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Monoamine Metabolites in CSF and Suicidal Behavior

Lil Träskman, MD; Marie Åsberg, MD; Leif Bertilsson, PhD; Lars Sjüstrand, MD
Arch Gen Psychiatry. 1981;38(6):631-636. doi:10.1001/archpsyc.1981.01780310031002.
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• Cerebrospinal fluid concentrations of the monoamine metabolites 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenyl glycol (MHPG) were measured in 30 psychiatric patients who had attempted suicide and 45 healthy volunteers. The suicide attempters had a significantly lower CSF 5-HIAA level than the controls, especially those who had made more violent attempts. After adjustment for differences in body height and age between controls and patients, the difference in 5-HIAA level became even more marked. Concentrations of 5-HIAA also were lower than normal in suicidal patients who were not diagnosed as depressed at the time of lumbar puncture, while HVA levels were lowered only in the depressives. A follow-up study of these and 89 more patients (depressed and/or suicidal) revealed a 20% mortality by suicide within a year after lumbar puncture in patients with a CSF 5-HIAA level below the median.

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