CSF (r = -.66, P less than .05). These data suggest that the heterogeneity of clinical response may be related to biological differences in depressed patients and that those with low initial dopaminergic function respond best to increased dopamine receptor stimulation.

Endorphins in human cerebrospinal fluid: clinical correlations to some psychotic states

The significance of endorphins, endogenous morphine-like agents, in some psychiatric disorders was investigated. Samples of cerebrospinal fluid were taken by lumbar puncture from healthy volunteers and from patients with schizophrenic, manic-depressive and puerperal psychosis and analyzed for two major fractions of endorphins (Fractions I and II). In 19 healthy volunteers the levels of the two fractions fell within a fairly narrow range. In contrast, six out of nine drug-free and symptom-rich schizophrenics showed elevated levels of Fraction I, which returned to normal or slightly supranormal values after treatment with neuroleptics or propranolol. This decrement was paralleled by a clinical improvement in four of six responding patients. In four manic-depressive patients, serial samples of cerebrospinal fluid revealed elevated endorphin levels, particularly Fraction I during the manic stage. In three out of four patients with puerperal psychosis, the levels of endorphins (either Fraction I or II) were elevated in the acute drug-free stage. During a later symptom-free stage, after treatment with ECT and/or neuroleptics, the endorphin levels were within the normal range. The present data lend credit to the hypothesis that endorphins are involved in some psychotic states in the human.

Cyclic AMP in cerebrospinal fluid of manic and depressive patients

Cyclic 3',5'-adenosine monophosphate (c-AMP) was measured in cerebrospinal fluid (CSF) of manic and depressive patients with and without probenecid administration both before and during treatment with various psychotropic drugs. Oral probenecid (100 mg/kg) produced substantial c-AMP accumulations in CSF suggesting a probenecid-sensitive transport mechanism for c-AMP. Baseline and probenecid-induced accumulations of c-AMP were not significantly different in manic and depressed patients, while baseline levels in depressed patients were higher than those in neurological controls. Imipramine, amitriptyline, lithium, tryptophan, and electroconvulsant therapies did not significantly alter levels or accumulations of c-AMP in CSF of depressed patients.

Pituitary thyrotropin response to thyrotropin-releasing hormone in affective illness: relationship to spinal fluid amine metabolites

The authors studied pituitary thyrotropin, i.e., thyroid-stimulating hormone (TSH), response to thyrotropin-releasing hormone (TRH) in patients with primary affective disorder. There were no overall differences between either depressed or manic patients and normal controls; however, the TSH response was significantly lower in the unipolar depressed patients than in either bipolar depressed patients or normal subjects. Bipolar patients in the manic phase tended to have a lower response than bipolar depressed patients. In the unipolar group, the TSH response showed a significant negative correlation with the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the CSF. These neuroendocrine responses may constitute markers of specific monoamine dysfunction in subgroups of patients with affective illness.

Synaptic membrane protein D2 in the cerebrospinal fluid of manic-melancholic patients

The synaptic membrane protein D2 was measured in the cerebrospinal fluid (CSF) of manic-melancholic patients. The concentration of D2 increased with the age of the patients until about 35 years of age. No difference was found between the D2-concentration in CSF from a control group compared with different manic-melancholic subgroups. The D2-concentration in CSF collected from the patients during depression or mania was compared with CSF collected from the same patients when their moods were normalized. In the case of the depressed patients, we found that the D2-concentration increased slightly when the mood was normalized.

Cerebrospinal fluid and plasma free cortisol concentrations in depression

Cerebrospinal fluid (CSF) cortisol levels were examined in a total group of 65 patients. Those who were not depressed (ND), and those suffering from depressive neuroses (DN) had marginally elevated values. Patients with unipolar depression (UD) and bipolar depression (BD) had levels twice as high as the ND and DN patients. Psychotic UD and BD patients had the highest values, three to four times as high as the ND and DN subjects. A significant reduction of CSF cortisol levels was observed following treatment and recovery. Manic patients had moderately elevated CSF cortisol values. The CSF results were in good agreement with plasma total cortisol levels and with urinary free cortisol excretion. Age and sex effects were not responsible for the observed differences; similar results were found in patient subgroups studied in Australia and in the United States. Preliminary equilibrium dialysis data are presented for plasma and CSF cortisol binding. CSF cortisol was 20% bound and 80% free. Plasma free cortisol levels were in good agreement with CSF free cortisol values. Depressed patients have increased tissue and central nervous system (CNS) exposure to free, physiologically active glucocorticoids. The appearance of severe depressive symptoms which manifest a diurnal rhythm may be determined in part by excesssve CNS exposure to glucocorticoids.

Cyclic AMP levels in cerebrospinal fluid in manic-melancholic patients

The concentrations of adenosine 3'5'-cyclic monophosphate (cyclic AMP) in cerebrospinal fluid (CSF) in manic-melancholic patients were studied. As control groups served patients suffering from other psychiatric disorders as well as neruological and orthopedic patients. The results showed no difference between the various diagnostic groups, including melancholic versus manic patients, unipolar versus bipolar types. The severity of the affective states measured by rating scales showed no correlation to cyclic AMP levels in CSF. The cyclic AMP levels were apparently not influenced by electroconvulsive therapy or treatment with lithium, neuroleptica, or tricyclic antidepressants.

The effect of lithium treatment on manic symptoms and levels of monoamine metabolites in cerebrospinal fluid of manic depressive patients

Clinical effects, levels of 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) in cerebrospinal fluid (CSF) and lithium levels in serum were examined in 13 manic depressive patients acutely admitted because of a manic or hypomanic episode. Patients were examined before and 12 days after the beginning of lithium treatment. Manic scores were significantly reduced during treatment. The levels of 5-HIAA as well as HVA increased significantly during treatment. The HVA to 5-HIAA ratio was significantly reduced, indicating a more pronounced change in 5-HIAA than in HVA. The 5-HIAA and HVA levels before as well as after 12 days of treatment were significantly correlated. No significant correlation was found between manic scores and monoamine metabolites in CSF or between lithium level in serum and reduction of manic scores or elevation of monoamine metabolites in CSF in the relative small number of patients studied.

Reduced central serotonergic activity in mania: implications for the relationship between depression and mania

For the past decade there has been extensive interest in the hypothesized association between brain amine function and disturbances in mood (either depression or mania). The more influential theories have postulated that clinical depression is associated with a decrease in aminergic function (either norepinephrine, dopamine or serotonin) while mania is associated with increased activity of these amines. This essentially ‘bipolar’ approach has tended to dominate most studies in this area. Evidence supporting these theories has been extensively reviewed (11, 61, 70) and need not be detailed here.

Changes on recovery in the concentrations of tryptophan and the biogenic amine metabolites in the cerebrospinal fluid of patients with affective illness

The concentration of the acid metabolites of dopamine, and 5-hydroxytryptamine (5-HT), homovanillic acid (HVA), and 5-hydroxyindolacetic acid (5-HIAA) respectively, were estimated in the cerebrospinal fluid of patients suffering from either unipolar or bipolar affective illness, both before and after recovery. Significantly low concentrations of HVA and 5-HIAA (P<0·01 and 0·05 respectively) were found in the unipolar depressed group and these did not return to normal on recovery. Depressed bipolar patients had levels within normal limits. In bipolar manic patients the HVA concentration fell on recovery to a level significantly lower (P<0·05) than controls. There was no difference in the levels of tryptophan in the CSF of any of the groups of patients nor was there any alteration on recovery. There was a high correlation between 5-HIAA and HVA in the same CSF. These findings are against the amine hypothesis which postulated in depression a lowered concentration of transmitter amine at synaptic junction.

Central norepinephrine metabolism in affective illness: MHPG in the cerebrospinal fluid

Concentrations of the norepinephrine metabolite 3-methoxy-4-hydroxyphenyl glycol in cerebrospinal fluid were measured by a gas chromatographic method in 34 patients with affective illness and in 44 controls. Concentrations of this metabolite in spinal fluid were significantly lower in depressed patients than in controls or manic patients. These low values may occur secondary to depressive phenomena such as reduced psychomotor activity, or they may reflect a primary change in norepinephrine metabolism in depressive illness.