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Relationship Between Central and Peripheral Serotonin Indexes in Depressed and Suicidal Psychiatric Inpatients

J. John Mann, MD; P. Anne McBride, MD; Richard P. Brown, MD; Markku Linnoilam, MD, PhD; Andrew C. Leon, PhD; Michael DeMeo, MD; Tammy Mieczkowski, MA; Joyce E. Myers, MD; Michael Stanley, PhD
Arch Gen Psychiatry. 1992;49(6):442-446. doi:10.1001/archpsyc.1992.01820060022003.
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• Serious suicidal behavior, affective disorders, and a variety of other psychopathologic behaviors and syndromes have been found to correlate with measures of the serotonin system. Clinical studies have employed a range of serotonin indexes, including the cerebrospinal fluid level of 5-hydroxyindoleacetic acid, the prolactin response to serotonin agonists, such as fenfluramine hydrochloride, and platelet serotonin-related proteins or serotonin content. Many of these indexes are correlated with suicidal behavior, but the interrelationship of these biologic measures has been uncertain. We studied the relationship of a series of serotonin indexes in patients in whom these measures were correlated with suicidal behavior. A positive correlation was found between cerebrospinal fluid 5-hydroxyindoleacetic acid and the maximal prolactin response to fenfluramine but not with platelet serotonin, receptor indexes. The fenfluramine-stimulated maximal prolactin response correlated with platelet serotonin2 receptor number, particularly in older patients. We conclude that cerebrospinal fluid 5-hydroxyindoleacetic acid measurements cannot be replaced but can be complemented by less invasive procedures, such as a fenfluramine challenge test or platelet serotonin2 measures, in the study of the relationship of the serotonin system to psychiatric disorders.


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