The effect of lithium treatment on manic symptoms and levels of monoamine metabolites in cerebrospinal fluid of manic depressive patients

Abstract

Clinical effects, levels of 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) in cerebrospinal fluid (CSF) and lithium levels in serum were examined in 13 manic depressive patients acutely admitted because of a manic or hypomanic episode. Patients were examined before and 12 days after the beginning of lithium treatment. Manic scores were significantly reduced during treatment. The levels of 5-HIAA as well as HVA increased significantly during treatment. The HVA to 5-HIAA ratio was significantly reduced, indicating a more pronounced change in 5-HIAA than in HVA. The 5-HIAA and HVA levels before as well as after 12 days of treatment were significantly correlated. No significant correlation was found between manic scores and monoamine metabolites in CSF or between lithium level in serum and reduction of manic scores or elevation of monoamine metabolites in CSF in the relative small number of patients studied.

The role of mood stabilisers in the treatment of the depressive facet of bipolar disorders

“…Serotonin (5-HT) neurotransmission was hypothesised to be involved, suggesting that lithium efficacy may be due to its enhancing of lithium on 5-HT may be presynaptic, with many secondary postsynaptic effects (El-Mallakh, 1996). Lithium administrations has shown to significantly increase the levels of cerebrospinal fluid (CFS) 5-hydroxindoleacetic acid (5-HIAA), which reflects serotonergic activity (Berrettini et al, 1985;Bowers and Heninger, 1977;Bunney and Garland-Bunney, 1987;Cowen et al, 1990;Fyro et al, 1975;Meltzer and Lowy, 1987;Mendels, 1971;Price et al, 1989Price et al, , 1990Swann et al, 1987;Wilk et al, 1972;Wood and Goodwin, 1987).…”

Predicting Response to Lithium in Mood Disorders

“…[86] Lithium administration has been shown to significantly increase the levels of 5-hydroxindoleacetic acid in cerebrospinal fluid, which reflects serotoninergic activity. [88][89][90][91][92][93][94][95][96][97][98][99] Earlier studies on this subject [100][101][102] reported negative results, but they were based on small sample sizes, and their findings were difficult to evaluate. Chronic lithium administration seems to enhance both electrophysiological and behavioral responses mediated by post-synaptic serotonin 1A (5-HT1A) receptors, [103] and it is associated with a significant reduction of 5-HT1 binding sites in the hippocampus.…”

Serotonin in mania and in the mechanism of action of mood stabilizers: a review of clinical studies

“…However, larger studies have generally shown that lithium increases CSF 5-HIAA levels in manic patients (20). Fyro et al (93) reported a significant increase in CSF 5-HIAA levels in 13 manic or hypomanic patients after 12 days treatment with lithium compared to before treatment. Bowers and Heninger (94) reported a similar effect after a mean of 27 days of lithium in 23 mixed affective disorder patients.…”