Hallucinations in patients with major depression. Interactions between CSF monoaminergic and endorphinergic indices

CSF levels of radioreceptorassayed endorphins Fraction I (EndFI, n = 92) and homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) (n = 118) were measured in patients with major depressive disorders according to Research Diagnostic Criteria (18% were psychotic; 11% hallucinated during the peak of the depressive episode). CSF measures (both "raw" variables and ranks) were uni- and multivariately correlated with both dichotomized and scored measures of hallucinations of any type. Hallucinations were statistically strongly associated with higher HVA levels, irrespective of prior medication with neuroleptics, and with the interactive product HVA X EndFI and the interactive ratio HVA/5-HIAA. Results suggest interactions between dopaminergic, serotonergic and endorphinergic neurotransmission being involved in the biochemical substrate of depressive hallucinatory episodes.