Higher CSF Levels of HVA and 5-HIAA in Delusional Compared to Nondelusional Depression

To the Editor.— The possible biochemical heterogeneity of affective disorders has been discussed during the last decade.1The bimodal distribution of 5-hydroxyindoleacetic acid (5-HIAA) in cerebrospinal fluid (CSF) supports the hypothesis that a subgroup of endogenous depressives have a disturbance in serotonin neurotransmission.2 Moreover, significantly lower homevanillic acid (HVA) levels in the CSF were found in depressed patients compared with healthy control subjects.3This finding and results from other studies indicate that dopamine might be involved in the pathogenesis of affective disorders.3The antidepressant effect of the dopamine agonists bromocriptine6,7and piribedil8supports this hypothesis. Silverstone7has shown that patients with bipolar but not unipolar depression responded to bromocriptine. This indicates that bipolar and unipolar depression might differ in central dopaminergic neurotransmission. Patients and Methods.— Our study group comprised 50 nontreated patients (age range, 24 to 73 years; 21 men and 29 women)