Summary
Psychotic women with schizophrenic symptoms were treated with melperone 100 mg×3 (n=29) or thiothixene 10 mg×3 (n=34) using a double-blind procedure. Before and during treatment, levels of HVA, MOPEG, and 5-HIAA, the major metabolites of DA, NE, and 5-HT, were determined in lumbar cerebrospinal fluid by a mass fragmentographic technique. Both treatments resulted in an elevation of the HVA levels after 2 weeks, thiothixene having a more marked effect. The effect of thiothixene but not of melperone persisted after 4 weeks. Thiothixene did not influence the MOPEG level, but melperone reduced it after 4 weeks of treatment. The 5-HIAA levels were not significantly altered by the drugs. The HVA/MOPEG and the HVA/5-HIAA ratios were highly significantly elevated by both drugs after 2 as well as 4 weeks. Thiothixene induced a significantly greater change of these ratios than melperone. The results supply evidence that thiothixene accelerates central dopamine metabolism in man, presumably by blocking DA receptors. Melperone appears to act similarly, but has an effect which is weaker and/or of shorter duration. During long-term treatment with melperone the receptors develop tolerance to it. The acceleration in DA metabolism declines and the effect of melperone switches instead to central NA metabolism. The results indicate that both drugs cause long-term changes in the activity ratios of central monoamine systems. It is suggested that such changes in several systems rather than single biochemical events may be related to the antipsychotic effects of neuroleptic drugs. This study also demonstrated the versatility of using monoamine metabolite analysis of the CSF as a tool for the quantification of biochemical effects of neuroleptic drugs on the human CNS.
Similar content being viewed by others
References
Alfredsson, G., Wiesel, F.-A., Skett, P.: Levels of chlorpromazine and its active metabolites in rat brain and the relationship to central monoamine metabolism and prolactin secretion. Psychopharmacology 53, 13–18 (1977)
Andén, N.-E., Butcher, S. G., Corrodi, H., Fuxe, K., Ungerstedt, U.: Receptor activity and turnover of dopamine and noradrenaline after neuroleptics. Europ. J. Pharmacol. 11, 303–314 (1970)
Bertilsson, L., Åsberg, M., Thorén, P.: Differential effect of chlorimipramine and nortriptyline on cerebrospinal fluid metabolites of serotonin and noradrenaline in depression. Europ. J. clin. Pharmacol. 7, 365–368 (1974)
Bishop, M. P., Fulmer, T. E., Gallant, D. M.: Thiothixene versus trifluoperazine in newlyadmitted schizophrenic patients. Current Therap. Res. 8, 509–514 (1966)
Bjerkenstedt, L.: The pharmacokinetics of melperone. (To be published 1978)
Bjerkenstedt, L., Härnryd, C., Gullberg, B., Sedvall, G.: Treatment of psychotic women with Melperone or Thiothixene (To be published 1978)
Bowers, M. B., Heninger, G. R., Gerbode, F.: Cerebrospinal fluid, 5-hydroxyindoleacetic acid and homovanillic acid in psychiatric patients. Int. J. Neuropharmac. 8, 255–262 (1969)
Carlsson, A., Lindqvist, M.: Effect of chlorpromazine or haloperidol on formation of 3-methoxytyramine and normetanephrine in mouse brain. Acta pharmacol. et toxicol. 20, 140–144 (1963)
Chase, T. N., Schnur, J. A., Gordon, E. K.: Cerebrospinal fluid monoamine catabolites in drug-induced extrapyramidal disorders. Neuropharmacol. 9, 265–268 (1970)
Christensen, J. A., Hernestam, S., Lassen, J. B., Sterner, N.: Pharmacological and toxicological studies on γ-(4-methyl-piperidino)-p-fluorobutyrophenone (FG 5111)—a new neuroleptic agent. Acta pharmacol. et toxicol. 23, 109–132 (1965)
Curzon, G., Gumpert, E. J. W., Sharpe, D. M.: Amine metabolites in the lumbar cerebrospinal fluid of humans with restricted flow of cerebrospinal fluid. Nature (New Biol.) 231, 189–191 (1971)
Dray, A., Gonye, T. J., Oakley, N. R., Tanner, T.: Evidence for the existence of a raphe projection to the substantia nigra in rat. Brain Res. 113, 45–57 (1976)
Fuxe, K.: Evidence for the existence of monoamine neurons in the central nervous system. Acta physiol. scand. 64, Suppl. 247, 37–85 (1965)
Fyrö, B., Wode-Helgodt, B., Borg, S., Sedvall, G.: The effect of chlorpromazine on homovanillic acid levels in cerebrospinal fluid of schizophrenic patients. Psychopharmacologia (Berl.) 35, 387–394 (1974)
Gallant, D. M., Bishop, M. P., Timmons, E., Gould, A. R.: Thiothixene (P-4657B): A controlled evaluation in chronic schizophrenic patients. Current Therap. Res. 8, 153–158 (1966)
Gordon, E., Perlow, M., Oliver, J., Ebert, M., Kopin, I.: Origins of catecholamine metabolites in monkey cerebrospinal fluid. J. Neurochem. 25, 347–349 (1975)
Gottfries, C.-G., Gottfries, I., Johansson, B., Olsson, R., Persson, T., Roos, B.-E., Sjöström, R.: Acid monoamine metabolites in human cerebrospinal fluid and their relations to age and sex. Neuropharmacol. 10, 665–672 (1971)
Gross, H., Haberler, H.: Klinische Erfahrungen mit Methylperon (Buronil®), einem neuen Butyrophenonderivat. Int. Pharmacopsychiat. 5, 44–53 (1970)
Hertting, G., Axelrod, J., Whitby, L. G.: Effect of drugs on the uptake and metabolism of H3-norepinephrine. J. Pharmacol. exp. Ther. 134, 146–153 (1961)
Jacobsson, L., von Knorring, L., Mattsson, B., Perris, C., Rapp, W., Edenius, B., Kettner, B., Magnusson, K. E., Villemoes, P.: Controlled trial of penfluridol and thiothixene in the maintenance treatment of chronic schizophrenic syndromes. Acta psychiat. scand. 54, 113–124 (1976)
Keller, H. H., Bartholini, G., Pletscher, A.: Increase of 3-methoxy-4-hydroxyphenylethylene glycol in rat brain by neuroleptic drugs. Europ. J. Pharmacol. 23, 183–186 (1973)
Møller-Nielsen, I., Christensen, A. V., Fjalland, B.: Receptor blockade and receptor super-sensitivity following neuroleptic treatment. In: Antipsychotic Drugs: Pharmacodynamics and Pharmacokinetics, 257–260. G. Sedvall, B. Uvnäs, Y. Zotterman, Eds., Oxford: Pergamon 1976
Nybäck, H., Sedvall, G.: Further studies on the accumulation and disappearance of catecholamines formed from tyrosine-14C in mouse brain. Effect of some phenothiazine analogues. Europ. J. Pharmacol. 10, 193–205 (1970)
Overall, J. E., Klett, C. J.: Applied multivariate analysis. New York: McGraw-Hill 1972
Persson, T., Roos, B.-E.: Clinical and pharmacological effects of monoamine precursors or haloperidol in chronic schizophrenia. Nature 217, 854 (1968)
Post, R. M., Goodwin, F. K., Gordon, E., Watkin, D. M.: Amine metabolites in human cerebrospinal fluid: Effect of cord transection and spinal fluid block. Science 179, 897–899 (1973)
Post, R. M.: Goodwin, F. K.: Time-dependent effects of phenothiazines on dopamine turnover in psychiatric patients. Science 190, 488–489 (1975)
Ross, S. B., Renyi, A. L.: In vivo inhibition of 3H-noradrenaline uptake by mouse brain slices in vitro. J. Pharm. Pharmac. 18, 322–323 (1966)
Schulsinger, F., Kirkegaard, A., Nielsen, S. K., Poulsen, H., Vangtorp, A., Gjeddebaek, N. F.: Kliniske forsøg med et nyt butyrofenonderivat, Buronil® (FG5111) ved svaer kronisk skizofreni. Nord. Med. 73, 605–609 (1965)
Sedvall, G., Fyrö, B., Nybäck, H., Wiesel, F.-A., Wode-Helgodt, B.: Mass fragmentometric determination of homovanillic acid in lumbar cerebrospinal fluid of schizophrenic patients during treatment with antipsychotic drugs. J. Psychiat. Res. 11, 75–80 (1974)
Sedvall, G.: Receptor feedback and dopamine turnover in CNS. In: Handbook of Psychopharmacology, Vol. 6, pp. 127–177. L. L. Iversen, S. D. Iversen, S. H. Snyder, Eds. New York: Plenum 1975
Sedvall, G., Alfredsson, G., Bjerkenstedt, L., Eneroth, P., Fyrö, B., Härnryd, C., Swahn, C.-G. Wiesel, F.-A., Wode-Helgodt, B.: Selective effects of psychoactive drugs on levels of monoamine metabolites and prolactin in cerebrospinal fluid of psychiatric patients. In: Proceedings of the Sixth International Congress of Pharmacology, Vol. 3, pp. 255–267. M. Airaksinen, Ed. Forssa (Finland): Forssan Kirjapaino Oy 1975
Sedvall, G., Bjerkenstedt, L., Fyrö, B., Härnryd, C., Wode-Helgodt, B.: The use of mass fragmentography to study effects of antipsychotic drugs on brain dopamine metabolism. In: Antipsychotic Drugs: Pharmacodynamics and Pharmacokinetics, pp. 331–342. G. Sedvall, B. Uvnäs, Y. Zotterman, Eds. Oxford: Pergamon 1976
Shopsin, B., Wilk, S., Gershon, S., Davis, K., Suhl, M.: Cerebrospinal fluid MHPG. Arch. Gen. Psychiatry 28, 230–233 (1973)
Sjöström, R., Roos, B.-E.: 5-Hydroxyindoleacetic acid and homovanillic acid in cerebrospinal fluid in manic-depressive psychosis. Europ. J. Clin. Pharmacol. 4, 170–176 (1972)
Snedecor, G. W., Cochran, W. G.: Statistical methods. Ames (Iowa): Iowa State University Press 1967
Swahn, C.-G., Sandgärde, B., Wiesel, F.-A., Sedvall, G.: Simultaneous determination of the three major monoamine metabolites in brain tissue and body fluids by a mass fragmentographic method. Psychopharmacology 48, 147–152 (1976)
Weissman, A.: Chemical, pharmacological and metabolic considerations on thiothixene. In: Thiothixene and the Thioxanthenes, pp. 1–10. I. S. Forrest, C. J. Carr, E. Usdin, Eds. New York: Raven 1974
Wiesel, F.-A., Bjerkenstedt, L., Skett, P.: Effects of Melperone, two of its metabolites and Thiothixene on central monoamine metabolism and serum prolactin levels in experimental animals. Psychopharmacology (To be published, 1978)
Wode-Helgodt, B., Fyrö, B., Gullberg, B., Sedvall, G.: The effect of chlorpromazine treatment on monoamine metabolite levels in cerebrospinal fluid of psychotic patients. Acta psychiat. scand. (In press, 1977)
Young, S. N., Lal, S., Martin, J. B., Ford, R. M., Sourkes, T. L.: 5-Hydroxyindoleacetic acid, homovanillic acid and tryptophan levels in CSF above and below a complete block of CSF flow. Psychiat. Neurol. Neurochir. (Amst.) 76, 439–444 (1973)
Author information
Authors and Affiliations
Additional information
Financial support was provided by the Swedish Medical Research Council (14X-03560), National Institutes of Mental Health, (MH 27254-01), Bethesda, Maryland, USA, F. Hoffmann-La Roche & Co., Basle, Switzerland, Svenska Sällskapet för Medicinsk Forskning, Karolinska Institutet, AB Ferrosan, Sweden, and Pfizer-Roerig, Sweden.
Rights and permissions
About this article
Cite this article
Bjerkenstedt, L., Gullberg, B., Härnryd, C. et al. Monoamine metabolite levels in cerebrospinal fluid of psychotic women treated with melperone or thiothixene. Arch. Psychiat. Nervenkr. 224, 107–118 (1977). https://doi.org/10.1007/BF00346479
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00346479