Oral d-fenfluramine test in treatment-refractory depression. Plasma prolactin response compared in patients with and without suicide attempts and in a healthy reference group.
BACKGROUND
Fenfluramine (d-FEN) has been used as a serotonin challenge agent to assess central serotonin availability. Blunted serum prolactin (PRL) response to d-FEN has been reported in depressed patients, in suicide-prone patients, and in patients with aggression and personality disorders. We have analyzed suicidality in relation to central serotonergic events by comparing the PRL response to d-FEN in chronically depressed patients with and without suicide attempts and in healthy volunteers.


METHODS
In 56 inpatients (10 patients with and 46 without suicide attempts) with at least 2 years of treatment-refractory depression (TRD) (DSM-IV) and a reference group of 30 healthy adults, the PRL response after an oral dose of 30 mg d-FEN was followed for 5 h.


RESULTS
Controlling for group differences in age, sex, and weight, the PRL response to d-FEN did not differ significantly between the three groups. Far from confirming the hypothesis of a blunted PRL response in depressed patients, our results suggest: (1) that duration and treatment resistance of depression may affect the PRL secretion, and (2) that TRD and major depression may differ in biological relationship to suicidal behavior.


CONCLUSIONS
The findings require corroboration in larger and more closely matched study populations. The fenfluramine concentration was not analyzed in blood.


CONCLUSIONS
PRL responses to d-FEN challenge did not differ between TRD patients with and without suicidality and the healthy reference group. Chronicity/treatment refractoriness per se may be related to a serotonergic mechanism.
Prochazka
H
H
Institute of Clinical Neuroscience, Department of Psychiatry, Göteborg University, Sahlgrenska University Hospital/Mölndal, SE-431 80, Mölndal, Sweden.
Sjögren
M
M
Agren
H
H
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002908:Chronic Disease; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000378:metabolism*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005277:Fenfluramine / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011388:Prolactin / Q000097:blood*; D012701:Serotonin / Q000378:metabolism*; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology*; D012720:Severity of Illness Index; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data
D005277:Fenfluramine; D011388:Prolactin; D012701:Serotonin; D017367:Selective Serotonin Reuptake Inhibitors