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March 1989, Vol 46, No. 3 >
Article | March 1989

Biochemical Classifications of Diagnostic Subgroups and D-Type Scores

William Z. Potter, MD, PhD; Markku Linnoila, MD, PhD
[+] Author Affiliations

Accepted for publication Sept 27, 1988.

Reprint requests to National Institutes of Mental Health, Building 10, Room 2046, Bethesda, MD 20892 (Dr Potter).


Arch Gen Psychiatry. 1989;46(3):269-271. doi:10.1001/archpsyc.1989.01810030075010
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References
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The article by Schatzberg et al1 in this issue of the Archives on the "D-score" reflects an unusually impressive and sustained effort. This work was initiated by Dr Joseph Schildkraut2 who is well known for providing one of the earliest formulations of the catecholamine hypothesis of affective disorders. The D-type score was the result of a discriminant function analysis of urinary catecholamine metabolites carried out with a stepwise entry of variables in the order in which they contributed to discriminating between a small group of bipolar manic-depressive and unipolar chronic charactrological depressions. Dr Schildkraut and Schatzberg and colleagues had observed that a single urinary catecholamine metabolite, 3-methoxy-4-hydroxyphenylglycol (MHPG), was by itself present in a significantly lower concentration in the bipolar than unipolar chronic characterological depressions and then considered the important possibility "that the other urinary metabolites might also contain information that would be useful in differentiating these two

REFERENCES

1 +
Schatzberg AF, Samson JA, Bloomingdale KL, Orsulak PJ, Gerson B, Kizuka PP, Cole JO, Schildkraut JJ:  Toward a biochemical classification of depressive disorders: X. Urinary catecholamines, their metabolites, and Dtype scores in subgroups of depressive disorders . Arch Gen Psychiatry 1989;;46:260-268.
2 +
Schildkraut JJ:  The catecholamine hypothesis of affective disorders: A review of supporting evidence . Am J Psychiatry 1965;;122:509-522.
3 +
Schildkraut JJ, Orsulak PJ, Gudeman JE, Schatzberg AF, Rohde WA, Labrie RA, Cahill JA, Cole JO, Frazier SH:  Norepinephrine metabolism in depressive disorders: Implications for a biochemical classification of depressions , in Cole JO, Schatzberg AF, Frazier SH (eds): Depression . New York, Plenum Press, 1978;, pp 75-101.
4 +
Wehr TA, Goodwin FK:  Can antidepressants cause mania and worsen the course of affective illness? Am J Psychiatry 1987;;144:1403-1411.
5 +
Freedman DX:  Strategies for research in biological psychiatry , in Meltzer HY (ed): Psychopharmacology: The Third Generation of Progress . New York, Raven Press, 1987;, pp 23-25.
6 +
Muscettola G, Potter WZ, Gordon EK, Goodwin FK:  Methodological issues in the measurement of urinary MHPG . Psychiatry Res 1981;;4:267-276.
7 +
Kopin IJ, Oliver JA, Polinsky RJ:  Relationship between urinary excretion of homovanillic acid and norepinephrine metabolites in normal subjects and patients with orthostatic hypotension . Life Sci 1988;;43:125-131.
8 +
Karoum F, Karson CN, Bigelow LB, Lawson WB, Wyatt RJ:  Preliminary evidence of reduced combined output of dopamine and its metabolites in chronic schizophrenia . Arch Gen Psychiatry 1987;;44:604-607.
9 +
Koslow SH, Maas JW, Bowden CL, Davis JM, Hanin I, Javaid J:  CSF and urinary biogenic amines and metabolites in depression and mania: A controlled, univariate analysis . Arch Gen Psychiatry 1983;;40:999-1010.
10 +
Rudorfer MV, Scheinin M, Karoum F, Ross RJ, Potter WZ, Linnoila M:  Reduction of norepinephrine turnover by serotonergic drugs in man . Biol Psychiatry 1984;;19:179-193.
11 +
Roy A, Pickar D, Douillet P, Karoum F, Linnoila M:  Urinary monoamines and monoamine metabolites in subtypes of unipolar depressive disorder and normal controls . Psychol Med 1986;;16:541-546.
12 +
Linnoila M, Oliver J, Adinoff B, Potter WZ:  High correlations of norepinephrine, dopamine, and epinephrine and their major metabolite secretion rates . Arch Gen Psychiatry 1988;;45:701-704.
13 +
Charney DS, Heninger GR, Sternberg DE, Landis H:  Abrupt discontinuation of tricyclic antidepressant drugs: Evidence for noradrenergic hyperactivity . Br J Psychiatry 1982;;141:377-386.
14 +
Kopin IJ, Polinsky RJ, Oliver JA, Oddershede IR, Ebert MH:  Urinary catecholamine metabolites distinguish different types of sympathetic neuronal dysfunction in patients with orthostatic hypotension . J Clin Endocrinol Metab 1983;;57:632.
15 +
Maas JW, Koslow ST, Davis J, Katz M, Frazer A, Bowden CL, Berman N, Gibbons R, Stokes P, Landis DH:  Catecholamine metabolism and disposition in healthy and depressed subjects . Arch Gen Psychiatry 1987;;44:337-344.
16 +
Roy A, Linnoila M, Karoum F, Pickar D:  Relative activity of metabolic pathways for norepinephrine in endogenous depression . Acta Psychiatr Scand 1986;;73:624-628.
17 +
Wode-Helgodt B, Fyrö B, Gullberg B, Sedvall G:  Effect of chlorpromazine treatment on monoamine metabolite levels in cerebrospinal fluid of psychotic patients . Acta Psychiatr Scand 1977;;56:129-142.
18 +
Risby ED, Hsiao JK, Sunderland T, Ågren H, Rudorfer MV, Potter WZ:  The effects of antidepressants on the HVA/5HIAA ratio . Clin Pharmacol Ther 1987;;42:547-554.
19 +
Roy A, Ågren H, Pickar D, Linnoila M, Doran A, Cutler NR, Paul SM:  Reduced CSF concentrations of homovanillic acid and homovanillic acid to 5hydroxy-indoleacetic ratios in depressed patients: Relationship to suicidal behavior and dexamethasone non-suppression . Am J Psychiatry 1986;;143:1539-1545.
20 +
Åsberg M, Ringberger VA, Sjövist F, Thoren P, Träskman L, Tuck JR:  Monoamine metabolites in cerebrospinal fluid and serotonin uptake inhibition during treatment with chlorimipramine . Clin Pharmacol Ther 1977;;21:201-207.
21 +
Berkenstedt L, Edman G, Flyckt L, Hagenfeldt L, Sedvall G, Weisel FA:  Clinical and biochemical effects of citalopram, a selective 5-HT reuptake inhibitor: A dose-response study in depressed patients . Psychopharmacology 1985;;87:253-259.
22 +
Ågren H, Mefford I, Rudorfer M, Linnoila M, Potter W:  Interacting neurotransmitter systems: A non-experimental approach to the 5HIAA-HVA correlation in human CSF . J Psychiatr Res 1986;;20:175-193.
23 +
Hsiao JK, Ågren H, Rudorfer MV, Linnoila M, Potter WZ:  Monoamine metabolite interactions and the prediction of antidepressant response . Arch Gen Psychiatry 1987;;44:1078-1083.
24 +
Davis JM, Koslow SH, Gibbons RD, Maas JW, Bowden CL, Casper R, Hanin I, Javaid JI, Chang SS, Stokes PE:  Cerebrospinal fluid and urinary biogenic amines in depressed patients and healthy controls . Arch Gen Psychiatry 1988;;45:705-717.
25 +
Linnoila M, Karoum F, Calil HM, Kopin IJ, Potter WZ:  Alteration of norepinephrine metabolism with desipramine and zimelidine in depressed patients . Arch Gen Psychiatry 1982;;39:1025-1028.
26 +
Linnoila M, Karoum F, Potter WZ:  Effect of low dose clorgyline on 24hour urinary monoamine secretion in rapidly cycling bipolar affective disorder patients . Arch Gen Psychiatry 1982;;39:513-516.

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1 +
Schatzberg AF, Samson JA, Bloomingdale KL, Orsulak PJ, Gerson B, Kizuka PP, Cole JO, Schildkraut JJ:  Toward a biochemical classification of depressive disorders: X. Urinary catecholamines, their metabolites, and Dtype scores in subgroups of depressive disorders . Arch Gen Psychiatry 1989;;46:260-268.
2 +
Schildkraut JJ:  The catecholamine hypothesis of affective disorders: A review of supporting evidence . Am J Psychiatry 1965;;122:509-522.
3 +
Schildkraut JJ, Orsulak PJ, Gudeman JE, Schatzberg AF, Rohde WA, Labrie RA, Cahill JA, Cole JO, Frazier SH:  Norepinephrine metabolism in depressive disorders: Implications for a biochemical classification of depressions , in Cole JO, Schatzberg AF, Frazier SH (eds): Depression . New York, Plenum Press, 1978;, pp 75-101.
4 +
Wehr TA, Goodwin FK:  Can antidepressants cause mania and worsen the course of affective illness? Am J Psychiatry 1987;;144:1403-1411.
5 +
Freedman DX:  Strategies for research in biological psychiatry , in Meltzer HY (ed): Psychopharmacology: The Third Generation of Progress . New York, Raven Press, 1987;, pp 23-25.
6 +
Muscettola G, Potter WZ, Gordon EK, Goodwin FK:  Methodological issues in the measurement of urinary MHPG . Psychiatry Res 1981;;4:267-276.
7 +
Kopin IJ, Oliver JA, Polinsky RJ:  Relationship between urinary excretion of homovanillic acid and norepinephrine metabolites in normal subjects and patients with orthostatic hypotension . Life Sci 1988;;43:125-131.
8 +
Karoum F, Karson CN, Bigelow LB, Lawson WB, Wyatt RJ:  Preliminary evidence of reduced combined output of dopamine and its metabolites in chronic schizophrenia . Arch Gen Psychiatry 1987;;44:604-607.
9 +
Koslow SH, Maas JW, Bowden CL, Davis JM, Hanin I, Javaid J:  CSF and urinary biogenic amines and metabolites in depression and mania: A controlled, univariate analysis . Arch Gen Psychiatry 1983;;40:999-1010.
10 +
Rudorfer MV, Scheinin M, Karoum F, Ross RJ, Potter WZ, Linnoila M:  Reduction of norepinephrine turnover by serotonergic drugs in man . Biol Psychiatry 1984;;19:179-193.
11 +
Roy A, Pickar D, Douillet P, Karoum F, Linnoila M:  Urinary monoamines and monoamine metabolites in subtypes of unipolar depressive disorder and normal controls . Psychol Med 1986;;16:541-546.
12 +
Linnoila M, Oliver J, Adinoff B, Potter WZ:  High correlations of norepinephrine, dopamine, and epinephrine and their major metabolite secretion rates . Arch Gen Psychiatry 1988;;45:701-704.
13 +
Charney DS, Heninger GR, Sternberg DE, Landis H:  Abrupt discontinuation of tricyclic antidepressant drugs: Evidence for noradrenergic hyperactivity . Br J Psychiatry 1982;;141:377-386.
14 +
Kopin IJ, Polinsky RJ, Oliver JA, Oddershede IR, Ebert MH:  Urinary catecholamine metabolites distinguish different types of sympathetic neuronal dysfunction in patients with orthostatic hypotension . J Clin Endocrinol Metab 1983;;57:632.
15 +
Maas JW, Koslow ST, Davis J, Katz M, Frazer A, Bowden CL, Berman N, Gibbons R, Stokes P, Landis DH:  Catecholamine metabolism and disposition in healthy and depressed subjects . Arch Gen Psychiatry 1987;;44:337-344.
16 +
Roy A, Linnoila M, Karoum F, Pickar D:  Relative activity of metabolic pathways for norepinephrine in endogenous depression . Acta Psychiatr Scand 1986;;73:624-628.
17 +
Wode-Helgodt B, Fyrö B, Gullberg B, Sedvall G:  Effect of chlorpromazine treatment on monoamine metabolite levels in cerebrospinal fluid of psychotic patients . Acta Psychiatr Scand 1977;;56:129-142.
18 +
Risby ED, Hsiao JK, Sunderland T, Ågren H, Rudorfer MV, Potter WZ:  The effects of antidepressants on the HVA/5HIAA ratio . Clin Pharmacol Ther 1987;;42:547-554.
19 +
Roy A, Ågren H, Pickar D, Linnoila M, Doran A, Cutler NR, Paul SM:  Reduced CSF concentrations of homovanillic acid and homovanillic acid to 5hydroxy-indoleacetic ratios in depressed patients: Relationship to suicidal behavior and dexamethasone non-suppression . Am J Psychiatry 1986;;143:1539-1545.
20 +
Åsberg M, Ringberger VA, Sjövist F, Thoren P, Träskman L, Tuck JR:  Monoamine metabolites in cerebrospinal fluid and serotonin uptake inhibition during treatment with chlorimipramine . Clin Pharmacol Ther 1977;;21:201-207.
21 +
Berkenstedt L, Edman G, Flyckt L, Hagenfeldt L, Sedvall G, Weisel FA:  Clinical and biochemical effects of citalopram, a selective 5-HT reuptake inhibitor: A dose-response study in depressed patients . Psychopharmacology 1985;;87:253-259.
22 +
Ågren H, Mefford I, Rudorfer M, Linnoila M, Potter W:  Interacting neurotransmitter systems: A non-experimental approach to the 5HIAA-HVA correlation in human CSF . J Psychiatr Res 1986;;20:175-193.
23 +
Hsiao JK, Ågren H, Rudorfer MV, Linnoila M, Potter WZ:  Monoamine metabolite interactions and the prediction of antidepressant response . Arch Gen Psychiatry 1987;;44:1078-1083.
24 +
Davis JM, Koslow SH, Gibbons RD, Maas JW, Bowden CL, Casper R, Hanin I, Javaid JI, Chang SS, Stokes PE:  Cerebrospinal fluid and urinary biogenic amines in depressed patients and healthy controls . Arch Gen Psychiatry 1988;;45:705-717.
25 +
Linnoila M, Karoum F, Calil HM, Kopin IJ, Potter WZ:  Alteration of norepinephrine metabolism with desipramine and zimelidine in depressed patients . Arch Gen Psychiatry 1982;;39:1025-1028.
26 +
Linnoila M, Karoum F, Potter WZ:  Effect of low dose clorgyline on 24hour urinary monoamine secretion in rapidly cycling bipolar affective disorder patients . Arch Gen Psychiatry 1982;;39:513-516.

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