title: Aggressivity, suicide attempts, and depression: relationship to cerebrospinal fluid monoamine metabolite levels.
abstract: BACKGROUND
  We have proposed a stress-diathesis model for suicidal behavior, in which major depression is a stressor and the diathesis is shared with aggression. Neurotransmitter correlates of the stress or diathesis have not been adequately evaluated by previous studies, because they did not simultaneously examine the relationship of multiple neurotransmitters to all three psychopathologies in the same population. In the present study we investigated the relationship of monoamine metabolites to aggressivity, suicidal behavior, and depression in patients with mood disorders.
  
  
  METHODS
  Ninety-three drug-free subjects with a major depressive episode underwent lumbar puncture and psychiatric evaluation. Cerebrospinal fluid CSF levels of 5hydroxyindolacetic acid (5-HIAA), homovanillic acid (HVA) and methoxy-hydroxy-phenylglycol (MHPG) were assayed. The relationships between monoamine metabolites and clinical variables were statistically evaluated.
  
  
  RESULTS
  Higher lifetime aggressivity correlated significantly with lower CSF 5-HIAA. Lower CSF 5-HIAA and greater suicidal intent were found in high-lethality suicide attempters compared with low-lethality suicide attempters. Low-lethality attempters did not differ biologically from nonattempters. No correlation between CSF HVA and any of the psychopathological variables was found. Only aggression showed a trend statistically in correlating positively with CSF MHPG levels.
  
  
  CONCLUSIONS
  Lower CSF 5-HIAA concentration was independently associated with severity of lifetime aggressivity and a history of a higher lethality suicide attempt and may be part of the diathesis for these behaviors. The dopamine and norepinephrine systems do not appear to be as significantly involved in suicidal acts, aggression, or depression. The biological correlates of suicide intent warrant further study.
authors.affiliation: Center for the Study of Suicidal Behavior, Department of Neuroscience, New York State Psychiatric Institute, New York, New York, USA.
authors.forename: G P
authors.initials: GP
authors.lastname: Placidi
authors.forename: M A
authors.initials: MA
authors.lastname: Oquendo
authors.forename: K M
authors.initials: KM
authors.lastname: Malone
authors.forename: Y Y
authors.initials: YY
authors.lastname: Huang
authors.forename: S P
authors.initials: SP
authors.lastname: Ellis
authors.forename: J J
authors.initials: JJ
authors.lastname: Mann
mesh_terms: D000328:Adult; D000374:Aggression / Q000502:physiology*; D003865:Major Depressive Disorder / Q000134:cerebrospinal fluid*; D005260:Female; D006719:Homovanillic Acid / Q000134:cerebrospinal fluid*; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000138:chemical synthesis*; D008297:Male; D008734:Methoxyhydroxyphenylglycol / Q000134:cerebrospinal fluid*; D008875:Middle Aged; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D013406:Suicide, Attempted / Q000523:psychology*
chemical_list: D008734:Methoxyhydroxyphenylglycol; D006897:Hydroxyindoleacetic Acid; D006719:Homovanillic Acid