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Relationship to Clinical Response and Serotonin Metabolism

Giovanni Muscettola, MD; Frederick K. Goodwin, MD; William Z. Potter, MD; Magda M. Claeys, PhD; Sanford P. Markey, PhD

Arch Gen Psychiatry. 1978;35(5):621-625.

Abstract
• In a double-blind study of depressed patients treated with imipramine hydrochloride, levels of imipramine and desipramine were measured in plasma and in CSF. Levels of both drugs in CSF were approximately 10% of plasma levels, but the levels in the two body fluids were highly correlated. The levels of both drugs were approximately equal in plasma, but desipramine predominated in CSF (imipramine/desipramine ratio of 0.8). The imipramine-induced alteration in CSF levels of the serotonin metabolite (5-hydroxy-indoleacetic acid [5HIAA]) correlated with imipramine levels but not with desipramine. For the group of patients showing a clear antidepressant response, the mean drug levels were nearly double those of the nonresponder group, a difference that did not quite reach statistical significance in this relatively small sample. The desipramine levels showed no responder-nonresponder difference, while the ratio of imipramine/desipramine was significantly higher among the responders. On the average this particular patient group had relatively low pretreatment levels of 5HIAA in CSF, an observation that may partially account for the relatively low overall response rate to imipramine.

Author Affiliations
From the Clinical Psychobiology Branch (Drs Muscettola, Goodwin, and Potter) and the Laboratory of Clinical Science (Drs Claeys and Markey), National Institute of Mental Health, Bethesda, Md. Dr Muscettola is now with the Department of Psychiatry, University of Naples, and Dr Claeys is with the Laboratory of Organic Chemistry, RUG, Ghent, Belgium.

Footnotes
Accepted for publication Oct 18, 1977.

Reprint requests to Clinical Psychobiology Branch, Bldg 10, Room 4S239, National Institutes of Mental Health, Bethesda, MD 20014 (Dr Goodwin).

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