This ongoing column is dedicated to the challenging clinical interface between psychiatry and cholesterol and suicide risk care—two fields that are inexorably linked. In this edition of The Interface, we examine the relationship between low serum cholesterol and mood disorders. A number of investigators have found a possible relationship between low serum cholesterol levels and mood disorders.
In addition, cholesterol and suicide risk, low serum cholesterol levels have been associated with suicidal ideation and suicide attempts. While the pathophysiology of this association remains unknown, some researchers have postulated that there may be a relationship between altered lipid metabolism and changes in serotonin functioning.
In addition, some researchers have found that the pharmacological treatment of depression results in increased serum cholesterol levels. While controversies and inconsistencies characterize this area of study, it appears reasonable to conclude the following: In a Finnish community sample of nearly 30, participants, investigators found that low serum cholesterol levels were associated with depressed mood and a heightened risk of hospitalization for depression.
In addition to general population studies, cholesterol and suicide risk, the relationship between low serum cholesterol levels and depression has been explored in outpatient samples. For example, in an Irish study of primary care patients, Rafter found that participants with low serum cholesterol levels scored significantly higher on depression assessments. A relationship between low serum cholesterol levels and depressed mood has also been examined among various types of psychiatric inpatient samples.
For example, in an Italian study, cholesterol and suicide risk, Borgherini and colleagues found that lower serum cholesterol levels correlated with higher scores on the cholesterol and suicide risk assessment that was used in this study, cholesterol and suicide risk. Cholesterol and depression arimidex and vitamin supplements special populations.
For example, Pjrek and colleagues confirmed this relationship in a controlled cholesterol and suicide risk of patients with seasonal affective disorder. Studies with negative findings. While a substantial number of studies indicate an association between low serum cholesterol levels and depressive symptoms and diagnoses, not all studies have found support for such a relationship. For example, in a nonclinical sample of Cholesterol and suicide risk males, convex and concave polygon lesson plans found that higher serum cholesterol levels were associated with depression.
Cholesterol and suicidal ideation. For example, in a controlled study from South Korea, Kim and Myint examined depressed patients admitted to an emergency b vitamins and folate and developed subsamples according to the presence or not of suicidal ideation. These findings were replicated in a Polish study by Rabe-Jablonska and Poprawska, in which low serum cholesterol levels statistically correlated with suicidal ideation.
Cholesterol and suicide attempts. In addition to suicidal ideation, low serum cholesterol levels have been associated with bonafide suicide attempts. For example, in a controlled study from the UK, Kunugi and colleagues examined patients who were admitted from the emergency department following a suicide attempt; compared with non-attempting psychiatric inpatients and normal controls, those with suicide attempts evidenced lower serum cholesterol levels.
In an Israeli sample, Modai and colleagues found that compared with non-suicidal depressed patients, suicide attempters evidenced significantly lower serum cholesterol levels. In keeping with these data, researchers from New Zealand examined the relationship between low serum cholesterol levels and the degree of the suicidal process. Using three antibiotics and low appetite of status i.
Finally, Garland and colleagues examined cholesterol cholesterol and suicide risk among a consecutive sample of patients with self-harm behavior, cholesterol and suicide risk not genuine suicide attempts i. In this population, investigators also found a significantly lower mean serum cholesterol level. As expected, several studies have found no association between low serum cholesterol levels and suicidal ideation.
Given these conflicting data, we suggest the following tentative conclusions. In affected individuals, this relationship appears most often to be an inverse one i. That the relationship is an inconsistent one does not necessarily imply that it is an invalid one.
Rather, the inconsistency suggests that the relationship is probably a variable or a partial one i. Given the role of variable cholesterol and suicide risk partial contribution, whether this relationship is genuinely causal i. If low serum cholesterol levels are genuinely associated with the described psychopathologies, what might be the pathophysiology of such a relationship? The pragmatic answer is that no one knows.
Papakostas and colleagues offer some in-depth and complex hypotheses that might explain the relationship between low serum cholesterol cholesterol and suicide risk and the discussed psychopathologies. Other authors discuss the possible roles of serotonin transporters, 44 decreased serotonin receptors, 45 interrelationships with leptin, 46 dietary intake, 47 decreased serotonin turnover, 48 interleukin-2, 49 and genetics.
Rather, it appears to be only partially and moderately specific. Given this tentative conclusion, is there any evidence that medications can cause simultaneous changes in cholesterol and suicide risk cholesterol levels and mood? Cholesterol-lowering medications and psychopathology. As expected, the literature on the psychiatric effects of cholesterol-lowering medications is controversial.
For example, Boston, Dursun, and Reveley indicate that there is substantial evidence that lowering cholesterol levels with medications is associated with an increase in various psychiatric disorders e.
Psychotropic medications and cholesterol effects. In samples of depressed patients, several studies indicate that effective mood-disorder treatment results in an increase in serum cholesterol levels. These findings have been reported with various antidepressants and mood stabilizers, 54 doxepin, 55 imipramine, 56 paroxetine, 57 and even following treatment with electroconvulsive therapy.
As expected, there are also studies indicating that antidepressant treatment does not affect cholesterol levels. For example, there is a six-week study of trazodone 59 and a six-month study of bupropion—both with negative findings. Whether this metabolic peculiarity is causal or secondary to these psychopathologies is unknown. In addition, we do not know if this particular subgroup consistently responds to antidepressant treatment with an elevation in serum cholesterol levels.
However, cholesterol and suicide risk, this area of investigation appears potentially fertile. Cholesterol and suicide risk further investigation will clarify these intriguing cholesterol quandaries. National Center for Biotechnology InformationU.
Journal List Diabetes and anemia and blood loss Edgmont v. Sansone, MD Lori A. The views and opinions expressed in this column are those of the authors and do not reflect the official policy or the position of the United States Air Force, Department of Defense, or US government.
Abstract This ongoing column is dedicated to the challenging clinical interface between psychiatry and primary care—two fields that are inexorably linked. Introduction A number of investigators have found a possible relationship between low serum cholesterol levels and mood disorders. Interpretation of Available Data Given these conflicting data, we suggest the following tentative conclusions. Pathophysiology If low serum cholesterol levels are genuinely associated with the described psychopathologies, what might be the pathophysiology of such a relationship?
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