Attempted suicide characteristics and cerebrospinal fluid amine metabolites in depressed inpatients.
BACKGROUND
Serotonin abnormalities have been reported in the brain of suicide victims. Evidence of a serotonin deficiency in suicide attempters is less consistent. We hypothesized that a serotonin deficiency may be present in suicide attempters whose attempt behavior more closely approximates completed suicide.


METHODS
Sixty-seven (67) drug-free depressed inpatients (46 suicide attempters, 21 nonattempters) underwent research clinical assessments and a lumbar puncture. Cerebrospinal fluid (CSF) monoamine metabolites were assayed. Degree of medical damage and intent of the most recent suicide attempt were rated.


RESULTS
CSF amine metabolites did not differentiate suicide attempters as a group from nonattempters. However, reduced serotonergic activity, as indicated by lower levels of CSF-5-hydroxyindoleacetic acid (5-HIAA) was associated with a history of planned suicide attempts and with suicide attempts that resulted in greater medical damage. Other monoamine metabolites did not correlate with seriousness of suicidal behavior, except for low CSF homovanillic acid and higher medical damage. No correlation was found with violent method.


CONCLUSIONS
Planned and more medically damaging suicide attempts appear to be associated specifically with low serotonergic activity and, therefore, resemble completed suicide both behaviorally and biochemically. It remains to be determined whether low levels of CSF 5-HIAA can predict greater medical damage in future suicide attempts.
Mann
J J
JJ
MHCRC for the Study of Suicidal Behavior, College of Physicians and Surgeons, Columbia University, New York, USA.
Malone
K M
KM
Sweeney
J A
JA
Brown
R P
RP
Linnoila
M
M
Stanley
B
B
Stanley
M
M
D000328:Adult; D000368:Aged; D002851:Chromatography, High Pressure Liquid; D003866:Depressive Disorder / Q000134:cerebrospinal fluid* / Q000150:complications*; D005260:Female; D006719:Homovanillic Acid / Q000134:cerebrospinal fluid; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000134:cerebrospinal fluid*; D007297:Inpatients; D008297:Male; D008734:Methoxyhydroxyphenylglycol / Q000134:cerebrospinal fluid; D008875:Middle Aged; D012720:Severity of Illness Index; D013406:Suicide, Attempted
D008734:Methoxyhydroxyphenylglycol; D006897:Hydroxyindoleacetic Acid; D006719:Homovanillic Acid