Symptom patterns in unipolar and bipolar depression correlating with monoamine metabolites in the cerebrospinal fluid: I. General patterns.

The symptom scores on the Schedule for Affective Disorders and Schizophrenia (SADS) of 21 unipolar and 12 bipolar depressive patients diagnosed with Research Diagnostic Criteria (RDC) were correlated with the monoamine metabolites homovanillic acid (HVA), 3-methoxy-4-hydroxyphenylglycol (MHPG), and 5-hydroxyindoleacetic acid (5HIAA) in the cerebrospinal fluid (CSF). For the unipolar group, multiple regression analyses revealed strong multiple correlations (from r = 0.92 to 0.97) to the effect that high- and low-HVA, high- and low-MHPG, and high- and low-5HIAA syndromes, respectively, could be isolated. The bipolars were too few for the same analyses to work well, but there is evidence for the high- and low-monoamine syndromes to be characterized by differential symptomatology in bipolar and unipolar patients. Through the comparison of monoamine metabolite values predicted from a total of 18 SADS symptom items with the true CSF values, a computer program was able to classify 20 of the 21 unipolar and all the 12 bipolars correctly. The results are consistent with a hypothesis of the pathoplastic role of individually set (genetically determined?) brain monoamine homeostases in shaping the profile of an affective episode.