Leo Sher, M.D.

Our research paper, “Higher cerebrospinal fluid homovanillic acid levels in depressed patients with comorbid posttraumatic stress disorder” was published 15 years ago in the March 2005 issue of European Neuropsychopharmacology (1).

In this study, we compared clinical features and cerebrospinal fluid (CSF) monoamine metabolites in drug-free depressed subjects with a current major depressive episode (MDE) without comorbid PTSD, subjects with a current MDE and comorbid PTSD, and healthy volunteers. In all, 113 unipolar depressed subjects without comorbid PTSD, 12 unipolar depressed subjects with comorbid PTSD, and 27 healthy volunteers were entered in the study. Among the 12 patients with PTSD, reported traumata precipitating PTSD were childhood abuse (N=7), physical threat to the patient (N=3), including intimate partner violence (N=1), and unknown (N=2).

The depressed groups had comparable Hamilton Depression Rating Scale, Brown–Goodwin Aggression Scale, and St. Paul Ramsey Life Events Scale scores but, as expected, higher scores than controls in all these scales. Depressed subjects with comorbid PTSD were more likely to have a reported history of childhood abuse than depressed subjects without comorbid PTSD. We observed that depressed subjects with comorbid PTSD had higher CSF homovanillic acid (HVA) levels compared with depressed subjects without comorbid PTSD or healthy volunteers. Higher HVA was present after adjustment for sex, lifetime aggression severity and depression scores, alcoholism, tobacco smoking, comorbid cluster B personality disorder, reported childhood abuse, and psychosis. We found no group difference in CSF 5-hydroxyindolacetic acid (5-HIAA) and 3-methoxy-4-hydroxyphenylglycol (MHPG) levels.

Higher dopaminergic activity may contribute to alterations in memory and other cognitive functions, anhedonia, and hypervigilance observed in PTSD. The results of our study underline the importance of taking into account comorbidity in mood disorder research.

Reference

1. Sher L, Oquendo MA, Li S, Burke AK, Grunebaum MF, Zalsman G, Huang YY, Mann JJ. Higher cerebrospinal fluid homovanillic acid levels in depressed patients with comorbid posttraumatic stress disorder. Eur Neuropsychopharmacol. 2005 Mar;15(2):203-9.