Sher Leo, Oquendo Maria A, Li Shuhua, Huang Yung-yu, Grunebaum Michael F, Burke Ainsley K, Malone Kevin M, Mann J John
Division of Neuroscience, Department of Psychiatry, Columbia University, New York, NY 10032, USA.
Neuropsychopharmacology. 2003 Sep;28(9):1712-9. doi: 10.1038/sj.npp.1300231. Epub 2003 Jun 25.
Major depression and alcoholism are often comorbid, resulting in more impairment and more suicidal behavior compared with either diagnosis alone. This study compared clinical features and cerebrospinal fluid (CSF) monoamine metabolites in depressed subjects with and without a history of alcoholism and healthy volunteers. We hypothesized that depressed subjects with a history of alcoholism would be more aggressive, impulsive, and suicidal than depressed subjects without a history of alcoholism, and would have lower CSF monoamine metabolite levels. We compared 63 subjects with a current major depressive episode (MDE) and a history of alcoholism, 72 subjects with a current MDE but without a history of alcoholism, and 22 healthy volunteers. Participants with a history of alcoholism were in remission for at least 6 months. All subjects were free from prescribed medications known to affect brain serotonin, dopamine, or norepinephrine systems for a minimum of 14 days. Depressive symptoms, lifetime aggression, impulsivity, Axis II disorders, and suicidal behavior were assessed. CSF was sampled and homovanillic acid (HVA), 5-hydroxyindolacetic acid (5-HIAA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) were assayed by high-performance lipid chromatography with electrochemical detection. Depressed subjects with a history of alcoholism did not differ from depressed subjects without a history of alcoholism in current severity of depressive symptoms, or in past suicidal behavior. Depressed subjects with a history of alcoholism had lower CSF HVA levels, and higher lifetime aggression and current suicide ideation scale scores and were more likely to be tobacco smokers compared with depressed subjects without a history of alcoholism. Low HVA was present after adjustment for sex, aggression and depression scores, cigarette smoking, antisocial and borderline personality disorders, psychomotor retardation, and delusions. Controls had CSF HVA levels intermediate between the two depressed groups. We found no group difference in CSF 5-HIAA and MHPG levels. In individuals with current MDE, those with a history of comorbid alcoholism had lower CSF HVA levels compared with those without a history of alcoholism. Low CSF HVA suggests that impaired dopaminergic activity is associated with a history of alcoholism in persons with current MDE.
重度抑郁症与酒精中毒常常合并出现，相较于单独的任何一种诊断，二者合并会导致更多的功能损害和更多的自杀行为。本研究比较了有和没有酒精中毒史的抑郁症患者以及健康志愿者的临床特征和脑脊液（CSF）单胺代谢产物。我们假设，有酒精中毒史的抑郁症患者比没有酒精中毒史的抑郁症患者更具攻击性、冲动性且有更多自杀行为，并且其脑脊液单胺代谢产物水平更低。我们比较了63名患有当前重度抑郁发作（MDE）且有酒精中毒史的受试者、72名患有当前MDE但无酒精中毒史的受试者以及22名健康志愿者。有酒精中毒史的参与者已戒酒至少6个月。所有受试者至少14天未服用已知会影响大脑血清素、多巴胺或去甲肾上腺素系统的处方药。评估了抑郁症状、终生攻击性、冲动性、轴II障碍和自杀行为。采集脑脊液样本，通过高效液相色谱电化学检测法测定高香草酸（HVA）、5-羟吲哚乙酸（5-HIAA）和3-甲氧基-4-羟基苯乙二醇（MHPG）。有酒精中毒史的抑郁症患者在当前抑郁症状的严重程度或过去的自杀行为方面与没有酒精中毒史的抑郁症患者没有差异。与没有酒精中毒史的抑郁症患者相比，有酒精中毒史的抑郁症患者脑脊液HVA水平更低，终生攻击性和当前自杀意念量表得分更高，且更有可能是吸烟者。在对性别、攻击性和抑郁得分、吸烟情况、反社会和边缘性人格障碍、精神运动迟缓以及妄想进行校正后，仍存在低HVA情况。对照组的脑脊液HVA水平介于两个抑郁症组之间。我们发现脑脊液5-HIAA和MHPG水平在各组之间没有差异。在患有当前MDE的个体中，有合并酒精中毒史的个体与没有酒精中毒史的个体相比，脑脊液HVA水平更低。脑脊液HVA水平低表明，当前患有MDE的人群中，多巴胺能活动受损与酒精中毒史有关。
