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Are Monoamine Metabolites in Cerebrospinal Fluid Worth Measuring?

Arch Gen Psychiatry. 1993;50(8):653-656. doi:10.1001/archpsyc.1993.01820200067007.
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AT The request of Daniel X. Freedman, past chief editor of the Archives, some brief comments are offered apropos of the reports of Hsiao et al1 and Kahn et al2 in this issue. Essentially, they report that alterations in the patterns of neurotransmitter metabolites in cerebrospinal fluid (CSF), rather than the levels of individual monoamine metabolites themselves, are correlated with clinically relevant parameters. The possibility that concentrations of monoamine (norepinephrine [NE], dopamine [DA], and serotonin [5-HT]) neurotransmitter metabolites in CSF reflect brain processes relevant to psychiatric illnesses is based on a number of lines of evidence adduced years ago.3 In one brief decade, classes of behaviorally active drugs were shown to differentially affect brain amines.4

The relevant history begins with findings reported in 1955 that the "tranquilizer," and now rarely used antihypertensive, reserpine, depleted 5-HT in the brain.45 Later, other amines were found also to

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