title: Depressive mania versus agitated depression: biogenic amine and hypothalamic-pituitary-adrenocortical function.
abstract: The existence of mixed affective states challenges the idea of specific biological abnormalities in depression and mania. We compared biogenic amines and hypothalamic-pituitary-adrenocortical (HPA) function in mixed manic (n = 8), pure manic (n = 11), agitated bipolar depressed (n = 20), and nonagitated bipolar depressed (n = 27) inpatients (Research Diagnostic Criteria). Mixed manics met Research Diagnostic Criteria for primary manic episodes and also met criteria for major depressive episodes except for duration. The norepinephrine metabolite methoxyhydroxy phenthylene glycol (MHPG) was higher in cerebrospinal fluid from mixed manic than from agitated depressed patients, consistent with differences previously reported between the overall samples of depressed and manic patients. Similarly, patients in a mixed state had higher urinary excretion of norepinephrine (NE) and elevated output of NE relative to its metabolites. HPA activity was similar in mixed manic and agitated depressed patients. These data suggest that mixed manics combine certain biological abnormalities considered to be characteristic of mania and of depression.
authors.affiliation: Department of Psychiatry, University of Texas Medical School, Houston 77225.
authors.forename: A C
authors.initials: AC
authors.lastname: Swann
authors.forename: P E
authors.initials: PE
authors.lastname: Stokes
authors.forename: S K
authors.initials: SK
authors.lastname: Secunda
authors.forename: J W
authors.initials: JW
authors.lastname: Maas
authors.forename: C L
authors.initials: CL
authors.lastname: Bowden
authors.forename: N
authors.initials: N
authors.lastname: Berman
authors.forename: S H
authors.initials: SH
authors.lastname: Koslow
mesh_terms: D000328:Adult; D000368:Aged; D001679:Biogenic Amines / Q000378:metabolism*; D003866:Depressive Disorder / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D003907:Dexamethasone; D005260:Female; D006719:Homovanillic Acid / Q000134:cerebrospinal fluid; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006897:Hydroxyindoleacetic Acid / Q000134:cerebrospinal fluid; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D008734:Methoxyhydroxyphenylglycol / Q000134:cerebrospinal fluid; D008875:Middle Aged; D009638:Norepinephrine / Q000652:urine; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology
chemical_list: D001679:Biogenic Amines; D008734:Methoxyhydroxyphenylglycol; D006897:Hydroxyindoleacetic Acid; D003907:Dexamethasone; D006854:Hydrocortisone; D009638:Norepinephrine; D006719:Homovanillic Acid