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Loudness dependence of auditory evoked potentials (LDAEP) in clinical monitoring of suicidal patients with major depression: a pilot study

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Abstract

Loudness dependence of auditory evoked potentials (LDAEP) is a validated in vivo marker of central serotonergic function. We aimed at measuring serotonergic activity in a follow-up study of suicidal patients. It should be investigated whether suicide attempts or suicidal states cause changes in the LDAEP. Thirteen patients (mean age, 40.9 ± 11.3 years; age range, 20–61, 6 male) with a major depressive episode who had attempted suicide or had suicidal plans (Hamilton Depression Rating Scale item 3 [suicidality] ≥3) were included in the study. LDAEP and psychometric measurements took place about 2, 5, 9 and 16 days after attempted suicide or suicidal action. On day 9, LDAEP was significantly higher compared to day 2 and day 16; there was a similar tendency compared to day 5. Instability of central serotonergic function is suggested resulting in reduced serotonergic activity about 1 week after suicide attempt. Further studies are necessary that include larger samples in order to distinguish between different psychiatric diseases and to consider confounding factors like gender, smoking, medication, impulsivity or lethality of suicidal action.

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References

  1. Agren H, Niklasson F (1986) Suicidal potential in depression: focus on CSF monoamine and purine metabolites. Psychopharmacol Bull 22:656–660

    PubMed  CAS  Google Scholar 

  2. Agren H, Osterberg B, Franzen O (1983) Depression and somatosensory evoked potentials: II. Correlations between SEP and depressive phenomenology. Biol Psychiatry 18:651–659

    PubMed  CAS  Google Scholar 

  3. Asberg M, Träskman L, Thoren P (1976) 5-HIAA in the cerebrospinal fluid. A biochemical suicide predictor? Arch Gen Psychiatry 33:1193–1197

    Article  PubMed  CAS  Google Scholar 

  4. Asberg M, Nordström P, Träskman-Bendz L (1986) Cerebrospinal fluid studies in suicide. An overview. Ann N Y Acad Sci 487:243–255

    Article  PubMed  CAS  Google Scholar 

  5. Banki CM, Molnar G, Vojnik M (1981) Cerebrospinal fluid amine metabolites, tryptophan and clinical parameters in depression. Part 2. Psychopathological symptoms. J Affect Disord 3:91–99

    Article  PubMed  CAS  Google Scholar 

  6. Becker U, Laakmann G, Baghai T, Kuhn K, Kauert G (1996) Liquor-5HT und depressive Störungen. Nervenarzt 67:65

    Google Scholar 

  7. Buchsbaum MS, Haier RJ, Murphy DL (1977) Suicide attempts, platelet monoamine oxidase and the average evoked response. Acta Psychiatr Scand 56:69–79

    Article  PubMed  CAS  Google Scholar 

  8. Chen TJ, Yu YW, Chen MC, Wang SY, Tsai SJ, Lee TW (2005) Serotonin dysfunction and suicide attempts in major depressives: an auditory event-related potential study. Neuropsychobiology 52:28–36

    Article  PubMed  CAS  Google Scholar 

  9. Cooper S, Kelly CB (1992) Psychopharmacology of depression and anxiety. Curr Op Psychiatry 5:79–83

    Article  Google Scholar 

  10. Coryell W, Schlesser M (2001) The dexamethasone suppression test and suicide prediction. Am J Psychiatry 158:748–753

    Article  PubMed  CAS  Google Scholar 

  11. Coryell W, Schlesser M (2007) Combined biological tests for suicide prediction. Psychiatry Res 150:187–191

    Article  PubMed  Google Scholar 

  12. Cremniter D, Thenault M, Jamain S, Meidinger A, Delmas C, Gaillard M (1994) Serotonine and suicide: a preliminary study concerning a sample of violent suicidal patients. Prog Neuropsychopharmacol Biol Psychiatry 18:871–878

    Article  PubMed  CAS  Google Scholar 

  13. Gallinat J, Kunz D, Lang UE, Kalus P, Juckel G, Eggers J, Mahlberg R, Staedtgen M, Wernicke C, Rommelspacher H, Smolka MN (2005) Serotonergic effects of smoking are independent from the human serotonin transporter gene promoter polymorphism: evidence from auditory cortical stimulus processing. Pharmacopsychiatry 38:158–160

    Article  PubMed  CAS  Google Scholar 

  14. Gardner DL, Lucas PB, Cowdry RW (1990) CSF metabolites in borderline personality disorder compared with normal controls. Biol Psychiatry 28:247–254

    Article  PubMed  CAS  Google Scholar 

  15. Hegerl U, Juckel G (1993) Intensity dependence of auditory evoked potentials as an indicator of central serotonergic neurotransmission: a new hypothesis. Biol Psychiatry 33:173–187

    Article  PubMed  CAS  Google Scholar 

  16. http://www.euro.who.int/en/what-we-do/health-topics/diseases-and-conditions/mental-health/facts-and-figures

  17. Juckel G, Gallinat J, Riedel M, Sokullu S, Schulz C, Möller HJ, Müller N, Hegerl U (2003) Serotonergic dysfunction in schizophrenia assessed by the loudness dependence measure of primary auditory cortex evoked activity. Schizophr Res 64:115–124

    Article  PubMed  Google Scholar 

  18. Juckel G, Hegerl U (1994) Evoked potentials, serotonin, and suicidality. Pharmacopsychiatry 27(Suppl 1):27–29

    Article  PubMed  Google Scholar 

  19. Juckel G, Hegerl U, Molnar M, Csepe V, Karmos G (1999) Auditory evoked potentials reflect serotonergic neuronal activity–a study in behaving cats administered drugs acting on 5-HT1A autoreceptors in the dorsal raphe nucleus. Neuropsychopharmacology 21:710–716

    Article  PubMed  CAS  Google Scholar 

  20. Juckel G, Mavrogiorgou P, Bredemeier S, Gallinat J, Frodl T, Schulz C, Möller HJ, Hegerl U (2004) Loudness dependence of primary auditory-cortex-evoked activity as predictor of therapeutic outcome to prophylactic lithium treatment in affective disorders—a retrospective study. Pharmacopsychiatry 37:46–51

    PubMed  CAS  Google Scholar 

  21. Juckel G, Molnar M, Hegerl U, Csepe V, Karmos G (1997) Auditory-evoked potentials as indicator of brain serotonergic activity–first evidence in behaving cats. Biol Psychiatry 41:1181–1195

    Article  PubMed  CAS  Google Scholar 

  22. Keilp JG, Oquendo MA, Stanley BH, Burke AK, Cooper TB, Malone KM, Mann JJ (2010) Future suicide attempt and responses to serotonergic challenge. Neuropsychopharmacology 35:1063–1072

    Article  PubMed  CAS  Google Scholar 

  23. Lemus CZ, Lieberman JA, Johns CA, Pollack S, Bookstein P, Cooper TB (1990) CSF 5-hydroxyindoleacetic acid levels and suicide attempts in schizophrenia. Biol Psychiatry 27:926–929

    Article  PubMed  CAS  Google Scholar 

  24. Lester D (1995) The concentration of neurotransmitter metabolites in the cerebrospinal fluid of suicidal individuals: a meta-analysis. Pharmacopsychiatry 28:45–50

    Article  PubMed  CAS  Google Scholar 

  25. Lidberg L, Tuck JR, Asberg M, Scalia-Tomba GP, Bertilsson L (1985) Homicide, suicide and CSF 5-HIAA. Acta Psychiatr Scand 71:230–236

    Article  PubMed  CAS  Google Scholar 

  26. Lindström MB, Ryding E, Bosson P, Ahnlide JA, Rosén I, Träskman-Bendz L (2004) Impulsivity related to brain serotonin transporter binding capacity in suicide attempters. Eur Neuropsychopharmacol 14:295–300

    Article  PubMed  Google Scholar 

  27. Malone KM, Waternaux C, Haas GL, Cooper TB, Li S, Mann JJ (2003) Cigarette smoking, suicidal behavior, and serotonin function in major psychiatric disorders. Am J Psychiatry 160:773–779

    Article  PubMed  Google Scholar 

  28. Mann JJ, Arango V (1992) Integration of neurobiology and psychopathology in a unified model of suicidal behavior. J Clin Psychopharmacol 12(2 Suppl):2S–7S

    PubMed  CAS  Google Scholar 

  29. Mann JJ, Malone KM, Psych MR, Sweeney JA, Brown RP, Linnoila M, Stanley B, Stanley M (1996) Attempted suicide characteristics and cerebrospinal fluid amine metabolites in depressed inpatients. Neuropsychopharmacology 15:576–586

    Article  PubMed  CAS  Google Scholar 

  30. Mann JJ, Brent DA, Arango V (2001) The neurobiology and genetics of suicide and attempted suicide: a focus on the serotonergic system. Neuropsychopharmacology 24:467–477

    Article  PubMed  CAS  Google Scholar 

  31. Möller HJ, Baldwin DS, Goodwin G, Kasper S, Okasha A, Stein DJ, Tandon R, Versiani M, WPA Section on Pharmacopsychiatry (2008) Do SSRIs or antidepressants in general increase suicidality? WPA Section on Pharmacopsychiatry: consensus statement. Eur Arch Psychiatry Clin Neurosci 258(Suppl 3):3–23

    Article  PubMed  Google Scholar 

  32. Müller-Oerlinghausen B, Roggenbach J (2002) Concretism in biological suicide research—are we eating the menu instead of the meal? Some thoughts on present research strategies. Pharmacopsychiatry 35:44–49

    Article  PubMed  Google Scholar 

  33. Nathan PJ, Segrave R, Phan KL, O’Neill B, Croft RJ (2006) Direct evidence that acutely enhancing serotonin with the selective serotonin reuptake inhibitor citalopram modulates the loudness dependence of the auditory evoked potential (LDAEP) marker of central serotonin function. Hum Psychopharmacol 21:47–52

    Article  PubMed  CAS  Google Scholar 

  34. Ninan PT, van Kammen DP, Scheinin M, Linnoila M, Bunney WE Jr, Goodwin FK (1984) CSF 5-hydroxyindoleacetic acid levels in suicidal schizophrenic patients. Am J Psychiatry 141:566–569

    PubMed  CAS  Google Scholar 

  35. Nock MK, Hwang I, Sampson N, Kessler RC, Angermeyer M, Beautrais A, Borges G, Bromet E, Bruffaerts R, de Girolamo G, de Graaf R, Florescu S, Gureje O, Haro JM, Hu C, Huang Y, Karam EG, Kawakami N, Kovess V, Levinson D, Posada-Villa J, Sagar R, Tomov T, Viana MC, Williams DR (2009) Cross-national analysis of the associations among mental disorders and suicidal behavior: findings from the WHO World Mental Health Surveys. PLoS Med 6:e1000123

    Article  PubMed  Google Scholar 

  36. Nordström P, Asberg M (1992) Suicide risk and serotonin. Int Clin Psychopharmacol 6(Suppl. 6):12–21

    Article  PubMed  Google Scholar 

  37. Nordström P, Samuelsson M, Asberg M, Träskman-Bendz L, Aberg-Wistedt A, Nordin C, Bertilsson L (1994) CSF 5-HIAA predicts suicide risk after attempted suicide. Suicide Life Threat Behav 24:1–9

    PubMed  Google Scholar 

  38. Norra C, Mrazek M, Tuchtenhagen F, Gobbelé R, Buchner H, Sass H, Herpertz SC (2003) Enhanced intensity dependence as a marker of low serotonergic neurotransmission in borderline personality disorder. J Psychiatr Res 37:23–33

    Article  PubMed  Google Scholar 

  39. Norra C, Becker S, Bröcheler A, Kawohl W, Kunert HJ, Buchner H (2008) Loudness dependence of evoked dipole source activity during acute serotonin challenge in females. Hum Psychopharmacol 23:31–42

    Article  PubMed  Google Scholar 

  40. Oliva J, Leung S, Croft RJ, O’Neill BV, O’Kane J, Stout J, Phan KL, Nathan PJ (2010) The loudness dependence auditory evoked potential is insensitive to acute changes in serotonergic and noradrenergic neurotransmission. Hum Psychopharmacol 25:423–427

    Article  PubMed  CAS  Google Scholar 

  41. O’Neill BV, Guille V, Croft RJ, Leung S, Scholes KE, Phan KL, Nathan PJ (2008) Effects of selective and combined serotonin and dopamine depletion on the loudness dependence of the auditory evoked potential (LDAEP) in humans. Hum Psychopharmacol 23:301–312

    Article  PubMed  Google Scholar 

  42. Oquendo MA, Placidi GP, Malone KM, Campbell C, Keilp J, Brodsky B, Kegeles LS, Cooper TB, Parsey RV, van Heertum RL, Mann JJ (2003) Positron emission tomography of regional brain metabolic responses to a serotonergic challenge and lethality of suicide attempts in major depression. Arch Gen Psychiatry 60:14–22

    Article  PubMed  Google Scholar 

  43. Peabody CA, Faull KF, King RJ, Whiteford HA, Barchas JD, Berger PA (1987) CSF amine metabolites and depression. Psychiatry Res 21:1–7

    Article  PubMed  CAS  Google Scholar 

  44. Pogarell O, Tatsch K, Juckel G, Hamann C, Mulert C, Popperl G, Folkerts M, Chouker M, Riedel M, Zaudig M, Moller HJ, Hegerl U (2004) Serotonin and dopamine transporter availabilities correlate with the loudness dependence of auditory evoked potentials in patients with obsessive-compulsive disorder. Neuropsychopharmacology 29:1910–1917

    Article  PubMed  CAS  Google Scholar 

  45. Pompili M, Serafini G, Innamorati M, Möller-Leimkühler AM, Giupponi G, Girardi P, Tatarelli R, Lester D (2010) The hypothalamic-pituitary-adrenal axis and serotonin abnormalities: a selective overview for the implications of suicide prevention. Eur Arch Psychiatry Clin Neurosci 260(8):583–600

    Article  PubMed  Google Scholar 

  46. Roggenbach J, Müller-Oerlinghausen B, Franke L (2002) Suicidality, impulsivity and aggression—is there a link to 5-HIAA concentration in the cerebrospinal fluid? Psychiatry Res 113:193–206

    Article  PubMed  CAS  Google Scholar 

  47. Roy A, De JJ, Linnoila M (1989) Cerebrospinal fluid monoamine metabolites and suicidal behavior in depressed patients. A 5-year follow-up study. Arch Gen Psychiatry 46:609–612

    Article  PubMed  CAS  Google Scholar 

  48. Roy A, Ninan P, Mazonson A, Pickar D, Van KD, Linnoila M, Paul SM (1985) CSF monoamine metabolites in chronic schizophrenic patients who attempt suicide. Psychol Med 15:335–340

    Article  PubMed  CAS  Google Scholar 

  49. Ryding E, Ahnlide JA, Lindström M, Rosén I, Träskman-Bendz L (2006) Regional brain serotonin and dopamine transporter binding capacity in suicide attempters relate to impulsiveness and mental energy. Psychiatry Res 148:195–203

    Article  PubMed  CAS  Google Scholar 

  50. Simmons JG, Nathan PJ, Berger G, Allen NB (2011) Chronic modulation of serotonergic neurotransmission with sertraline attenuates the loudness dependence of the auditory evoked potential in healthy participants. Psychopharmacology (Berl) 217:101–110

    Article  CAS  Google Scholar 

  51. Spreux-Varoquaux O, Alvarez JC, Berlin I, Batista G, Despierre PG, Gilton A, Cremniter D (2001) Differential abnormalities in plasma 5-HIAA and platelet serotonin concentrations in violent suicide attempters: relationships with impulsivity and depression. Life Sci 69:647–657

    Article  PubMed  CAS  Google Scholar 

  52. Träskman L, Asberg M, Bertilsson L, Sjostrand L (1981) Monoamine metabolites in CSF and suicidal behavior. Arch Gen Psychiatry 38:631–636

    Article  PubMed  Google Scholar 

  53. Träskman-Bendz L, Asberg M, Schalling D (1986) Serotonergic function and suicidal behavior in personality disorders. Ann N Y Acad Sci 487:168–174

    Article  PubMed  Google Scholar 

  54. Uhl I, Gorynia I, Gallinat J, Mulert C, Wutzler A, Heinz A, Juckel G (2006) Is the loudness dependence of auditory evoked potentials modulated by the selective serotonin reuptake inhibitor citalopram in healthy subjects? Hum Psychopharmacol 21:463–471

    Article  PubMed  CAS  Google Scholar 

  55. van Praag HM, Plutchik R, Conte H (1986) The serotonin hypothesis of (auto)aggression. Critical appraisal of the evidence. Ann N Y Acad Sci 487:150–167

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was financially supported by FoRUM, the competitive research programme of the Faculty of Medicine, Ruhr University Bochum (Az: F518-06).

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Correspondence to Idun Uhl.

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Uhl, I., Illes, F., Graßnickel, V. et al. Loudness dependence of auditory evoked potentials (LDAEP) in clinical monitoring of suicidal patients with major depression: a pilot study. Eur Arch Psychiatry Clin Neurosci 262, 487–492 (2012). https://doi.org/10.1007/s00406-012-0297-8

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