uicide is a major public health issue in the West,where it is among the top 10 causes of death.Throughoutworld, suicide accounts for about 1 million deaths peryear, ie, 1 death every 40 seconds, according to the WorldHealth Organization,1 and constitutes a heavy familial,social, and economic burden.Some data concerning suicide are of major interest. First,despite effort in prevention, suicide rates do not appearbe decreasing (Figure 1)1 and, in many industrializedcountries, the number of people dying through suicide issignificantly higher than the number of people dying inautomobile accidents. Second, suicide rates in adolescentsand young adults increased in the last two or threedecades, and in many countries suicide mortality rates arethe third, or even the second, cause of death among youngpeople.In view of these data, much effort has been made to studythe biology of suicide, and a central serotonergic dys-function is possibly the most studied biological parame-ter. Initial in vivo evidence comes from a study showing alower concentration of acid 5-hydroxyindoleacetic acid(5-HIAA) in the cerebrospinal fluid (CSF) of depressedsuicidal patients compared with depressed nonsuicidalpatients.2 Many have further confirmed this result, notonly in depression but also in schizophrenia and person-ality disorder,3 showing that lower 5-HIAA CSF concen-tration is associated with suicidal behavior regardless ofpsychiatric diagnosis.Keywords: serotonin;
suicidal behavior; genetic susceptibility; depression; schizophreniaAuthor affiliations: Departamento de Morfologia, Universidade Federal deMinas Gerais, Belo Horizonte-MG, Brazil (Humberto Corrêa); Departamento deFarmacologia, Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil(Marco Aurélio Romano-Silva; Ana Carolina Campi-Azevedo; Vivtor Lima);Serviço de Psiquiatria, Universidade Federal de Minas Gerais, Belo Horizonte-MG,Brazil (Humberto Corrêa; Marco Aurélio Romano-Silva); FORENAP (ResearchInstitute for Neuroscience and Neuropsychiatry (Fabrice Duval; Jean-Paul Macher)Address for correspondence: Humberto Corrêa, MD, Departamento deMorfologia, Universidade Federal de Minas Gerais, Avenida Antônio Carlos6627, CEP 31280-901, Belo Horizonte, Minas Gerais, Brazil(e-mail: correa@task.com.br)B a s i c r e s e a r c h4 0 8Research on serotonin and suicidal behavior:neuroendocrine and molecular approachesHumberto Corrêa, MD; Marco Aurélio Romano-Silva, MD, PhD;Fabrice Duval, MD; Ana Carolina Campi-Azevedo, Msc; Vivtor Lima, MD;Jean-Paul Macher, MDSWe carried out two studies to test the hypothesis thataltered central serotonergic function, as assessed by lowerprolactin (PRL) response to d-fenfluramine (D-FEN), ismore closely associated with suicidal behavior than a par-ticular psychiatric diagnosis. A D-FEN test was performedin 85 major depressed inpatients, 33 schizophrenic inpa-tients, and 18 healthy controls. We showed that PRLresponse to D-FEN is a marker of suicidality, regardless ofpsychiatric disorder. We then examined the associationbetween the serotonin (5-hydroxytryptamine) receptor 5-HT2A gene polymorphism (T102C) and suicide in a sam-ple of Brazilian psychiatric inpatients (95 with schizo-phrenia, 78 with major depression) and 52 healthy con-trols. No differences were found in genotypic frequenciesacross patients and controls. Overall, no differences werefound between patients with (n=66) and without (n=107)a history of suicide attempt. We also compared patientswith a history of severe suicide attempts (lethality>3;n=32) and patients without such a history (n=107), butthey did not exhibit different genotypic frequencieseither. These results show that the 5-HT2A gene polymor-phism (T102C) may not be involved in the genetic suscep-tibility to suicidal behavior.Dialogues Clin Neurosci. 2002;4:408-416.
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