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Maria A. Oquendo, MD; Ramin S. Hastings, BS; Yung-yu Huang, MS; Norman Simpson, BS; R. Todd Ogden, PhD; Xian-zhang Hu, MD, PhD; David Goldman, MD; Victoria Arango, PhD; Ronald L. Van Heertum, MD; J. John Mann, MD; Ramin V. Parsey, MD, PhD

Arch Gen Psychiatry. 2007;64(2):201-208.

Context  Depression in bipolar disorder is clinically indistinguishable from that observed in major depressive disorder. As in major depression, selective serotonin reuptake inhibitors targeting brain serotonin transporters are first-line treatments for bipolar depression. Associations of serotonin transporter promoter polymorphisms and bipolarity have been reported; however, research on alterations in serotonergic neurotransmission in bipolar depression remains scant.

Objectives  To assess in vivo brain serotonin transporter binding potential (BP₁, proportional to serotonin transporter number) in patients with bipolar depression and controls and to examine the relationship between serotonin transporter binding and genotype.

Design  Case-control study.

Setting  University hospital.

Participants  A sample of 18 medication-free patients with bipolar depression and 41 controls.

Main Outcome Measures  In vivo brain serotonin transporter binding was measured using positron emission tomography and radiolabeled trans-1,2,3,5,6,10-β-hexahydro-6-[4-(methylthio)phenyl]pyrrolo-[2,1-a]-isoquinoline ([¹¹C](+)-McNeil 5652). Participants were genotyped assessing biallelic and triallelic 5-HTTLPR polymorphisms.

Results  Patients with bipolar disorder had 16% to 26% lower serotonin transporter BP₁ in the midbrain, amygdala, hippocampus, thalamus, putamen, and anterior cingulate cortex. Triallelic 5-HTTLPR genotypes were unrelated to serotonin transporter BP₁.

Conclusions  Lower serotonin transporter BP₁ in bipolar depression overlaps with that observed in major depression and suggests that serotonergic dysfunction is common to depressive conditions.

Author Affiliations: Departments of Psychiatry (Drs Oquendo, Ogden, Arango, Mann, and Parsey and Mr Huang) and Radiology (Drs Van Heertum and Mann and Mr Simpson), Columbia University College of Physicians and Surgeons, New York, NY; Department of Neuroscience, New York State Psychiatric Institute, New York (Drs Oquendo, Ogden, Arango, Van Heertum, Mann, and Parsey and Messrs Hastings, Huang, and Simpson); Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Md (Drs Hu and Goldman); and Department of Biostatistics, Columbia University School of Public Health, New York (Dr Ogden).

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