Serotonergic Studies in Patients With Affective and Personality Disorders

TLDR

Dysfunction of the central serotonergic system has been linked to depression and to suicidal and/or impulsive aggressive behavior. The study aimed to assess central serotonergic function in relation to depression, suicide attempts, and impulsive aggression. Prolactin responses to a single oral dose of fenfluramine hydrochloride (60 mg) were measured in 45 male patients with major affective and/or personality disorders and in 18 normal male controls. Patients showed reduced prolactin responses compared to controls, and these reductions correlated with suicide attempts in all patients and with impulsive aggression only in those with personality disorder, but not with depression, indicating that diminished serotonergic function is present in a subset of affective and personality disorder patients and is linked to suicide risk and, in personality disorder, to impulsive aggression.

Abstract

• Dysfunction of the central serotonergic system has been variously associated with depression and with suicidal and/or impulsive aggressive behavior. To evaluate central serotonergic function in relation to these variables, prolactin responses to a singledose challenge with fenfluramine hydrochloride (60 mg orally), a serotonin releasing/uptake-inhibiting agent, were examined in 45 male patients with clearly defined major affective (n = 25) and/or personality disorder (n 20) and in 18 normal male control patients. Prolactin responses to fenfluramine among all patients were reduced compared with responses of controls. Reduced prolactin responses to fenfluramine were correlated with history of suicide attempt in all patients but with clinician and selfreported ratings of impulsive aggression in patients with personality disorder only; there was no correlation with depression. These results suggest that reduced central serotonergic function is present in a subgroup of patients with major affective and/or personality disorder and is associated with history of suicide attempt in patients with either disorder, but with impulsive aggression in patients with personality disorder only.