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John M. Davis, MD; Stephen H. Koslow, MD; Robert D. Gibbons, PhD; James W. Maas, MD; Charles L. Bowden, MD; Regina Casper, MD; Israel Hanin, MD; Javaid I. Javaid, PhD; Sidney S. Chang, MD; Peter E. Stokes, MD

Arch Gen Psychiatry. 1988;45(8):705-717.

Abstract
• The National Institute of Mental Health—Clinical Research Branch Collaborative Study investigated 132 drug-free, severely depressed patients and 80 healthy controls. Forty-five percent of the depressed patients excreted markedly elevated levels of urinary epinephrine (E) and metanephrine (MET), while only 5% of healthy controls did so. Using gaussian mixture distributions, we identified two subgroups of depressed patients: one excreting normal levels and the other excreting high levels of urinary E, MET, norepinephrine, and normetanephrine. Cerebrospinal fluid homovanillic acid levels were low in a subgroup of depressed patients. When analyzed by subgroup, the elevated E+MET group had markedly lower cerebrospinal fluid homovanillic acid levels than controls, whereas depressed patients with normal catecholamine levels did not. Since it has been postulated that there are two subgroups of depressed patients, those with low 3-methoxy-4-hydroxyphenylglycol (MHPG) levels and normal 5-hydroxyindoleacetic acid (5-HIAA) levels and those with normal MHPG levels and low 5-HIAA levels, several analyses were performed to see if such a group could be identified. Our analysis failed to find evidence of a subgroup of depressives with low MHPG and normal 5-HIAA levels or normal MHPG and low 5-HIAA levels.

Author Affiliations
From the Illinois State Psychiatric Institute (Drs Davis, Gibbons, and Javaid), Department of Psychiatry, University of Illinois, Chicago (Drs Davis, Gibbons, and Javaid), Michael Reese Hospital and Medical Service (Dr Casper), Chicago; Loyola University Medical Center, Maywood, Ill (Dr Hanin); National Institute of Mental Health, Rockville, Md (Dr Koslow); The University of Texas Health Science Center, San Antonio (Drs Maas and Bowden); the Veterans Administration Medical Center, Brockton, Mass (Dr Chang); and Cornell University Medical College, New York (Dr Stokes).

Footnotes
Accepted for publication July 7, 1987.

Reprints not available.

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