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A Critical Evaluation

Ross J. Baldessarini, MD

Arch Gen Psychiatry. 1975;32(9):1087-1093.

Abstract
• A leading hypothesis concerning a biological basis of the affectove disorders is that altered metabolism of brain amines may underlie the cause or pathophysiology of these conditions. Features of affective illnesses supporting biological hypotheses include the somatic symptoms, diurnal rhythm, and apparent "endogenicity" of many severe depressions, and evidence of a genetic basis of manic-depressive illness. Development and preclinical study of medical therapies for the disorders substantially supported a relationship between mood-disturbances and neurotransmitters and stimulated considerable advances in the physiology and pharmacology of central synaptic neurotransmission. Unfortunately, studies of amine metabolism in patients have not provided consistent support for the amine hypotheses. Moreover, these hypotheses have not led to a coherent biological theory of abnormal behavior, to an objective basis for differential diagnosis, or to the rational development of treatments more effective or safer than those known.

Author Affiliations
From the Psychiatric Research Laboratories, Massachusetts General Hospital, and the Department of Psychiatry, Harvard Medical School, Boston.

Footnotes
Accepted for publication April 25, 1975.

Read in part before an American Association for the Advancement of Science symposium, San Francisco, Feb 27, 1974.

Reprint requests to the Neuropharmacology Laboratory, Massachusetts General H ospital, Fruit Street, Boston, MA 02114 (Dr. Baldessarini).

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