Tricyclic Antidepressant Washout Effects on Cerebrospinal Fluid and Urinary Monoamine and Metabolites

To the Editor.—  Our previous publication on cerebrospinal fluid (CSF) and urinary concentrations of biogenic amines and metabolites in depression reported higher concentrations in many of these measures relative to the concentrations measured from samples collected from age- and sexmatched normal healthy controls.¹ The possibility exists that these higher concentrations in depressed subjects are due to an inadequate drug washout period before sample collection. This may be especially true in light of the publication by Charney et al² that reported a rebound or increase in concentrations of plasma and urinary 3-methoxy-4-hydroxyphenylethylene glycol (MHPG) following withdrawal of tricyclic antidepressants.²

Patients and Methods.—  On intake into this study, all medications were withdrawn and information regarding medication usage during the current illness was obtained from all subjects and recorded on a medication review form. Drug class (eg, antidepressant, neuroleptic, anxiolytics, sedatives), specific generic information, and time of discontinuation of medication(s)