The comments of Drs McEntee and Mair raise a number of issues worthy of discussion. However, their underlying concern seems to be whether it is appropriate to conclude that an improvement of memory during treatment with fluvoxamine maleate in patients with Korsakoff's psychosis (KP) suggests an etiologic role of serotonergic mechanisms in alcoholic organic brain disease. They indicate that "more direct data," eg, diminished pretreatment levels of cerebrospinal fluid (CSF) 5-hydroxyin-doleacetic acid (5-HIAA) or improvement of memory test performance by treatment with selective serotonin agonists, would be required to substantiate the hypothesis of underlying serotonergic dysfunction in KP.Although the assessment in vivo of central serotonergic function is of considerable interest in understanding a wide range of psychiatric abnormalities,1,2 it is uncertain whether CSF levels of 5-HIAA actually provide a measure of functionally active serotonin in periventricular brain regions.3 Therefore, the absence of a significant correlation between
Martin PR, Adinoff B, Eckardt MJ, et al. Memory Improvement in Korsakoff's Disease With Fluvoxamine-Reply. Arch Gen Psychiatry. 1990;47(10):978–979. doi:10.1001/archpsyc.1990.01810220094016
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