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Cerebrospinal Fluid and Urinary Monoamine Metabolites and Treatment Outcome

Alan C. Swann, MD; Stephen H. Koslow, PhD; Martin M. Katz, PhD; James W. Maas, MD; Javaid Javaid, PhD; Steven K. Secunda, MD; Eli Robins, MD

Arch Gen Psychiatry. 1987;44(4):345-354.

Abstract
• Treatment of manic patients with lithium carbonate was associated with significant decreases in cerebrospinal fluid (CSF) 3-methoxy-4-hydroxyphenylglycol (MHPG) and urinary norepinephrine excretion. These measures, before treatment, were higher in manic patients than in either depressed or normal subjects and correlated significantly with severity of mania. Levels in CSF of homovanillic acid and 5-hydroxyindoleacetic acid did not correlate with severity or with change during lithium carbonate treatment. Responders(about70%of the patients) did not differ from nonresponders in pretreatment mania ratings or neurotransmitter measures. The CSF MHPG and urinary norepinephrine excretion were reduced during lithium carbonate treatment in both responders and nonresponders. Unlike the case before treatment, urinary MHPG excretion was higher during treatment in nonresponders than in responders and correlated with several indexes of symptom severity. These results support a relationship between mania and increased noradrenergic function. Treatment outcome, however, was not related exclusively to the reduction of noradrenergic indexes by lithium carbonate since reductions were similar in both responders and nonresponders. Reduced noradrenergic activity may therefore be necessary but not sufficient for successful outcome during lithium carbonate treatment.

Author Affiliations
From the Department of Psychiatry, University of Texas Medical School and University of Texas Mental Sciences Institute, Houston (Dr Swann); Neuroscience Research Branch, National Institute of Mental Health, Bethesda, Md (Dr Koslow); Department of Psychiatry, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY (Dr Katz); Department of Psychiatry, University of Texas Health Sciences Center, San Antonio (Dr Maas); Illinois State Psychiatric Institute, Chicago (Dr Javaid); and Department of Psychiatry, Washington University, St Louis (Dr Robins). Dr Secunda is in private practice in Springfield, Pa.

Footnotes
Accepted for publication June 6, 1986.

Reprint requests to University of Texas Mental Sciences Institute, PO Box 20708, Houston, TX 77225 (Dr Swann).

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