Hypocholesterolemia and affective disorders

Statins-From Fungi to Pharmacy

Statins have been used in the treatment of hyperlipidemia, both as monotherapy and in combination therapy. Natural fermentation processes of fungi such as Monascus spp., Penicillium spp., Aspergillus terreus, and Pleurotus ostreatus have given rise to natural statins. Compactin (mevastatin), the original naturally occurring statin, is the primary biotransformation substrate in the manufacturing process of marketed drugs. Statins are classified into natural, semi-synthetic derivatives of natural statins, and synthetic ones. Synthetic statins differ from natural statins in their structural composition, with the only common feature being the HMG-CoA-like moiety responsible for suppressing HMG-CoA reductase. Statins do not differ significantly regarding their pleiotropic and adverse effects, but their characteristics depend on their pharmacokinetic parameters and chemical properties. This paper focuses on describing the processes of obtaining natural statins, detailing the pharmacokinetics of available statins, divided into natural and synthetic, and indicating their pleiotropic effects.

Lipid Biomarker Research in Bipolar Disorder: A Scoping Review of Trends, Challenges, and Future Directions

Bipolar disorder (BD) is a disabling disorder with heterogeneous symptom profiles and trajectories. Like many other neuropsychiatric disorders, clinical decision making related to diagnoses and choice of treatment is based on clinical assessments alone, and risk prediction for treatment success or resistance at an individual level remains sparse. An enormous effort to add biological markers to this risk prediction is ongoing. The role of lipids in normal brain functioning is well established, and several hypotheses about the role of lipids in the pathogenesis of neuropsychiatric disorders, including BD, have been made. The frequent comorbidity between neuropsychiatric disorders and cardiovascular disease, the genetic overlap of risk genes for severe mental disorders and genes involved in lipid regulation, and the lipid-altering effects of antipsychotics and mood stabilizers indicate that lipids could hold promise as biomarkers for neuropsychiatric disorders, including BD. To date, reviews of lipid biomarkers in schizophrenia and major depression have noted caveats for future investigations, while reviews of lipid biomarker research in BD is missing. In the current scoping review, we present a comprehensive overview of trends in previous research on lipid biomarkers in BD. The current literature varies greatly in the phenotypes investigated and study designs, leading to divergent findings. Small sample size; potential confounders related to physical activity, nutritional status, and medication use; and cross-sectional designs were frequently reported limitations. Future research may benefit from pivoting toward utilization of newer laboratory techniques such as lipidomics, but consistent use of study methods across cohorts is also needed.

Sex difference in lipid levels in first-diagnosed drug-naïve depression patients: A case-control and 12-weeks follow-up study

AIM

Patients with depression have a high prevalence of developing dyslipidemia. In this study, we aim to investigate the difference of serum lipids, including total cholesterol (TCH), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG), between the depressed patients and healthy controls. Sex differences in lipids and their psychological correlations were also included.

METHODS

The study included 56 healthy controls (males/females = 26/30) and 110 first-diagnosed drug-naïve outpatients (males/females = 35/75). A total of 42 patients (males/females = 14/28) were followed for 3 months.

RESULTS

A significant difference was found in TCH and LDL-C among healthy control and patients. Interestingly, female patients with first-diagnosed, drug-naïve depression had lower atherogenic indices than male patients. After 3 months of antidepressants therapy, female patients exhibited detrimental changes in serum lipids, namely increased TG and atherogenic index. Moreover, correlation analysis showed significant correlations between changes of depression inventory (HAMD and BDI) score and serum lipids (TCH, HDL-C) in depressed patients.

CONCLUSION

We found that dyslipidemia was more common in female patients with depression during therapy with antidepressants. Moreover, the altered serum lipids and atherogenic index might be a hallmark of female patients. Further investigation of sex differences in lipid metabolism of depression is warranted.

Lipid and Glycemic Profiles in Patients with Bipolar Disorder: Cholesterol Levels Are Reduced in Mania

Background and Objectives: Bipolar disorder (BD) is a severe mental condition with a lifetime prevalence estimated around 2% among the general population. Due to risk factors, etiological mechanisms, and the chronic use of psychotropic medications, people with BD are frequently affected by medical comorbidities, such as metabolic syndrome (MetS), associated with altered blood levels of glucose, cholesterol, and triglycerides. Moreover, the lipid concentration may be associated with the severity of psychiatric symptoms. Materials and Methods: Five hundred and forty-two in- and outpatients (418 affected by BD and 124 affected by schizophrenia) were recruited in two Italian university hospitals. A blood examination assessing the fasting glucose, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides was performed. Results: No significant differences were found in the lipid and glycemic profiles between patients with BD and schizophrenia. When considering only the BD sample, we found that patients experiencing a manic episode had significantly lower total cholesterol, HDL, and LDL than euthymic patients. Moreover, the total and LDL cholesterol levels were significantly lower in (hypo)manic than depressed patients. Mood episodes did not influence the triglyceride and glucose levels in our sample. Conclusions: Clinicians should pay attention to blood cholesterol levels in patients with BD, as differences in concentrations may predispose them to severe medical conditions and can be associated with the onset of mood episodes.

Depression, mitochondrial bioenergetics, and electroconvulsive therapy: a new approach towards personalized medicine in psychiatric treatment - a short review and current perspective

Major depressive disorder (MDD) is a globally occurring phenomenon and developed into a severe socio-economic challenge. Despite decades of research, the underlying pathophysiological processes of MDD remain incompletely resolved. Like other mental disorders, MDD is hypothesized to mainly affect the central nervous system (CNS). An increasing body of research indicates MDD to also change somatic functioning, which impairs the physiological performance of the whole organism. As a consequence, a paradigm shift seems reasonable towards a systemic view of how MDD affects the body. The same applies to treatment strategies, which mainly focus on the CNS. One new approach highlights changes in the bioenergetic supply and intracellular network dynamics of mitochondria for the pathophysiological understanding of MDD. Mitochondria, organelles of mostly all eukaryotic cells, use carbon compounds to provide biochemical energy in terms of adenosine triphosphate (ATP). ATP is the bioenergetic currency and the main driver for enzymatic activity in all cells and tissues. Clinical symptoms of MDD including fatigue, difficulties concentrating, and lack of motivation were reported to be associated with impaired mitochondrial ATP production and changes in the density of the mitochondrial network. Additionally, the severity of these symptoms correlates negatively with mitochondrial functioning. Psychotherapy, antidepressant medication, and electroconvulsive therapy (ECT), a method used to treat severe and treatment-resistant forms of MDD, achieve robust antidepressant effects. The biological mechanisms beyond the treatment response to antidepressant strategies are partially understood. Here, mitochondrial functioning is discussed as a promising new biomarker for diagnosis and treatment effects in MDD.

A preliminary study of bipolar disorder type I by mass spectrometry-based serum lipidomics

The present study aimed at investigating possible alterations in the serum lipid profile of euthymic patients with bipolar disorder type I (BD) compared to healthy controls (HC). Thirty-five individuals from both genders were recruited, with 14 diagnosed and treated as BD patients (BD group) and 21 healthy subjects (HC group). Clinical assessment was based on the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Young Mania Rating Scale (YMRS), and 17-items of Hamilton Depression Rating Scale (HDRS-17) data, which were used to confirm diagnosis, to verify psychiatric comorbidities, and to estimate the severity of manic and depressive symptoms. Ultra-high performance liquid chromatography (UHPLC) coupled to high resolution mass spectrometry (HRMS) was applied to analyze the lipids extracted from all serum samples from both studied groups. In this pioneer and exploratory study, we observed different serum lipid profiles for BD and HC groups, especially regarding glycerophospholipid, glycerolipid, and sphingolipid distribution. Multivariate statistical analyses indicated that 121 lipids were significantly different between BD and HC. Phosphatidylinositols were identified as the most altered lipids in BD patient sera. The results of this preliminary study reinforce the role of lipid abnormalities in BD and offer additional methodological possibilities for investigation in the field.

African Americans, Depression, and Suicide Risk

The aim of the current study was to determine which variable would be a better predictor of suicide risk: perceived social support or serum cholesterol level. There was a significant negative correlation between suicide risk and perceived social support but no significant correlation between suicide risk and serum cholesterol. Perceived social support was a better predictor of suicide risk than was serum cholesterol level and accounted for 17% of the variance. Depressed patients with a history of suicide attempt had a significantly lower serum cholesterol level, scored significantly higher on the Suicide Risk Scale, and scored significantly lower on the Perceived Social Support Scale than did depressed patients with no history of suicide attempt. Findings suggest that perceived social support is a better predictor of suicide risk for depressed African Americans.

Serum lipid profile changes after successful treatment with electroconvulsive therapy in major depression: A prospective pilot trial

BACKGROUND

Cholesterol is reduced in depressed patients, however, these patients have a higher risk for cardiovascular diseases. Electroconvulsive therapy (ECT) is a highly effective treatment option for specific forms of depression. Like for other non-pharmacological therapies targeting depression such as psychotherapy or sleep deprivation, there is a lack of evidence about the effects on peripheral lipid parameters. Our objective was to study the impact of ECT as a non-pharmacological treatment on the peripheral lipid pattern in depressive patients.

METHOD

Peripheral lipid profile composition before and after a course of ECT was analysed in 27 non-fasting inpatients at a university psychiatric hospital with DSM-IV major depressive episode. For the impact of ECT treatment on each lipid parameter a multivariate repeated measurement regression analysis was performed and computed separately for every dependent variable.

RESULTS

Total Cholesterol and the cholesterol subtypes HDL and LDL were increased after the treatment compared to baseline. Apolipoprotein A1 was also increased after ECT, whereas apolipoprotein B was not. Indices for the prediction of cardiovascular diseases were unchanged after successful treatment by ECT. The reduction of depressive psychopathology negatively correlated with increases of HDL cholesterol and apolipoprotein A1.

LIMITATIONS

Subjects received several antidepressants and other psychotropic medication before and during the ECT.

CONCLUSIONS

In our preliminary pilot study ECT as a non-pharmacological, effective treatment of depression led to distinct effects on the peripheral lipid pattern.

Total serum cholesterol, atherogenic indices and their longitudinal association with depressive symptoms among US adults

Serum cholesterol, both total and lipoprotein fractions, has been associated with mid- and late-life depression. Using longitudinal data on a large and ethnically diverse sample of urban adults, the associations of serum lipid profile measured by high or low total cholesterol (TC; >200 mg dl(-1); <160 mg dl(-1)) and by atherogenic indices, namely high total cholesterol and low-density lipoprotein cholesterol relative to high-density lipoprotein cholesterol, with change in total and domain-specific depressive symptoms over time were examined. Findings were compared by sex. (Hypothesis 1) In addition, baseline depressive symptoms as predictors for longitudinal change in lipid profile trajectory were tested. (Hypothesis 2) Mixed-effects regression analyses stratified by sex was used. Sample sizes of participants (n) and repeated observations (n') were: Hypothesis 1 (Men: n=826 ; n'=1319; Women: n=1099 ; n'=1817); Hypothesis 2 (Men: n=738; n'=1230; Women: n=964; n'=1678). As hypothesized, a higher level of atherogenic indices was linked to faster increase in depressive symptom scores, particularly depressed affect and interpersonal problems, though this relationship was found only among women. Among men a U-shaped relationship between baseline TC and longitudinal increase in somatic complaints and a direct link between low TC and longitudinal putative improvement in positive affect was found. On excluding statin users among women, low TC was associated with slower increase in depressed affect over time, whereas high TC was associated with faster increase in interpersonal problems. In summary, atherogenic indices were directly linked to faster increase in depressive symptoms among women only. More studies are needed to explain these sex-specific associations.

Female attempted suicide patients with low HDL levels are at higher risk of suicide re-attempt within the subsequent year: a clinical cohort study

Our aims were, to clarify the blood lipid differences [Total serum cholesterol (TC), High-density lipoprotein (HDL), Low density lipoprotein (LDL), Triglyceride (TG)] between female patients who had attempted suicide and controls and to determine whether we could use the patients׳ initial lipid profiles to predict suicide re-attempt within the subsequent year. A total of 284 participants (110 cases and 174 controls) were recruited, with no differences in body mass index, age, blood sampling time and gender. Blood samples were collected from all participants for serum lipid profiles and assayed in an auto-analyzer. We divided the suicide re-attempter group into suicide attempters in the subsequent year (SSY) and suicide attempters after the subsequent year (SASY). The TC, LDL, and TG levels were significantly lower in the suicidal group than in the control group. HDL was significantly higher in the suicidal group than in the control group. Low TG (<70mg/dL) (OR (odds ratio)=12.8; 95% CI (confidence interval)=5.4-30.5; p<0.0001)and low LDL/HDL (<1.8) (OR=4.1; 95% CI=1.8-9.3; p=0.001) were significantly associated with a current suicide attempt. HDL levels in the SSY (41.5±4.5mg/dL) were lower than in the non-suicide attempters group (NSA) (50.9±10.3mg/dL) and SASY (58.7±12.8mg/dL)(d.f.=2, F=5.2, p=0.007). Serum HDL level may be a potential candidate predictor for the future risk of suicidality.

Advances in biomarkers of major depressive disorder

Major depressive disorder (MDD) is characterized by mood, vegetative, cognitive, and even psychotic symptoms and signs that can cause substantial impairments in quality of life and functioning. Biomarkers are measurable indicators that could help diagnosing MDD or predicting treatment response. In this chapter, lipid profiles, immune/inflammation, and neurotrophic factor pathways that have long been implicated in the pathogenesis of MDD are discussed. Then, pharmacogenetics and epigenetics of serotonin transport and its metabolism pathway, brain-derived neurotrophic factor, and abnormality of hypothalamo-pituitary-adrenocortical axis also revealed new biomarkers. Lastly, new techniques, such as proteomics and metabolomics, which allow researchers to approach the studying of MDD with new directions and make new discoveries are addressed. In the future, more data are needed regarding pathophysiology of MDD, including protein levels, single nucleotide polymorphism, epigenetic regulation, and clinical data in order to better identify reliable and consistent biomarkers for diagnosis, treatment choice, and outcome prediction.

Neuropsychiatric adverse events associated with statins: epidemiology, pathophysiology, prevention and management

Statins, or 3-hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitors, such as lovastatin, atorvastatin, simvastatin, pravastatin, fluvastatin, rosuvastatin and pitavastatin, are cholesterol-lowering drugs used in clinical practice to prevent coronary heart disease. These drugs are generally well tolerated and have been rarely associated with severe adverse effects (e.g. rhabdomyolysis). Over the years, case series and data from national registries of spontaneous adverse drug reaction reports have demonstrated the occurrence of neuropsychiatric reactions associated with statin treatment. They include behavioural alterations (severe irritability, homicidal impulses, threats to others, road rage, depression and violence, paranoia, alienation, antisocial behaviour); cognitive and memory impairments; sleep disturbance (frequent awakenings, shorter sleep duration, early morning awakenings, nightmares, sleepwalking, night terrors); and sexual dysfunction (impotence and decreased libido). Studies designed to investigate specific neuropsychiatric endpoints have yielded conflicting results. Several mechanisms, mainly related to inhibition of cholesterol biosynthesis, have been proposed to explain the detrimental effects of statins on the central nervous system. Approaches to prevent and manage such adverse effects may include drug discontinuation and introduction of dietary restrictions; maintenance of statin treatment for some weeks with close patient monitoring; switching to a different statin; dose reduction; use of ω-3 fatty acids or coenzyme Q10 supplements; and treatment with psychotropic drugs. The available information suggests that neuropsychiatric effects associated with statins are rare events that likely occur in sensitive patients. Additional data are required, and further clinical studies are needed.

Lipid trajectories as predictors of depressive symptoms: the Young Finns Study

OBJECTIVE

The aim of this study was to identify common trajectories of lipid levels across childhood and early adulthood life span.

DESIGN

The sample was a subpopulation of 824 young adults (3 to 9 years of age at baseline in 1980) of the ongoing population-based prospective Cardiovascular Risk in Young Finns Study. Lipid levels were determined in 1980, 1983, 1986, and 2001.

MAIN OUTCOME MEASURES

Depressive symptoms were assessed using a modified version of Beck's Depression Inventory (Beck, 1967) in 1992 and 2001.

RESULTS

The 2 triglycerides trajectories (steeply vs. moderately increasing) were differently related to depressive symptoms in adulthood. The trajectory showing steep increase over time was associated with higher level of depressive symptoms (M 2.18, 95% CI [2.08, 2.28] vs. 1.99, [1.95, 2.04]). This relationship persisted after adjustments for various risk factors. These triglycerides trajectories accounted for part of the association between high body mass index and depressive symptoms.

CONCLUSION

A pattern of steeply increasing triglyceride levels throughout childhood and adulthood may be associated with increased the risk of depressive symptoms in adulthood. This pattern may also be one link between obesity and depressive symptoms.

Increased health risk in subjects with high self-reported seasonality

BACKGROUND

Seasonal variations in mood and behaviour, termed seasonality, are commonly reported in the general population. As a part of a large cross-sectional health survey in Hordaland, Norway, we investigated the relationship between seasonality, objective health measurements and health behaviours.

METHODOLOGY/PRINCIPAL FINDINGS

A total of 11,545 subjects between 40-44 years old participated, completing the Global Seasonality Score, measuring seasonality. Waist/hip circumference, BMI and blood pressure were measured, and blood samples were analyzed for total cholesterol, HDL cholesterol, triglycerides and glucose. Subjects also completed a questionnaire on miscellaneous health behaviours (exercise, smoking, alcohol consumption). Hierarchical linear regression analyses were used to investigate associations between seasonality and objective health measurements, while binary logistic regression was used for analysing associations between seasonality and health behaviours. Analyses were adjusted for sociodemographic factors, month of questionnaire completion and sleep duration. Seasonality was positively associated with high waist-hip-ratio, BMI, triglyceride levels, and in men high total cholesterol. Seasonality was negatively associated with HDL cholesterol. In women seasonality was negatively associated with prevalence of exercise and positively associated with daily cigarette smoking.

CONCLUSIONS/SIGNIFICANCE

High seasonality was associated with objective health risk factors and in women also with health behaviours associated with an increased risk for cardiovascular disease.

Cholesterol and affective morbidity

Depression and mania have been linked with low cholesterol though there has been limited prospective study of cholesterol and subsequent course of affective illness. We studied the relationship between fasting total cholesterol and subsequent depressive and manic symptoms. A total of 131 participants from a prospective cohort study were identified as having had a fasting total cholesterol evaluation at intake. Participants were predominantly inpatients at index visit and were followed for a median of 20 and up to 25 years. Cholesterol was modeled with age, gender, and index use of a mood stabilizer in linear regression to assess its influence on subsequent depressive symptom burden in participants with unipolar disorder as well as depressive and manic symptom burden in participants with bipolar disorder. Among bipolar participants (N=65), low cholesterol predicted a higher proportion of follow-up weeks with manic, but not depressive symptoms. Cholesterol did not appear to predict depressive symptom burden among participants with unipolar depression (N=66). Lower cholesterol levels may predispose individuals with bipolar disorder to a greater burden of manic symptomatology and may provide some insight into the underlying neurobiology.

Lipid levels in female patients with affective disorders

The role of serum lipids [total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG)] in the pathophysiology of mood disorders is not clear. The aim of this study was to determine lipid profiles in patients with affective disorders. The study included medication-free female subjects (41 patients with bipolar disorder, 22 in a manic and 19 in a depressive phase), 34 patients with major depression, and 50 healthy controls. Serum lipid levels were determined using standard laboratory tests. All patients had significantly lower HDL-C values than control subjects. Increased TG levels were found in patients with bipolar disorder compared with healthy subjects. The changes in lipid profiles persisted when data were adjusted for age, smoking and menopausal status. The results revealed no differences in cholesterol and LDL-C levels and body mass index, but significant differences in the ratios of cholesterol/HDL-C and LDL-C/HDL-C (atherogenic index) among groups. Our results suggest that low HDL-C levels and a high atherogenic index might be a hallmark of affective disorders. Since low HDL-C levels could be a risk factor for the development of coronary heart disease, further investigation of lipid metabolism in affective disorders is warranted.

Plasma apolipoprotein E is decreased in schizophrenia spectrum and bipolar disorder

We have shown that plasma apolipoprotein E is significantly decreased in treatment-free subjects with schizophrenia spectrum and bipolar disorder but increases after treatment in bipolar disorder. Levels of apolipoprotein D were not changed by treatment. Hence changed apolipoprotein E could be involved in abnormalities in lipid homeostasis in some subjects with psychiatric diseases.

Mood symptoms and serum lipids in acute phase of bipolar disorder in Taiwan

Serum lipids have been found to play important roles in the pathophysiology of mood disorders. The aim of the present study was therefore to investigate the relationship between symptom dimensions and serum cholesterol and triglyceride levels, and to explore correlates of lipid levels during acute mood episodes of bipolar I disorder in Taiwan. Measurements were taken of the serum cholesterol and triglyceride levels in patients with bipolar I disorder hospitalized for acute mood episodes (68 manic, eight depressive, and six mixed). The relationships between serum lipids levels and various clinical variables were examined. The mean serum levels of cholesterol (4.54 mmol/L) and triglycerides (1.16 mmol/L) of sampled patients were comparable to those of the general population in the same age segment. Severe depressive symptoms and comorbid atopic diseases were associated with higher serum cholesterol levels. A negative association was noted between serum triglyceride levels and overall psychiatric symptoms. Compared with previous studies on Western populations, racial differences may exist in lipids profiles of bipolar disorder patients during acute mood episodes. Increased serum cholesterol levels may have greater relevance to immunomodulatory system and depressive symptoms, in comparison with manic symptoms.

Serum lipid levels in seasonal affective disorder

Previous research has assessed the relationship between blood lipid levels and depression with contradictory results. Several studies have linked low cholesterol levels with impulsive, aggressive and suicidal behaviours. The aim of this pilot study was to examine serum lipids in a sample of patients suffering from seasonal affective disorder (SAD). We conducted a retrospective analysis of data on total serum cholesterol and serum triglycerides in 39 SAD patients and 40 non-seasonally depressed or schizophrenic control subjects. Study subjects had to be free of psychotropic drugs for at least 2 weeks. Analysis of covariance (ANCOVA) was performed to assess group differences. After adjustment for significant covariates SAD patients had significantly lower total cholesterol levels (5.21 +/- 1.14 mmol/l) than control subjects (5.94 +/- 1.11 mmol/l; p = 0.013). Moreover, hypercholesterolemia (total cholesterol > 5.20 mmol/l) was significantly less frequent in the SAD group (46.2%) than in the control group (75.0%; p = 0.012). Total serum triglycerides did not differ significantly between SAD patients (1.54 +/- 1.07 mmol/l) and controls (1.56 +/- 0.96 mmol/l; p = 0.126). The results of this study support the idea that low cholesterol levels may be of pathogenetic importance in SAD. Further study in larger clinical samples is warranted to clarify our findings.

Changes in plasma cholesterol in mood disorder patients: does treatment make a difference?

OBJECTIVES

To examine the impact of treatment in patients with acute episodes of major depressive (MD) and manic or hypomanic (M/HM) episodes and co-morbid generalized anxiety symptoms, on the total cholesterol blood levels (TC).

METHOD

A consenting series of patients with acute episodes of DSM IV-R confirmed diagnosis of MD or M/H were included. Subjects were treated with antidepressants, mood stabilizers, or both. The Hamilton depression scale (HAM-D21), the modified mania rating scale (MMRS), and the Hamilton anxiety scale (HAM-A) were utilized to evaluate clinical symptoms. Blood samples were drawn for TC estimations after 10 h of fasting on two occasions over time. The first sample was taken before treatment was started, and the second 4 weeks after treatment. The relationship between changes in TC and the severity of psychiatric symptoms, as measured on HAM-D, MMRS, and the HAM-A, were analysed.

RESULTS

56 subjects (34 with MD and 22 with M/HM episodes) completed the study. About 4 weeks after treatment there was a statistically significant increase in the TC in patients with MD versus a significant decrease in patients with M/HM episodes.

CONCLUSION

Our results replicate earlier reports of significant increase in the cholesterol levels in depressed patients after treatment. We report a significant decrease of TC levels in M/HM episodes with treatment. Although the results in previous reports and in our study are statistically significant, their clinical significance requires further examination in longer-term studies.

Lipid connection to bipolar disorder

Bipolar disorder is a severe and chronic illness affecting approximately 1.5% of the American population. Despite the availability of mood bipolarstabilizers such as lithium, valproate, carbamazepine and lamotrigine, bipolar disorder is characterized by high rates of recurrence, as treatment with these and other drugs is ineffective for and not tolerated by a significant percentage of patients. Several hypotheses have been postulated to explain the mechanism(s) of action of mood stabilizers. However, the biological and molecular bases of the disease are not fully understood, hampering the development of more effective and safer drugs. A large body of evidence associates lipids (cholesterol, phospholipids and fatty acids) with the mechanism and pathology of bipolar disorder. The purpose of this paper is to review the lipid connection to bipolar disorder.

Serum Lipids and Risk Factors for Attempted Suicide in Patients with Alcohol Dependence

BACKGROUND

Alcohol dependence is a major risk factor for suicidal behavior. Although a number of risk factors have been suggested there is still no well-defined risk profile for attempted suicide in alcoholic patients. Alterations of serum lipids have been associated with completed as well as attempted suicide and with suicidal ideation. This study investigated potential demographic and clinical risk factors for attempted suicide in alcohol-dependent patients taking serum lipids additionally into consideration.

METHODS

One-hundred ten alcohol-dependent patients who were admitted to a psychiatric university hospital department for inpatient treatment were grouped according to whether or not they had a lifetime history of attempted suicide. Attempters versus nonattempters as well as attempters who used a violent versus a nonviolent suicide method were compared.

RESULTS

Patients who had attempted suicide at least once in their life differed significantly from those who had no history of suicide attempts. Univariate analyses showed that they were younger (41.7 years vs 46.8 years; p = 0.003), were more often smokers (97% vs 77%; p = 0.011), had more frequently coabused benzodiazepines (54% vs 17%; p = 0.002), and scored currently higher on the Montgomery and Asberg Depression Rating Scale (MADRS) global scale (26.3 vs 20.2; p = 0.005) as well as the "suicidal thoughts" item (1.8 vs 0.6; p = 0.001). Additionally, they had higher serum triglyceride levels (178.9 vs 127.5; p = 0.039). A logistic regression analysis left coabuse of benzodiazepines [odds ratio (OR), 5.26; p = 0.001], younger age (OR per year increase of age, 0.91; p = 0.006), and current MADRS item 10 ("suicidal thoughts") score (OR per point increase in MADRS item 10 score, 1.43; p = 0.019) as significant factors. Suicide attempters who had used a violent method were significantly more often male (82% vs 44%; p = 0.035), were younger (38.2% vs 45.1 years; p = 0.008), and had less frequently coabused tranquilizers (35% vs 78%; p = 0.018) than nonviolent attempters.

CONCLUSIONS

These findings contribute to the development of a more specific profile of alcohol-dependent individuals at risk for suicidal behavior. Further research is required to determine the role of serum triglycerides for suicidal behavior in patients with alcohol dependence.

Leptin and cholesterol levels are low in major depressive disorder, but high in schizophrenia

BACKGROUND

Appetite, food intake and weight are frequently altered in psychiatric disorders such as major depression and schizophrenia. Leptin is an adipocyte hormone, as the product of the ob gene, regulating food intake and energy balance providing the hypothalamus with information on the amount of body fat. Leptin seems to be strongly associated with lipid metabolism. Moreover, leptin is involved in the control of other behaviors and in brain development. There are few studies about the amounts of plasma leptin in mood disorder and schizophrenia with inconsistent findings. The relationship between leptin and major depressive disorder is still unknown. We planned to investigate the relationship of the serum leptin concentration, cholesterol, and BMI between patients with major depressive disorder, schizophrenic patients and healthy control subjects.

METHODS

In the present study, the BMI, plasma cholesterol and leptin levels, BDI, and BPRS were compared in 69 patients with major depressive disorder, 78 schizophrenic patients, and 51 healthy controls.

RESULTS

The major findings of our study included (1) leptin and cholesterol levels were low in patients with major depressive disorder, but high in schizophrenic patients; (2) negative correlations between BDI scores and serum cholesterol or leptin levels in the patients with major depressive disorder; (3) an inconsistently positive correlation between mean leptin levels, cholesterol, and BMI among different groups; (4) positive correlations between serum cholesterol or leptin levels and the length of illness in the schizophrenic patients.

CONCLUSIONS

In this study, our results indicate that that leptin and cholesterol might play differently important pathophysiological roles in these psychiatric disorders.

Reductions in cholesterol and synaptic markers in association cortex in mood disorders

OBJECTIVES

Cholesterol forms an integral part of cell membranes and is a major component of myelin. Furthermore, cholesterol also plays a vital role in the development, function and stability of synapses. While low serum cholesterol has previously been associated with mood disorders, cholesterol levels have yet to be quantified within the brain in these disorders. The aim of this study was to quantify sterol levels in the brains of patients with major psychiatric disorders and further to relate these levels to markers of myelin and synapses.

METHODS

Samples of visual association cortex were obtained postmortem from subjects with bipolar disorder (BPD), major depressive disorder (MDD) and schizophrenia (SCZ) and from controls (all n = 15). Concentrations of brain cholesterol, its precursors lathosterol, desmosterol and lanosterol and its metabolite 24S-hydroxycholesterol were determined by gas-liquid chromatography. Immunoreactivity for myelin basic protein (MBP), synaptophysin and VAMP was quantified by enzyme-linked immunosorbent assay.

RESULTS

Cholesterol levels were 13% lower in MDD (p = 0.018) and 10% lower in BPD (p = 0.052) compared with controls. Cholesterol precursor or metabolite concentrations did not differ between groups. Synaptophysin immunoreactivity was 20% lower in BPD (p = 0.025) and VAMP immunoreactivity 37% lower in MDD (p = 0.032) and 45% lower in BPD (p = 0.009). MBP immunoreactivity was not altered in any disorder.

CONCLUSIONS

Our data suggest that lower brain cholesterol levels and a reduction in synapses may be features of mood disorders.

Serum lipid profiles in major depression with clinical subtypes, suicide attempts and episodes

BACKGROUND

We tried to report the data between serum lipid profiles and major depression with different clinical subtypes, with or without suicide attempts, and with single episode or recurrent episodes.

METHOD

During a 2-year period, a total of 168 participants (109 patients with major depression and 59 subjects in a healthy control group) were recruited in this study. Blood samples for serum lipid profiles in all participants were collected. Data analysis was performed by using an analysis of covariance (ANCOVA) with body mass index (BMI) adjustment.

RESULTS

The data showed that there were no significant differences of any kind in serum lipid profiles between depressive patients with melancholic feature or atypical feature, with or without suicide attempts nor between depressive patients with single episode or recurrent episodes.

CONCLUSION

The results suggested there were no serum lipid profiles used as biological markers to distinguish the clinical subtypes, suicide attempts and episodes in patients with major depression.

Mood Scores in Relation to Hormone Replacement Therapies during Menopause: A Prospective Randomized Trial

There is lack of studies in literature about the long-term effects of hormone replacement therapies and cholesterol levels on mood scores in menopause. In the present study we have investigated whether serum lipid levels affect mood scores in menopause and evaluated the long-term effects of the combined hormone replacement regimens (HRT) on depressive symptoms in postmenopausal women. In this prospective-randomized, placebo-controlled, double-blind study, 286 women in menopause were divided into four groups according to therapeutic regimens they received; 1) Conjugated equine estrogen (CEE) of 0.625 mg plus medroxyprogesterone acetate (MPA) of 2.5 mg (n = 79), 2) CEE (0.625 mg) plus MPA of 5 mg (n = 77), 3) tibolone of 2.5 mg (a selective tissue estrogenic activity regulator) (n = 76), and 4) Calcium (Ca) of 1,000 mg (n = 54). Beck Depression Inventory (BDI), and serum levels of lipoprotein lipids were assessed before and after 12-months of treatment with oral continuous HRT and Ca supplementation. BDI scores in the study groups were not correlated with lipid profiles. We compared two subgroups of patients with initial BDI scores 0-14 (normal mood scores) in order to asses for the possible relation between the lipid profile and mood. Following treatment, first subgroup had increased scores to 15-30 (mildly depressed women, n = 27) and the second subgroup preserved BDI scores of 0-14 (normal mood scores, n = 23). Serum levels of total cholesterol, high-density lipoprotein, low-density lipoprotein and body mass index were found to be similar between these two groups. BDI scores decreased significantly in all HRT groups after 12 months of treatment, compared to Ca group (p < 0.05). We did not observe any correlation between BDI scores and lipid profiles before and following continuous HRT or Ca supplementation. Continuous combined hormone replacement regimens, CEE + MPA and tibolone, have superior long-term effects on mood scores in menopause and should be considered during the decision process for use of HRT due to menopausal symptoms.

Aberration of cholesterol level in first-onset bipolar I patients

Cholesterol interacts with serotonin and it has been found to be associated with some clinical symptoms of mood disorders. There is a paucity of data on first-onset bipolar patients and from Asian population. The total cholesterol (TC) level was examined in 25 bipolar I patients with a single manic episode (BPSM) and 30 controls. The TC level was significantly lower in the BPSM than in the controls. There were negative correlations between the Young mania rating scale (YMRS) scores and the pretreatment TC level in BPSM. This study suggests that the TC level can be changed after treatment in bipolar manic patients, although more studies involving different ethnic groups will be needed.

Lipid and lipoprotein levels in depressive disorders with melancholic feature or atypical feature and dysthymia

The purpose of the present study was to explore the relationship between serum lipid and lipoprotein levels and clinical subtypes in patients with depressive disorders. A total of 207 patients who were admitted for general health screening were assessed by using the semistructured clinical interview for Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria for the possibility of having depressive disorders. Blood and physical examinations were done to rule out systemic diseases. A total of 142 patients without systemic diseases was recruited for further analysis, including dysthymia (n = 35), major depressive disorder with melancholic feature (n = 22), major depressive disorder with atypical feature (n = 46) and normal controls (n = 39). Analysis of covariance after age adjustment reveals significant differences in patients with melancholic feature and patients with atypical feature in serum concentrations of triglyceride (TG) and very-low-density-lipoprotein cholesterol (VLDL) in men, and high-density-lipoprotein cholesterol (HDL) in women. This suggests that the TG, VLDL and HDL levels might be used as biological markers to differentiate between major depressive patients with melancholic feature or atypical feature.

Serum lipid levels and suicide attempts

OBJECTIVE

To determine whether a correlation exists between lower serum lipid concentrations and increased suicide risk.

METHOD

Serum lipid profiles were pair-matched for 60 patients who had recently experienced failed attempts at suicide and equal numbers of non-suicidal psychiatric patients, and normal controls. Suicide attempt severity was scored using Weisman and Worden's risk-rescue rating scale.

RESULTS

(a). Total serum cholesterol and low density lipoprotein levels were found to be lower in the parasuicidal population at statistically significant levels (P < 0.01 and <0.05, respectively); (b). triglyceride concentrations were lower in suicide attempters with major depression compared with non-suicidal depressed patients; and (c). risk-rescue rating scores were negatively correlated with total serum cholesterol levels (r = -0.347, P = 0.007).

CONCLUSION

Low lipid metabolism may be a potential biological marker in the assessment of suicide risk. Further investigations are necessary to elucidate the biological mechanisms of these findings.

Correlation between serum lipid, lipoprotein concentrations and anxious state, depressive state or major depressive disorder

The purpose of this study was to investigate the correlation between serum lipid, lipoprotein concentrations and anxious state, depressive state or major depressive disorder. A total of 207 patients admitted for general health screening were recruited during a 1-year period. Using the Chinese Health Questionnaire, the Taiwanese Depression Questionnaire and the semi-structured clinical interview for DSM-IV, one psychiatrist screened all participants for the presence of anxiety or depressive disorders. Blood samples for serum lipid and lipoprotein concentrations and physical examination records were collected simultaneously. For patients who did not have systemic diseases (n=162), we found that high-density lipoprotein (HDL) cholesterol and the ratio of total cholesterol (TC)/HDL differed significantly among anxious state, depressive state and normal groups in men after age adjustment. On the other hand, the ratios of TC/HDL and low-density lipoprotein (LDL)/HDL showed significant differences between patients with major depressive disorder and normal controls in women. This study suggested that the level of HDL cholesterol and the ratios of TC/HDL and LDL/HDL (atherogenic index) might be another markers of the possible association between serum lipids and anxiety or depression.

Association between low plasma levels of cholesterol and relapse in cocaine addicts

OBJECTIVE

In light of recent studies suggesting the existence of associations between low concentrations of cholesterol and various psychiatric disorders, we decided to explore relationships between cholesterol levels and relapse rates in a group of cocaine addicts who had undergone inpatient detoxification.

METHODS

The total cholesterol levels of 38 non-opiate-dependent and non-alcohol-dependent cocaine addicts were determined while they were hospitalized. Drug use was subsequently assessed 3, 6, and 12 months after patients were discharged from the hospital.

RESULTS

Comparisons of the cholesterol levels (obtained during hospitalization) of relapsers and nonrelapsers by analyses of covariance with age and weight as covariates revealed significantly lower cholesterol values in patients who relapsed at 3 months (p =.046), 6 months (p =.030), and 12 months (p =.019) after discharge.

CONCLUSIONS

This study showed an association between a low total cholesterol level and relapse rates in detoxified cocaine addicts. Reasons for the predictive value of low cholesterol levels for relapse for up to 1 year after cholesterol measurements were made are unclear. These data are preliminary and in need of replication.

Relationship between attempted suicide, serum cholesterol level and novelty seeking in psychiatric in-patients

This study sought to compare the serum cholesterol levels of psychiatric in-patients, with and without recent suicidal behavior. The hypothesis was that the temperament dimension novelty seeking (NS) would be an intermediary variable, correlated with both serum cholesterol level and suicidal behavior. The study included 155 psychiatric in-patients, 21.9% (n=34) of whom had recently attempted suicide. Their cholesterol level was compared to that of patients with no suicide attempt. The NS dimension was explored with the aid of Cloninger's Temperament and Character Inventory. Significantly lower average cholesterol levels were found in women who had attempted suicide before hospitalization than for the others (4.71 mmol/l+/-0.83 vs. 5.52 mmol/l+/-1.36). Similar results were not found for men. However, the average NS scores did not differ according to suicide attempts in women or in men, and the scores of NS were not correlated with cholesterol level. This study confirms an association between low cholesterol and suicidal behavior in women only, but this association seems independent from the NS personality dimension. The absence of a correlation between serum cholesterol levels and suicidal behavior in men could be linked to the small number of men included in the study.

Sleep-related violence and low serum cholesterol: a preliminary study

To examine whether there is a relationship between serum cholesterol level and sleep-related violence, we evaluated 15 patients with violent behavior during sleep (VBS) and 15 normal control subjects. The patient and control groups were matched for sex, age, and weight. There were 13 women and two men in each group. The patients with VBS had lower serum total cholesterol, triglyceride, and low-density lipoprotein levels than the healthy subjects. Low cholesterol may effect serotonergic neuronal activity and some types of 5-HT receptors, then may be related to violent behavior during sleep.

Low serum cholesterol is correlated to suicidality in a Korean sample

OBJECTIVE

The aim of this study was to examine further the association between low total serum cholesterol and suicidal behaviour.

METHOD

We measured the serum cholesterol levels in 231 patients admitted to an emergency room following a suicide attempt, in 231 age-,sex- and diagnosis-matched non-suicidal psychiatric controls, and in 231 age- and sex-matched normal controls. The suicide attempt patients were divided into five grades according to the degree of injury.

RESULTS

The mean total cholesterol level of the suicide attempt patients was significantly lower than that of the psychiatric and normal controls. When the suicide attempt patients and non-suicidal psychiatric controls were divided by diagnosis, this significant relationship held true for major depressive disorders and personality disorders, but not for schizophrenia and bipolar disorders. Cholesterol level and the severity of suicide attempt were inversely correlated.

CONCLUSION

The results suggest that cholesterol level may serve as a marker for suicide risk. Possible explanations are discussed.

Association of personal and familial suicide risk with low serum cholesterol concentration in male lithium patients

OBJECTIVE

We sought to establish whether low cholesterol concentration may be associated with a personal history of attempted suicide or a family history of completed suicide in psychiatric out-patients on maintenance lithium treatment, who represent a population at risk for suicide.

METHOD

We retrospectively reviewed charts regarding 783 out-patients consecutively admitted to a lithium clinic from 1976 to 1999. Individual age- and gender-specific quartile of serum cholesterol concentration were correlated against personal lifetime suicide attempts and completed suicide in first-degree relatives.

RESULTS

The proportion of men with a personal lifetime history of attempted suicide, especially if violent, and that of men with history of completed suicide in a first-degree relative were significantly higher among the group with cholesterol concentration in the lowest quartile compared to the group with cholesterol levels above the 25th percentile.

CONCLUSION

Low cholesterol concentration should be studied further as a potential biological/genetic marker of suicide risk.

Correlation between serum lipid concentrations and psychological distress

This study examines the correlations between serum lipid levels and psychological distress. There were 4444 consecutive attendees of general health clinics who participated in the study. Psychological symptoms were measured by the Taiwanese version of the Symptoms Check List 90, revised (T-SCL-90-R). Levels of fasting serum lipids, including total cholesterol, total triglycerides and high-density lipoprotein cholesterol (HDL-C), were determined. Multiple linear regression analyses, with adjustment for confounders, revealed that the concentration of HDL-C had significant inverse associations with scores of depression, somatization and phobic anxiety. Women with an HDL-C level lower than 35 mg/dl scored significantly higher on depression, interpersonal sensitivity, phobia, anxiety, somatization and aggressive hostility, while subjects with a total cholesterol concentration lower than 160 mg/dl scored significantly higher on anxiety, aggressive hostility, phobia, and psychoticism. This study provides, for the first time, comprehensive data derived from the Taiwanese population on the link between lipids and psychological symptoms, revealing a reverse correlation between depression and serum concentrations of HDL-C.

Low-density lipoprotein apheresis in the treatment of atherosclerosis and other potential uses

This review concerns the clinical impact of low-density lipoprotein (LDL) apheresis for patients with refractory hypercholesterolemia. We examine and provide examples of investigations that have demonstrated the clinical benefits of LDL apheresis. In addition to benefits derived from the stabilization or regression of arterial lesions, we highlight other possible mechanisms related to clinical improvement. We also discuss the potential advantages of lipid apheresis for the treatment of patient populations other than those characterized by severe hypercholesterolemia and premature coronary heart disease.

Serum lipid concentrations in patients with comorbid generalized anxiety disorder and major depressive disorder

OBJECTIVE

To examine the lipid levels in a sample of patients with comorbid generalized anxiety disorder (GAD) and major depressive disorder (MDD).

METHODS

Serum lipid concentrations were examined in 40 patients with both GAD and MDD, in 27 patients with MDD only, in 26 patients with GAD only, and in 24 healthy control subjects.

RESULTS

All mean serum cholesterol concentrations are presented in Table 1. The mean serum total cholesterol concentration in patients with both GAD and MDD was significantly higher than in MDD-only patients, GAD-only patients, and control subjects. The triglyceride concentration was also significantly higher in patients with both GAD and MDD than in MDD-only patients, GAD-only patients, and control subjects. Patients with both GAD and MDD had a lower mean high-density lipoprotein cholesterol (HDL-C) concentration than did patients with GAD only and control subjects. The serum concentration of low-density lipoprotein cholesterol (LDL-C) was higher in patients with both GAD and MDD than in patients with MDD only and GAD only and healthy control subjects.

CONCLUSIONS

Our findings indicate that the patients with both GAD and MDD have increased serum cholesterol, triglyceride, and LDL-C and reduced HDL-C levels. These patients may have a greater risk of mortality from coronary artery disease (CAD) than do patients with either depression or anxiety disorder.

Randomized trial of the effects of cholesterol-lowering dietary treatment on psychological function

PURPOSE

Epidemiological studies have suggested that cholesterol lowering could affect psychological functioning. This study was designed to test whether cholesterol-lowering diets adversely affect mood and cognitive function.5.2 mM [198 mg/dL]) to either a low-fat diet, a Mediterranean diet, or a waiting-list control. Cholesterol levels, psychological well-being (depression, anxiety, hostility), and cognitive function were assessed at baseline, 6 weeks, and 12 weeks.

RESULTS

Total serum cholesterol levels fell significantly more in the intervention groups (8.2% reduction) than in the control group (P <0.001). All three groups showed a modest improvement in psychological well-being during the 12-week treatment period, but there were no differences among the groups. There were no between-group differences on three measures of cognitive function, but for a fourth measure, which involved the task with the greatest processing load, the two intervention groups did significantly worse (P <0.001) than the control group. The change in performance was correlated with the change in total serum cholesterol level (r = 0. 21, P = 0.01).

CONCLUSIONS

Two dietary interventions that successfully lowered serum cholesterol levels had no adverse effect on mood. There was some evidence for a relative impairment in cognitive function in the treated groups in one of four cognitive tests, but additional studies will be required to determine the relevance of this finding.

Low HDL cholesterol, aggression and altered central serotonergic activity

Many studies support a significant relation between low cholesterol levels and poor impulse, aggression and mood control. Evidence exists also for a causal link between low brain serotonin (5-HT) activity and these behaviors. Mechanisms linking cholesterol and hostile or self-destructive behavior are unknown, but it has been suggested that low cholesterol influences 5-HT function. This study was designed to explore the relationship between plasma cholesterol, measures of impulsivity and aggression, and indices of 5-HT function in personality disordered cocaine addicts. Thirty-eight hospitalized male patients (age 36.8+/-7.1) were assessed with the DSM-III-R, the Buss-Durkee Hostility Inventory (BDHI), the Barratt Impulsiveness Scale (BIS) and the Brown-Goodwin Assessment for Life History of Aggression. Fasting basal cholesterol (total, LDL and HDL) was determined 2 weeks after cocaine discontinuation. On the same day 5-HT function was assessed by neuroendocrine (cortisol and prolactin) and psychological (NIMH and 'high' self-rating scales) responses following meta-chlorophenylpiperazine (m-CPP) challenges. Reduced neuroendocrine responses, 'high' feelings and increased 'activation-euphoria' following m-CPP have been interpreted as indicating 5-HT alterations in a variety of psychiatric conditions. Significantly lower levels of HDL cholesterol were found in patients who had a history of aggression (P=0.005). Lower levels of HDL cholesterol were also found to be significantly associated with more intense 'high' and 'activation-euphoria' responses as well as with blunted cortisol responses to m-CPP (P=0.033, P=0.025 and P=0.018, respectively). This study gives further support to existing evidence indicating that in some individuals, the probability of exhibiting impulsive and violent behaviors may be increased when cholesterol is low. It also suggests that low cholesterol and alterations in 5-HT activity may be causally related.

Cholesterol levels in mood disorders: high or low?

OBJECTIVES

To assess cholesterol levels in patients with mood disorders.

METHODS

All consecutively admitted patients meeting inclusion criteria (n = 50) who were hospitalized in an affective disorders unit received assessments of cholesterol levels. Correlations were made with diagnosis using DSM-IV criteria, current mood states, and other clinical and demographic features of illness. Exclusion criteria included current alcohol abuse, medical illnesses that could influence cholesterol levels, eating disorders, and age greater than 70 years.

RESULTS

Cholesterol levels did not differ based on diagnostic status of unipolar depression or bipolar disorder. In the total sample, cholesterol levels were lower in patients with current manic (170.2 +/- 38.9, p = 0.05) and depressive (182.0 +/- 42.0) than in mixed (226.4 +/- 43.3) episodes (p = 0.05). In subgroups of patients with bipolar disorder, manic episodes (169.9 +/- 38.8, n = 9) were associated with lower cholesterol levels than depressive (201.0 +/- 49.4) or mixed (226.4 +/- 44.4) episodes (p = 0.02 for comparison of manic and mixed episodes). Body mass index (BMI), age, alcohol use, and gender did not account for these findings.

CONCLUSIONS

Cholesterol levels were lower in manic and depressive than in mixed episodes. No differences were found between diagnoses of unipolar or bipolar mood disorders. Cholesterol may be a state rather than a trait function, and may be influenced by the acute mood state.

Lowered omega3 polyunsaturated fatty acids in serum phospholipids and cholesteryl esters of depressed patients

Depression is associated with a lowered degree of esterification of serum cholesterol, an increased C20:4omega6/C20:5omega3 ratio and decreases in omega3 fractions in fatty acids (FAs) or in the red blood cell membrane. The aims of the present study were to examine: (i) serum phospholipid and cholesteryl ester compositions of individual saturated fatty acids (SFAs), monounsaturated FAs (MUFAs) and polyunsaturated FAs (PUFAs) in major depressed patients vs. healthy volunteers; (ii) the relationships between the above FAs and lowered serum zinc (Zn), a marker of the inflammatory response in depression; and (iii) the effects of subchronic treatment with antidepressants on FAs in depression. The composition of the FAs was determined by means of thin layer chromatography in conjunction with gas chromatography. Lipid concentrations were assayed by enzymatic colorimetric methods. The oxidative potential index (OPI) of FAs was computed in 34 major depressed inpatients and 14 normal volunteers. Major depression was associated with: increased MUFA and C22:5omega3 proportions and increased C20:4omega6/C20:5omega3 and C22:5omega6/C22:6omega3 ratios; lower C22:4omega6, C20:5omega3 and C22:5omega3 fractions in phospholipids; lower C18:3omega3, C20:5omega3 and total (sigma)omega3 FAs, and higher C20:4omega6/C20:5omega3 and sigmaomega6/sigmaomega3 ratios in cholesteryl esters; lower serum concentrations of phospholipids and cholesteryl esters; and a decreased OPI. In depression, there were significant and positive correlations between serum Zn and C20:5omega3 and C22:6omega3 fractions in phospholipids; and significant inverse correlations between serum Zn and the sigmaomega6/sigmaomega3, C20:4omega6/C20:5omega3, and C22:5omega6/C22:6omega3 ratios in phospholipids. There was no significant effect of antidepressive treatment on any of the FAs. The results show that, in major depression, there is a deficiency of omega3 PUFAs and a compensatory increase in MUFAs and C22:5omega6 in phospholipids. The results suggest that: (i) there is an abnormal metabolism of omega3 PUFAs in depression; (ii) the FA alterations in depression are related to the inflammatory response in that illness; and (iii) the disorders may persist despite successful antidepressant treatment.

Low cholesterol level in patients with panic disorder: the association with major depression

BACKGROUND

The purpose of this study was to examine whether an association exists between low cholesterol level and major depression in patients with panic disorder.

METHODS

The subjects of the study were 16 patients panic disorder only, 16 panic disorder patients had also current major depressive episode, and 16 normal control subjects. An automated enzymatic colorimetric method was used for cholesterol determination.

RESULTS

Panic disorder patients had higher serum cholesterol than panic disorder patients with major depression and normal controls.

CONCLUSION

There is an association between low cholesterol level and the presence of major depression in patients with panic disorder.

LIMITATION

Future studies with large sample are needed to confirm this finding.

CLINICAL RELEVANCE

A low serum cholesterol level might serve as biological marker of major depression in patients panic disorder.

Suicide: a four-pathway clinical-biochemical model

This chapter, based on a review of recent research as well as data presented in this report, proposes four hypothetical pathways leading to suicide in clinical depression: (1) an acute pathway involving severe anxiety/agitation associated with high brain corticotrophin-releasing factor (CRF or CRH) levels, (2) trait baseline and reactivity hopelessness, (3) severe anhedonia, and (4) trait impulsiveness associated with low brain serotonin turnover and low total cholesterol as a possible peripheral correlate. Clinical research showing evidence for acute versus chronic high-risk suicide factors and other studies linking severe anxiety/agitation to high CRF levels will be presented as associated with acute suicidal risk, which is potentially reversible with recognition and treatment. Evidence for anhedonia severity as a risk factor and trait, as well as evidence that baseline hopelessness and sensitivity are traits related to chronic suicide risk, will be presented. Finally, evidence relating low serum cholesterol to suicide in depressed inpatients will be presented in the context of literature suggesting a relationship between low serum cholesterol and violent death and suicide in population studies. Data suggesting a relationship between low serum cholesterol and decreased CSF 5-HIAA, suggesting reduced serotonin turnover, will be presented, in light of prior studies relating low CSF 5-HIAA and violent suicide. These data taken together suggest four pathways to suicide that are worth investigating in order to better understand the mechanisms leading to this behavior. Future possibilities and applications of these findings are discussed.

The Münster Heart Study (PROCAM): total mortality in middle-aged men is increased at low total and LDL cholesterol concentrations in smokers but not in nonsmokers

BACKGROUND

Some large epidemiological studies have shown an increase in mortality at low levels of total and LDL cholesterol. It has been speculated that low cholesterol levels may play a causative role in this association. To investigate this question, we analyzed all deaths occurring among middle-aged men in the Münster Heart Study (PROCAM), one of the largest prospective epidemiological studies of coronary heart disease risk markers in Europe.

METHODS AND RESULTS

In the Münster Heart Study, 10,856 men aged 36 to 65 years at study entry (46.8+/-7.3 years [mean+/-SD]) were followed for 4 to 14 years (7.1+/-2.4 years). During this period, 313 deaths occurred--46 from myocardial infarction, 48 from suspected or definite sudden cardiac death, 14 from cerebrovascular disease, and 10 from other diseases of the circulatory system. There were 121 deaths from cancer and 33 deaths from violent causes (injuries in 16, suicide in 14, and homicide in 3 cases). Death in 29 cases occurred from other causes and was unexplained in 12 cases. Total cholesterol, LDL cholesterol, and the LDL/HDL ratio showed a J-shaped relationship with total mortality. At high total and LDL cholesterol concentrations, increased mortality was due to increased coronary deaths. At low total and LDL cholesterol concentrations, increased mortality was seen in smokers only and was explained by an increase in smoking-related cancer deaths.

CONCLUSIONS

The increase in mortality at low levels of total and LDL cholesterol among middle-aged men in the Münster Heart Study is explained by an increase in smoking-related cancer deaths among smokers.