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Sen P, Adewusi D, Blakemore AI, Kumari V. How do lipids influence risk of violence, self-harm and suicidality in people with psychosis? A systematic review. Aust N Z J Psychiatry 2022; 56:451-488. [PMID: 34240626 PMCID: PMC9036157 DOI: 10.1177/00048674211025608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Low cholesterol has been linked with violent and suicidal behaviour in people with schizophrenia. This association, if consistently present, may be a promising biological marker that could assist clinicians in decision making regarding risk and treatment. We conducted a systematic review to assess whether there is a reliable association between lipid profile (total cholesterol, high- and low-density lipoprotein cholesterol, and triglycerides) and aggression, self-harm or suicide in people with schizophrenia, and whether effects are similar in males and females. METHOD Relevant databases were searched to identify primary research studies (up to November 2020) that (1) involved adults (some samples also included 16- to 18-year olds) with a confirmed diagnosis of schizophrenia, schizoaffective disorder or psychosis; and (2) included a standardised assessment of verbal aggression, physical aggression against objects, physical aggression against self (including suicide) or others. The search yielded 23 studies eligible for inclusion following a quality appraisal. RESULTS Suicidality was the most commonly assessed subtype of aggression (20 studies). For suicidality, about half the studies, including the study with the largest sample size, found a link with total cholesterol. An association between low total cholesterol and violence towards others was found in six of nine studies that investigated this. The evidence for a link with violence was the strongest for total cholesterol, followed by low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, and the weakest for triglycerides. Only a few studies investigated sex differences and yielded mixed evidence. Studies focussed on self-harm as well as involving females in forensic settings were lacking. CONCLUSION There is encouraging evidence of an association between low total cholesterol and aggression towards others as well as suicidality in schizophrenia. Future studies should systematically explore this association in people with schizophrenia who have a significant history of violence, suicidality and self-harm, both inpatients and community, and also investigate underlying mechanisms.
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Affiliation(s)
- Piyal Sen
- Department of Life Sciences, Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK,GKT School of Medicine, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Danielle Adewusi
- GKT School of Medicine, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Alexandra I Blakemore
- Department of Life Sciences, Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK,Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Veena Kumari
- Department of Life Sciences, Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK,Veena Kumari, Department of Life Sciences, and Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK.
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2
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Abstract
Suicide is a world health priority. Studies over the last few decades have revealed the complexity underlying the neurobiological mechanisms of suicide. Researchers have found dysregulations in the serotonergic system, the stress system, neural plasticity, lipid metabolism, and cell signaling pathways in relation to suicidal behaviors. These findings have provided more insight into the final path leading to suicide, at which medical intervention should be applied to prevent the action. However, because these molecular mechanisms have been implicated in both depression and suicide, the specificity of the mechanisms has been obscured. In this review, we summarize the main findings of studies on molecular mechanisms of suicidal behavior from the last 2 decades, with particular emphasis on the potential, independent role of each mechanism that is not contingent upon an underlying psychopathology, such as depression. The act of suicide is multifactorial; no single molecular mechanism is sufficient to fully account for the act. Knowledge of the reciprocal interactions among these molecular mechanisms and studying them in the context of brain circuitry by using neuroimaging techniques will provide a better understanding of the neurobiology of suicide.
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Affiliation(s)
- Sangha Kim
- Department of Psychiatry, Yeouido St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyoung-Uk Lee
- Department of Psychiatry, Uijeongbu St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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3
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Kotyuk E, Biro V, Bircher J, Elek Z, Sasvari M, Szekely A. ABCA1 Polymorphism, a Genetic Risk Factor of Harm Avoidance. JOURNAL OF INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1027/1614-0001/a000235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Even though cholesterol homeostasis and self-harm behaviors have shown to be associated, gene polymorphisms of the cholesterol system have not been studied yet in the context of self-harm related personality traits. Here we present an association study between six ABCA1 polymorphisms and temperament scales measured by Cloninger’s Temperament and Character Inventory on 253 young adults. An association between ABCA1 rs4149264 and harm avoidance has been observed. This association remained significant after Bonferroni correction. Haplotype analysis confirmed an independent association between rs4149264 and harm avoidance. ABCA1, a cholesterol homeostasis gene, is a candidate gene for harm related personality traits.
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Affiliation(s)
- Eszter Kotyuk
- Postdoctoral Research Program, Hungarian Academy of Sciences, Budapest, Hungary
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Viktor Biro
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Julianna Bircher
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Zsuzsanna Elek
- Institute of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | - Maria Sasvari
- Institute of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | - Anna Szekely
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
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4
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Messaoud A, Mensi R, Mrad A, Mhalla A, Azizi I, Amemou B, Trabelsi I, Grissa MH, Salem NH, Chadly A, Douki W, Najjar MF, Gaha L. Is low total cholesterol levels associated with suicide attempt in depressive patients? Ann Gen Psychiatry 2017; 16:20. [PMID: 28428806 PMCID: PMC5392998 DOI: 10.1186/s12991-017-0144-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/05/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Patients with major depressive disorder (MDD) have a high risk of suicide. Many pathophysiological factors involved in MDD and suicide such us a low cholesterol levels have been associated with MDD and increased vulnerability to suicide. In this study, we investigate the relation between lipid parameters and suicide risk in patients with MDD. METHODS Plasma levels of total cholesterol, triglycerides, and high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c) were determined in 160 patients meeting the DSM-IV-TR criteria for MDD (110 patients without suicidal behavior and 52 suicidal attempters) and 151 healthy controls. RESULTS A significant decrease in plasma cholesterol levels was observed in the group of suicidal depressive patients compared to those without suicidal behavior (p < 0.001). For the other lipid levels (triglycerides, HDL cholesterol, and LDL cholesterol), there were no significant differences between suicidal and non-suicidal patients. CONCLUSIONS Our study showed a significant decrease in plasma cholesterol levels in suicidal patients. This result support the hypothesis of the association of low plasma cholesterol level and suicidal behavior in patients with major depressive disorder.
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Affiliation(s)
- A Messaoud
- Research Laboratory 'Vulnerability to psychotic disorders LR 05 ES 10', Department of Psychiatry, Monastir University Hospital, University of Monastir, Monastir, Tunisia
| | - R Mensi
- Research Laboratory 'Vulnerability to psychotic disorders LR 05 ES 10', Department of Psychiatry, Monastir University Hospital, University of Monastir, Monastir, Tunisia.,Laboratory of Biochemistry-Toxicology, Monastir University Hospital, University of Monastir, Monastir, Tunisia
| | - A Mrad
- Research Laboratory 'Vulnerability to psychotic disorders LR 05 ES 10', Department of Psychiatry, Monastir University Hospital, University of Monastir, Monastir, Tunisia
| | - A Mhalla
- Research Laboratory 'Vulnerability to psychotic disorders LR 05 ES 10', Department of Psychiatry, Monastir University Hospital, University of Monastir, Monastir, Tunisia
| | - I Azizi
- Research Laboratory 'Vulnerability to psychotic disorders LR 05 ES 10', Department of Psychiatry, Monastir University Hospital, University of Monastir, Monastir, Tunisia.,Laboratory of Biochemistry-Toxicology, Monastir University Hospital, University of Monastir, Monastir, Tunisia
| | - B Amemou
- Research Laboratory 'Vulnerability to psychotic disorders LR 05 ES 10', Department of Psychiatry, Monastir University Hospital, University of Monastir, Monastir, Tunisia
| | - I Trabelsi
- Department of Emergency, Monastir University Hospital, University of Monastir, Monastir, Tunisia
| | - M H Grissa
- Department of Emergency, Monastir University Hospital, University of Monastir, Monastir, Tunisia
| | - N Haj Salem
- Department of Forensic Medicine, Monastir University Hospital, University of Monastir, Monastir, Tunisia
| | - A Chadly
- Department of Forensic Medicine, Monastir University Hospital, University of Monastir, Monastir, Tunisia
| | - W Douki
- Research Laboratory 'Vulnerability to psychotic disorders LR 05 ES 10', Department of Psychiatry, Monastir University Hospital, University of Monastir, Monastir, Tunisia.,Laboratory of Biochemistry-Toxicology, Monastir University Hospital, University of Monastir, Monastir, Tunisia
| | - M F Najjar
- Laboratory of Biochemistry-Toxicology, Monastir University Hospital, University of Monastir, Monastir, Tunisia
| | - L Gaha
- Research Laboratory 'Vulnerability to psychotic disorders LR 05 ES 10', Department of Psychiatry, Monastir University Hospital, University of Monastir, Monastir, Tunisia
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5
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Tomson K, Vaht M, Laas K, Veidebaum T, Harro J. Effect of a human serotonin 5-HT 2A receptor gene polymorphism on impulsivity: Dependence on cholesterol levels. J Affect Disord 2016; 206:23-30. [PMID: 27455355 DOI: 10.1016/j.jad.2016.07.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 06/30/2016] [Accepted: 07/16/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Impulsivity is multidimensional: Low impulse control may result in behavioural disorders, but acting on the spur of moment may also be advantageous. Previous studies have shown negative associations between different facets of impulsivity and serotonergic function. Other investigations have found negative correlations between serum lipid levels and impulsivity. METHODS We have investigated whether the functional polymorphism -1438A/G in the serotonin 5-HT2A receptor gene (HTR2A) is associated with impulsivity levels and whether there is any interaction with serum lipid levels. This analysis was based on data of the population-representative Estonian Children Personality Behaviour and Health Study at age 25. Impulsivity was self-reported with the Adaptive and Maladaptive Impulsivity Scale. RESULTS Subjects with the A/A genotype of the HTR2A -1438A/G polymorphism had higher scores of Maladaptive impulsivity, but not Adaptive impulsivity. In females, high LDL and total cholesterol levels increased the genotype effect. In males, in the highest quartile of total or LDL cholesterol the genotype effect was altered, with G/G homozygotes having the highest Maladaptive impulsivity levels. LIMITATIONS Only one cohort of the European Youth Heart Study (EYHS) was used in the current study and impulsivity measures were self-reported. CONCLUSIONS Our results do not support the notion that low cholesterol levels universally lead to higher impulsivity, but it was found that high total and LDL cholesterol levels moderate the effect of the HTR2A gene promoter polymorphism. This suggests that future studies on impulsivity need to consider the interaction of serotonergic measures with the whole range of cholesterol levels.
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Affiliation(s)
- Katrin Tomson
- Division of Neuropsychopharmacology, Department of Psychology, University of Tartu, Ravila 14A, Tartu, Estonia; Department of Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia.
| | - Mariliis Vaht
- Division of Neuropsychopharmacology, Department of Psychology, University of Tartu, Ravila 14A, Tartu, Estonia.
| | - Kariina Laas
- Division of Neuropsychopharmacology, Department of Psychology, University of Tartu, Ravila 14A, Tartu, Estonia.
| | - Toomas Veidebaum
- National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia.
| | - Jaanus Harro
- Division of Neuropsychopharmacology, Department of Psychology, University of Tartu, Ravila 14A, Tartu, Estonia.
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Abstract
OBJECTIVES To evaluate if n-3 polyunsaturated fatty acids (PUFAs) and lipid levels are associated with episodes of self-harm or depression over a 10-year period. METHODS We included 40 individuals who self-harmed and 40 controls. Episodes of self-harm and depression were ascertained and levels of depression, impulsivity, suicidal ideation and plasma lipid levels measured at baseline and at 10-year follow-up. RESULTS Further episode(s) of self-harm occurred in 26% of cases. Omega-3 PUFAs or lipids were not predictive of depressive or self-harm episodes. Baseline eicosapentaenoic acid levels were modestly correlated with suicidal ideation at follow-up and dihomo-γ-linolenic acid and arachidonic acid were modestly correlated with motor impulsivity at follow-up in cases. CONCLUSIONS Despite significant negative correlations at baseline between plasma lipids, n-3 PUFAs and psychopathology, these levels were not predictive of clinical outcome over a 10-year period. Further research however is required due to the relatively low sample size and the risk of selection bias due to loss to follow-up in this study.
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7
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Misiak B, Kiejna A, Frydecka D. Higher total cholesterol level is associated with suicidal ideation in first-episode schizophrenia females. Psychiatry Res 2015; 226:383-8. [PMID: 25618471 DOI: 10.1016/j.psychres.2014.12.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/06/2014] [Accepted: 12/19/2014] [Indexed: 01/08/2023]
Abstract
There are inconsistent reports showing that the relationship between total cholesterol (TC) level and suicidality might be gender-specific. We compared 30 first-episode schizophrenia (FES) patients reporting suicidal ideation based on the Operational Criteria for Psychotic Illness (OPCRIT) checklist with 70 FES patients, who have never experienced suicidal ideation. After controlling for potential confounders, higher TC was associated with suicidal ideation only in FES females. Future studies should disentangle biological underpinnings of this gender-specific association.
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Affiliation(s)
- Błażej Misiak
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wroclaw, Poland; Department of Genetics, Wroclaw Medical University, 1 Marcinkowski Street, 50-368 Wroclaw, Poland.
| | - Andrzej Kiejna
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wroclaw, Poland
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wroclaw, Poland
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Patra BN, Khandelwal SK, Chadda RK, Ramakrishnan L. A controlled study of serum lipid profiles in Indian patients with depressive episode. Indian J Psychol Med 2014; 36:129-33. [PMID: 24860211 PMCID: PMC4031578 DOI: 10.4103/0253-7176.130968] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Lower levels of circulating lipid fractions and cholesterol are risk factors for impulsivity and depressive disorder. A lower level of serum cholesterol is also associated with patients presenting with history of self-harm. MATERIALS AND METHODS A total of 30 depressive patients and 30 healthy matched control subjects were recruited from the department of Psychiatry of a tertiary care hospital. We measured serum total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein cholesterol and triglyceride levels of both patient and control group. RESULTS The serum TC and LDL-cholesterol levels were found to be significantly lower in study group than that of control group. CONCLUSION Lower levels of serum cholesterol are associated with depressive disorder.
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Affiliation(s)
- Bichitra Nanda Patra
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Sudhir K Khandelwal
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh K Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
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9
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Kim JM, Stewart R, Kang HJ, Jeong BO, Kim SY, Bae KY, Kim SW, Shin IS, Yoon JS. Longitudinal associations between serum cholesterol levels and suicidal ideation in an older Korean population. J Affect Disord 2014; 152-154:517-21. [PMID: 24007784 DOI: 10.1016/j.jad.2013.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/10/2013] [Accepted: 08/10/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Relationships between low total cholesterol levels and suicidality have been reported but there has been little investigation of this issue in older age groups. This study aimed to investigate longitudinal associations between serum lipid levels and suicidal ideation in an older population. METHODS 732 community dwelling elderly aged 65 or over were evaluated at baseline. Of 639 did not have suicidal ideation at baseline, 579 (90.6%) were followed two years later. Prevalence and incidence of suicidal ideation within the previous one month was ascertained. Serum levels of total-, high density lipoprotein (HDL)-, low density lipoprotein (LDL)- cholesterol, and triglycerides were assayed at both baseline and follow-up. Baseline data on potential covariates including sociodemographic characteristics, life stress, social support, pain, alcohol drinking, depressive symptoms, cognitive function, and disability were gathered. RESULTS Both higher and lower total and LDL cholesterol levels at baseline and a decline in total cholesterol levels over the follow-up period predicted an increased incidence of suicidal ideation at follow-up independent of sociodemographic and clinical covariates. Significant cross-sectional associations were found between suicidal ideation at baseline and higher total and LDL cholesterol levels. LIMITATIONS Suicidal ideation was the outcome of the study. Therefore generalizability should be considered. CONCLUSIONS These results support a role of dyslipidemia in the etiology of late-life suicidal ideation. Not only low but also higher cholesterol levels predicted the incidence of suicidal ideation in elders. Lipid sub-fraction assays might be informative in this respect at least in older populations.
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Affiliation(s)
- Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, and Depression Clinical Research Center, Chonnam National University Hospital, Gwangju, Republic of Korea
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Klinitzke G, Steinig J, Blüher M, Kersting A, Wagner B. Obesity and suicide risk in adults--a systematic review. J Affect Disord 2013; 145:277-84. [PMID: 22871535 DOI: 10.1016/j.jad.2012.07.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 07/11/2012] [Accepted: 07/12/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is evidence from prospective studies that obesity is positively associated with depression. In contradiction to this, however, a number of studies have revealed that the number of completed suicides decreases with increasing BMI. The objective of this systematic review is to elucidate this ambiguous research field, providing an overview of literature examining the relationship between obesity and risk of suicide in adults (>18 years). METHODS Literature searches of the databases PubMed/Medline, PsychInfo, and Web of Sciences were conducted. Fifteen studies concerning completed suicide, suicide attempts and suicidal ideation met the inclusion criteria (seven prospective and eight cross-sectional studies). RESULTS Eight studies evaluating completed suicide reported an inverse relationship between BMI and suicide, meaning that obese people are less likely to commit suicide than people of low or normal weight, whereas one study showed no association and one showed a positive association. Studies about suicide attempts and ideation, on the other hand, found results that differed depending on gender. While obese woman reported more suicide attempts and suicidal ideation, obese men reported less attempts and thoughts. DISCUSSION The role of confounding variables such as age or psychiatric illness on suicide risk are discussed and remaining research questions are outlined, especially regarding the role of different underlying biological pathways and consideration of different classes of obesity.
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Affiliation(s)
- G Klinitzke
- Leipzig University Medical Center, IFB AdiposityDiseases, University of Leipzig, Leipzig, Germany.
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11
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Olié E, Picot MC, Guillaume S, Abbar M, Courtet P. Measurement of total serum cholesterol in the evaluation of suicidal risk. J Affect Disord 2011; 133:234-8. [PMID: 21521628 DOI: 10.1016/j.jad.2011.03.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 02/18/2011] [Accepted: 03/13/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Many studies have demonstrated an association between suicidal behavior and low levels of total serum cholesterol. To our knowledge, this association has mainly been reported in men. This case-control study was undertaken to assess the association between serum cholesterol level and suicide attempts in both genders. METHODS A total of 3207 subjects was included, divided into three groups: 510 patients with a history of suicidal attempts, 275 patients with no history of suicidal attempts, and 2422 controls. Mean and quartile total cholesterol levels were compared between the three groups according to gender. ROC curves were drawn to determine the biologically relevant threshold. RESULTS After adjustment for age, cholesterol level was significantly lower (p<0.01) in suicide attempters than in non-attempters and controls for both genders. Male non-suicide attempters had similar cholesterol levels to controls (p=0.7), but the levels in female non-attempters were significantly higher (p=0.004). The proportion of suicide attempters in the lowest cholesterol level quartile (51.3% of men, 40.1% of women) was significantly higher than that in the highest quartile (8.1% of men, 12.4% of women). For triglyceride level, no difference was found between the three groups, suggesting that this association was not due to malnutrition linked to depression. LIMITATIONS The effect of acute or chronic administration of medications on serum cholesterol levels was not controlled. Psychiatric history in surgical controls was not recorded. CONCLUSIONS Total serum cholesterol levels measured at admission may be a useful biological marker of suicidal risk.
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Affiliation(s)
- Emilie Olié
- Université Montpellier 1, Montpellier, France
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12
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Cholesterol and CSF 5-HIAA in attempted suicide. J Affect Disord 2010; 125:388-92. [PMID: 20299106 DOI: 10.1016/j.jad.2010.02.111] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 02/09/2010] [Accepted: 02/09/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Low serum cholesterol has been linked to suicide and violent behaviour. The same kind of associations has been reported regarding low levels of 5-hydroxyindolacetic acid (5-HIAA) in the cerebrospinal fluid (CSF) and suicidal behaviour. The hypothesis of the link between serum cholesterol and suicide incorporate serotonin. It proposes that low cholesterol is related to altered serotonergic neurotransmission. A correlation between CSF 5-HIAA and serum cholesterol has been shown in animal studies, but has not been found in humans. AIM To study the interrelationship between serum cholesterol and CSF 5-HIAA in suicide attempters. Since both cholesterol and CSF 5-HIAA are associated with suicide and violent suicide attempts, we also investigated the correlation with suicide, violent suicide attempt method, suicide intent, hopelessness and depression severity. METHODS Serum total cholesterol and CSF 5-HIAA were measured in 42 medication free suicide attempters. Patients were assessed with Becks's Hopelessness scale (BHS), Suicide Intent Scale (SIS) and Montgomery-Asberg depression rating scale (MADRS) and followed-up for causes of death. RESULTS Serum total cholesterol and CSF 5-HIAA showed a significant positive correlation adjusted for age, body mass index and substance abuse diagnosis. Cholesterol and CSF 5-HIAA levels did not differ between violent and non-violent suicide attempters or between suicide completers and survivors. CONCLUSIONS These findings indicate that the serotonergic system may be connected to serum cholesterol in patients with a recent suicide attempt.
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13
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Cholesterol, CSF 5-HIAA, violence and intent in suicidal men. Psychiatry Res 2010; 178:217-9. [PMID: 20452040 DOI: 10.1016/j.psychres.2008.07.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 04/19/2008] [Accepted: 07/31/2008] [Indexed: 11/21/2022]
Abstract
Associations between suicide, violent behaviour and both hypocholesterolaemia and low 5-hydroxyindolacetic acid (5-HIAA) in the cerebrospinal fluid (CSF) have been suggested. The relationships between lipids, the serotonergic system, suicidal and aggressive behaviors are complex. We explored relationships between serum cholesterol, CSF 5-HIAA, the planning subscale of suicide intent and violence of attempted suicide method in 13 medication-free male suicide attempters and eight healthy volunteers. Serum high-density lipoprotein cholesterol (HDL-C) levels were significantly lower in suicide attempters than in controls. HDL-C showed a significant positive correlation with the planning subscale of suicide intent in non-violent suicide attempters. A positive association was observed between CSF 5-HIAA and serum cholesterol in suicides. The role of cholesterol may be different in planned non-violent suicide attempts compared with violent suicide attempts.
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Markianos M, Koutsis G, Evangelopoulos ME, Sfagos C. Serum total cholesterol correlates positively to central serotonergic turnover in male but not in female subjects. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:527-31. [PMID: 20159029 DOI: 10.1016/j.pnpbp.2010.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 02/05/2010] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
Abstract
Reduced central serotonergic activity and low total serum cholesterol have been related to increased aggression, violent behavior, and suicidality. Searching for a correlation between them, we estimated serum total cholesterol and CSF levels of the main serotonin metabolite 5-HIAA in medication free male and female subjects for whom diagnostic lumbar puncture was performed. To eliminate age influence, we included in the study subjects in the age range 26 to 45years. In a group of 62 subjects (30 males), found negative after diagnostic neurological examination, the correlation was not significant for the whole group, but after sex stratification, a significant positive correlation was revealed for males but not for females. These results were replicated in a second group of 76 subjects (31 males) with clinical and laboratory findings suggestive of multiple sclerosis (clinically isolated syndrome). The results link low cholesterol to low serotonergic activity only in males, predisposing them for violent and risky behaviors. This phenomenon could be seen as an evolutionary trait, possibly a result of the distinct role of males in a hunter-gatherer environment of evolutionary adaptedness, and may contribute to the understanding of the higher incidence of violent behavior observed in males.
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Affiliation(s)
- Manolis Markianos
- Athens University Medical School, Eginition Hospital, Department of Neurology, Greece.
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15
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Abstract
In this review, we examine the history of the neurobiology of suicide, as well as the genetics, molecular and neurochemical findings in suicide research. Our analysis begins with a summary of family, twin, and adoption studies, which provide support for the investigation of genetic variation in suicide risk. This leads to an overview of neurochemical findings restricted to neurotransmitters and their receptors, including recent findings in whole genome gene expression studies. Next, we look at recent studies investigating lipid metabolism, cell signalling with a particular emphasis on growth factors, stress systems with a focus on the role of polyamines, and finally, glial cell pathology in suicide. We conclude with a description of new ideas to study the neurobiology of suicide, including subject-specific analysis, protein modification assessment, neuroarchitecture studies, and study design strategies to investigate the complex suicide phenotype.
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Boscarino JA, Erlich PM, Hoffman SN. Low serum cholesterol and external-cause mortality: potential implications for research and surveillance. J Psychiatr Res 2009; 43:848-54. [PMID: 19135214 DOI: 10.1016/j.jpsychires.2008.11.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Revised: 11/09/2008] [Accepted: 11/18/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Previous studies suggested that low total cholesterol was associated with external mortality, including deaths from suicide, homicide, and accidents. However, this reported association was potentially confounded, since cholesterol was also reported to be associated with alcohol abuse, anti-social personality disorder, and other risk factors for external mortality. METHOD We examined external-cause mortality among a national sample of 4462 male, US veterans at baseline in 1985. Using Cox regressions to estimate survival time, we assessed the impact of low baseline total cholesterol < or =165 mg/dl, age, race, intelligence, BMI, alcohol abuse, anti-social personality disorder, depression, and other factors at follow-up. Study follow-up continued until December 31, 2000. A total of 55 external mortalities occurred during this approximately 16-year period. RESULTS Multivariate Cox regressions predicting external-cause mortality suggested that three predictor variables were significant: low total cholesterol, morbid depression, and anti-social personality disorder, with hazard ratios (HRs) of 1.97 (p=0.046), 1.76 (p=0.043), and 2.22 (p=0.006), respectively. In addition, a significant interaction was detected for low cholesterol x morbid depression (p<0.005), whereby those with both at baseline were approximately 7 times more likely to die from external mortality (HR=6.5, 95% CI=3.07-13.76). CONCLUSION Among a national random sample of community-based men, lower baseline cholesterol predicted external mortality and revealed an interaction with morbid depression. Patients presenting with low cholesterol and morbid depression in clinical practice may warrant clinical attention and surveillance.
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Affiliation(s)
- Joseph A Boscarino
- Center for Health Research, Geisinger Clinic, 100 N. Academy Avenue, MC 44-00, Danville, PA 17822, United States.
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Olson MB, Kelsey SF, Matthews KA, Bairey Merz CN, Eteiba W, McGorray SP, Cornell CE, Vido DA, Muldoon MF. Lipid-lowering medication use and aggression scores in women: a report from the NHLBI-sponsored WISE study. J Womens Health (Larchmt) 2008; 17:187-94. [PMID: 18321170 PMCID: PMC2896287 DOI: 10.1089/jwh.2007.0379] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM The aim of this study was to examine the association between the use of lipid-lowering medication and aggressive responding, hostility, cynicism, and depression scores in women undergoing coronary angiography. METHODS The cohort included 498 women from the National Heart, Lung and Blood Institute (NHLBI)-sponsored Women's Ischemia Syndrome Evaluation (WISE) study. WISE is a four-center study of women with chest pain who underwent quantitative coronary angiography for suspected myocardial ischemia. The psychosocial indices included the Cook Medley Hostility questionnaire, measuring aggression, hostility, and cynicism, and the Beck Depression Inventory (BDI). RESULTS Compared to those not on lipid-lowering medication, women receiving lipid-lowering pharmacotherapy were older (62 vs. 55 years, p < 0.001) and had more hypertension, dyslipidemia, diabetes, and coronary artery disease (CAD, defined as > or =50% stenoses in at least one epicardial artery) (all p < 0.003). Women on lipid-lowering medication had higher aggressive responding scores than those not on medication, 3.0 +/- 1.8 vs. 2.7 +/- 1.7, respectively (age-adjusted p < 0.003). This association persisted after adjustment for coronary risk factors, education, and extent of angiographic disease (CAD) (p < 0.005), and after exclusion of women using psychotropic medications (p < 0.001). Hostility, cynicism, and depression scores did not differ by medication use.
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Affiliation(s)
- Marian B Olson
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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18
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Marcinko D, Marcinko V, Karlović D, Marcinko A, Martinac M, Begić D, Jakovljević M. Serum lipid levels and suicidality among male patients with schizoaffective disorder. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:193-6. [PMID: 17850945 DOI: 10.1016/j.pnpbp.2007.08.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 08/12/2007] [Accepted: 08/12/2007] [Indexed: 11/19/2022]
Abstract
Suicidal behavior in schizoaffective disorder is a serious problem and suicide risk during lifetime ranges between 5%-10%. Neurobiology of suicidal behavior has not been studied sufficiently, and a high number of studies are oriented toward lipid investigation. The aim of our study was to investigate whether there were differences in the level of lipids (cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides) in hospitalized suicidal (n=20) and non-suicidal (n=20) patients with schizoaffective disorder. The study also included male healthy control subjects (n=20). Hamilton Depression Rating Scale (HDRS-17), and Positive and Negative Syndrome Scale (PANSS) were used to confirm the level of psychopathology in patients with schizoaffective disorder. Severity of suicidality was measured by Scale for Suicide Ideation (SSI) at time of admission. Results of the study indicated significantly lower concentrations of cholesterol (p<0.001), LDL-cholesterol (p<0.01) and HDL-cholesterol (p<0.01). There were no differences in the number of previous hospitalization and previous suicide attempts between suicidal and non-suicidal patients (p>0.05). Duration of the illness was significantly (p<0.05) shorter in suicidal patients. Suicidal patients also had a significantly higher score on HDRS-17 (p<0.001) and PANSS (p<0.01) compared to non-suicidal patients.
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Affiliation(s)
- Darko Marcinko
- Department of Psychiatry, University Hospital Zagreb, Kispatićeva 12, 10000 Zagreb, Croatia.
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Fiedorowicz JG, Coryell WH. Cholesterol and suicide attempts: a prospective study of depressed inpatients. Psychiatry Res 2007; 152:11-20. [PMID: 17360043 PMCID: PMC1965495 DOI: 10.1016/j.psychres.2006.09.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 06/08/2006] [Accepted: 09/08/2006] [Indexed: 10/23/2022]
Abstract
Low cholesterol levels have commonly been associated with various suicide measures. We sought to examine suicide attempts in a prospective sample of depressed patients that on prior analysis demonstrated an association between low cholesterol and subsequent suicide completions. Seventy-four inpatients with Research Diagnostic Criteria unipolar major depression, bipolar depression or schizoaffective depression entered a prospective follow-up study from 1978 to 1981. Kaplan-Meier survival analysis and Cox regression were utilized to elucidate the relationship between cholesterol levels and subsequent severe suicide attempts as well as all suicide attempts regardless of severity. Attempts preceding index hospitalization and other lifetime attempts were evaluated cross-sectionally. Low serum cholesterol levels did not predict subsequent suicide attempts. Contrary to our hypothesis, the high cholesterol group was associated with increased risk of suicide attempts on survival analysis in those less than median age. Nonetheless, in cross-sectional analysis, the low cholesterol group had more suicide attempts preceding index hospitalization and more remote lifetime attempts. The results from this prospective dataset do not support an association between low cholesterol and subsequent suicide attempts despite replicating the retrospective findings of previous case-control and cross-sectional studies.
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Affiliation(s)
- Jess G Fiedorowicz
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive W279 GH, Iowa City, IA 52242, USA.
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Gietl A, Giegling I, Hartmann AM, Schneider B, Schnabel A, Maurer K, Möller HJ, Rujescu D. ABCG1 gene variants in suicidal behavior and aggression-related traits. Eur Neuropsychopharmacol 2007; 17:410-6. [PMID: 17187964 DOI: 10.1016/j.euroneuro.2006.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Revised: 11/13/2006] [Accepted: 11/22/2006] [Indexed: 11/17/2022]
Abstract
The ABCG1 transporter seems to be involved in human cholesterol and sterol homeostasis. As alterations in cholesterol homeostasis have been widely linked to aggression, violence and suicidal behavior, we considered ABCG1 as a candidate gene for these traits. We studied 5 gene variants of ABCG1 in a sample of 571 suicide attempters, healthy controls and suicide completers. We also analyzed the relation to aggression-related traits, assessed by STAXI and FAF. Regarding the genotypes, there was no association with completed or attempted suicide with the tested SNPs. Regarding alleles, only one SNP (rs1044317) showed a slight association with suicide attempters in comparison to the controls. Interestingly, rs225374 G allele carriers had higher scores on the STAXI subscales "State Anger" and "Anger Out", as well as on the FAF subscales "Spontaneous Aggression", "Irritability" and "Aggression". Carriers of the rs914189 G allele scored higher on the FAF subscales "Spontaneous Aggression", "Reactive Aggression" and "Aggression". Carriers of the rs1044317 G allele had lower scores for STAXI "Trait Anger" and "Trait Temperament", and higher scores for STAXI "Anger Control". Our results provide evidence that the ABCG1 may influence aggression-related traits. Given that these represent intermediate phenotypes of suicidal behavior, ABCG1 might also act on suicidal behavior through these traits. The observed associations warrant further replications.
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Affiliation(s)
- Anton Gietl
- Molecular and Clinical Neurobiology, Department of Psychiatry, Ludwig Maximilians University, Nussbaumstr. 7, D-80336 Munich, Germany
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Coryell W, Schlesser M. Combined biological tests for suicide prediction. Psychiatry Res 2007; 150:187-91. [PMID: 17289156 PMCID: PMC1880882 DOI: 10.1016/j.psychres.2006.01.021] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Revised: 11/22/2005] [Accepted: 01/02/2006] [Indexed: 10/23/2022]
Abstract
Disturbances in serotonin neuroregulation and in hypothalamic-pituitary-adrenal axis activity are both likely, and possibly independent, factors in the genesis of suicidal behavior. This analysis considers whether clinically accessible measures of these two disturbances have additive value in the estimation of risk for suicide. Seventy-four inpatients with RDC major or schizoaffective depressive disorders entered a prospective follow-up study from 1978-1981, underwent a dexamethasone suppression test (DST) and had fasting serum cholesterol levels available in the medical record. As reported earlier, patients who had had an abnormal DST result were significantly more likely to commit suicide during follow-up. Serum cholesterol concentrations did not differ by DST result and low cholesterol values were associated with subsequent suicide when age was included as a covariate. These results indicate that, with the use of age-appropriate thresholds, serum cholesterol concentrations may be combined with DST results to provide a clinically useful estimate of suicide risk.
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Affiliation(s)
- William Coryell
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, 2-205 MEB, Iowa City, IA 52242-1000, USA.
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22
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Agostini JV, Tinetti ME, Han L, McAvay G, Foody JM, Concato J. Effects of Statin Use on Muscle Strength, Cognition, and Depressive Symptoms in Older Adults. J Am Geriatr Soc 2007; 55:420-5. [PMID: 17341246 DOI: 10.1111/j.1532-5415.2007.01071.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine the relationship between hydroxymethyl glutaryl coenzyme A reductase inhibitor (statin) use and proximal muscle strength, cognition, and depression in older adults. DESIGN Observational cohort study. SETTING Outpatient primary care clinics. PARTICIPANTS Seven hundred fifty-six community-dwelling veterans aged 65 and older. MEASUREMENTS Timed chair stands (a measure of proximal muscle strength), Trail Making Test Part B (a measure of cognition), and the Center for Epidemiologic Studies Depression Scale score were measured at baseline and 1-year follow-up. Participants were assessed for statin prescriptions (and indications for or contraindications to their use), concomitant medication use, comorbidities, and other potential confounders. RESULTS Statin users (n=315) took a mean 6.6 medications, versus 4.6 for nonusers (n=441), and had a median duration of statin use of 727 days. Statin users were more likely to be white and had (as expected) more cardiac, cerebrovascular, and peripheral vascular disease. Based on multivariable models adjusting for pertinent covariates, statin users performed modestly better than nonusers for timed chair stands (-0.5 seconds; P=.04), Trail Making Test Part B (-7.7 seconds; P=.08), and depression scores (-0.2 points; P=.49) at follow-up. Of potentially high-risk participants (based on age, comorbidity, and number of medications), statin users also showed similar 1-year changes as nonusers, although worsened depression scores were found in those with greater comorbidity (+0.88 points; P=.10). CONCLUSION Older, community-dwelling male participants taking maintenance statin therapy had similar outcomes to those of nonusers in tests of muscle strength, cognition, and depression, but further examination of benefits and harms in different subgroups is warranted.
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Affiliation(s)
- Joseph V Agostini
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut 06516, USA.
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Garland MR, Hallahan B, McNamara M, Carney PA, Grimes H, Hibbeln JR, Harkin A, Conroy RM. Lipids and essential fatty acids in patients presenting with self-harm. Br J Psychiatry 2007; 190:112-7. [PMID: 17267926 DOI: 10.1192/bjp.bp.105.019562] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Low cholesterol has been reliably demonstrated in people who self-harm. AIMS To determine whether people who self-harm also have low levels of essential fatty acids (EFAs) and to examine associations between the EFAs and serotonergic function. METHOD Depression, impulsivity and suicidal intent were measured in patients with self-harm (n=40) and matched controls, together with plasma lipids and EFAs. Platelet serotonergic studies were carried out in a subgroup (n=27). RESULTS Patients with self-harm had significantly more pathology on all psychometric measures, lower mean total cholesterol levels (4.18 (s.d.=0.93) v. 4.87 (s.d.=0.83) mmol/l, P=0.003) and lower mean total EFA levels (89. 5 (15.6) v.103.7 (17.1) microg/ml, P=0.0001) than controls after adjustment for confounding variables. Total n-3 and n-6 EFA levels were also significantly lower. Impulsivity and depression scores were significantly inversely correlated with both n-6 EFAs and n-3 EFAs, but were not associated with total or low-density lipoprotein cholesterol levels. Platelet serotonergic measures did not differ between groups, and were not related to psychobiological measures. CONCLUSIONS Lower plasma EFA levels combined with low cholesterol concentrations were associated with self-harm as well as impulsivity and affect. This was not related to platelet serotonergic measures.
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Affiliation(s)
- Malcolm R Garland
- Department of Adult Psychiatry, Galway University Hospital and the Clinical Sciences Institute, National University of Ireland, Ireland.
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Abstract
Efforts to identify clinical risk factors for complete suicide through the follow-up of depressed patients have yielded relatively few robust predictors. Those identified by at least three studies are (in order of decreasing frequency) suicidal plans/attempts, male sex, being single or living alone, inpatient status, and hopelessness. Because the best established of these predictors has only modest sensitivity and specificity, the need for other robust tools is clear. A rich body of research has identified two biological risk factors for suicide in depressive disorder: hypothalamic-pituitary-adrenal axis hyperactivity and deficits in serotonin function. Moreover, there is now considerable evidence that the dexamethasone suppression test and measures of serum cholesterol concentrations, respectively, may provide a clinically useful reflection of these two mechanisms. Observations that these measures appear to be additive, both with each other and with other clinical risk factors, indicate that a substantial improvement in the clinician's ability to assess suicide risk is possible.
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Affiliation(s)
- William H Coryell
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.
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Zhang J, McKeown RE, Hussey JR, Thompson SJ, Woods JR, Ainsworth BE. Low HDL cholesterol is associated with suicide attempt among young healthy women: the Third National Health and Nutrition Examination Survey. J Affect Disord 2005; 89:25-33. [PMID: 16263178 DOI: 10.1016/j.jad.2005.05.021] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2004] [Accepted: 05/11/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Serum cholesterol is reported to be associated with suicidality, but studies conducted among general healthy population are rare. We examined the association between serum cholesterol and suicidality in a national sample of the general population of US. METHODS We used the data of 3237 adults aged 17 to 39 years, who completed a mental disorder diagnostic interview and had blood specimens collected after a 12-h fast, as a part of the Third National Health and Nutrition Examination Survey, 1988-1994. The serum concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were dichotomized according to the recommended levels of the National Cholesterol Education Program. A polytomous logistic regression was employed to control for covariates. RESULTS Independent of socio-demographic variables, health risks and nutrition status, and a history of medical and psychiatric illness (including depression), a significant association between low HDL-C (< or = 40 mg/dl) and increased prevalence of suicide attempts was observed in women (OR=2.93, 95% CI=1.07-8.00). No significant evidence was found to support an association between cholesterol and suicide ideation in women. Serum cholesterol was unrelated with either suicide ideation or attempts in men. LIMITATION The inherent limitation of cross-sectional design prevented the authors from investigating causality. CONCLUSIONS Low HDL-C is significantly associated with suicide attempts in women. Further studies are necessary to explore the clinical application of serum cholesterol as an indicator for suicide attempts among high risk population.
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Affiliation(s)
- Jian Zhang
- Division of Health and Family Studies, Institute for Families in Society, University of South Carolina, United States.
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Favaro A, Caregaro L, Di Pascoli L, Brambilla F, Santonastaso P. Total serum cholesterol and suicidality in anorexia nervosa. Psychosom Med 2004; 66:548-52. [PMID: 15272101 DOI: 10.1097/01.psy.0000127873.31062.80] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE No published study has evaluated the relationship between serum cholesterol and suicidality in anorexia nervosa (AN). AIMS To assess psychiatric and nutritional correlates of serum cholesterol in a sample of AN patients. METHODS Serum cholesterol and nutritional status were evaluated in a sample of 74 AN patients, before starting any type of refeeding. All subjects underwent a structured clinical interview and completed the Hopkins Symptom Checklist. RESULTS Subjects who reported previous suicide attempts, impulsive self-injurious behavior, or current suicidal ideation showed significantly lower cholesterol levels than subjects without suicidality. Cholesterol levels were negatively correlated with the severity of depressive symptoms in all the patients with the exception of those with recurrent binge eating. A multivariate analysis showed that the relationships between cholesterol levels and suicidal behavior and ideation do not seem to be affected by the nutritional and metabolic factors considered in the study. CONCLUSIONS Notwithstanding the influence of important metabolic factors affecting cholesterolemia in AN, our research tends to confirm previous studies that have found an association between low cholesterol levels and suicidality.
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Affiliation(s)
- Angela Favaro
- Department of Neuroscience, University of Padua, Padua, Italy
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Ormiston T, Wolkowitz OM, Reus VI, Johnson R, Manfredi F. Hormonal changes with cholesterol reduction: a double-blind pilot study. J Clin Pharm Ther 2004; 29:71-3. [PMID: 14748901 DOI: 10.1111/j.1365-2710.2003.00540.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The lowering of high serum cholesterol levels may be associated with increased non-cardiac mortality due to behavioral changes, although such endpoints are likely rare. OBJECTIVE This current study sought to determine if hormonal changes accompany pharmacologically induced decreases in serum cholesterol levels. METHOD Cholesterol, dopamine, homovanillic acid (HVA), serotonin, 5-HIAA, testosterone, cortisol and pregnenolone were measured at baseline and after 4 weeks of treatment. RESULTS Subjects' cholesterol levels significantly declined within 4 weeks. Concomitant significant increase in dopamine and HVA were noted. CONCLUSION Although this study is limited in size, it raises the possibility that cholesterol-lowering drug treatment is associated with hormonal perturbations.
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Affiliation(s)
- T Ormiston
- Department of Internal Medicine, Santa Clara Valley Medical Center, San Jose, CA, USA.
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Lalovic A, Sequeira A, DeGuzman R, Chawky N, Lesage A, Seguin M, Turecki G. Investigation of completed suicide and genes involved in cholesterol metabolism. J Affect Disord 2004; 79:25-32. [PMID: 15023477 DOI: 10.1016/s0165-0327(02)00453-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2002] [Accepted: 11/22/2002] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several lines of evidence support the association between low or lowered levels of serum total cholesterol and suicide. Genetic epidemiological studies suggest that genes predispose to suicide. Given that genes control many aspects of cholesterol biosynthesis and metabolism, one approach through which to explore the putative association between low cholesterol and suicide is through genetic studies. METHODS We examined the potential role of five genes encoding proteins involved in cholesterol biosynthesis and transport in a total sample of 305 male Caucasian subjects, consisting of 145 suicide completers and 160 controls. We investigated variation in the HMG CoA reductase (HMGCR), 7-dehydrocholesterol reductase (DHCR7), lipoprotein lipase (LPL), low-density lipoprotein receptor (LDLR), and apolipoprotein E (APOE) genes. RESULTS We were unable to detect significant differences in allele or genotype frequencies between the suicide cases and controls for any of the genes studied. No relationship was found between genotype and impulsivity or aggression as measured using the BIS and BDHI, respectively. LIMITATIONS The limitations of this study are consistent with the typical limitations inherent in most genetic association studies involving complex behavioral traits. CONCLUSION Although these genes are unlikely to play a major role in susceptibility to suicide, further studies in a larger sample are necessary to reveal the smaller genetic effects, if present.
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Affiliation(s)
- Aleksandra Lalovic
- McGill Group for Suicide Studies, Douglas Hospital Research Centre, 6875 LaSalle Blvd., Verdun, Québec, Canada H4H 1R3
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Papakostas GI, Ongür D, Iosifescu DV, Mischoulon D, Fava M. Cholesterol in mood and anxiety disorders: review of the literature and new hypotheses. Eur Neuropsychopharmacol 2004; 14:135-42. [PMID: 15013029 DOI: 10.1016/s0924-977x(03)00099-3] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2002] [Revised: 06/17/2003] [Accepted: 06/17/2003] [Indexed: 12/01/2022]
Abstract
Cholesterol plays an integral role in the structure and function of the cell membrane and may also affect neurotransmission in the central nervous system. Previous work has identified abnormalities in serum cholesterol levels in patients with mood and anxiety disorders as well as in suicidal patients. However, the biological significance of these abnormalities remains to be clarified. An understanding of how serum cholesterol relates to the pathophysiology of mood disorders may generate biological markers that predict treatment response as well as targets for novel therapeutic strategies. In this article, we review the literature studying the significance of cholesterol in mood and anxiety disorders, with an emphasis on new studies focusing on the adverse impact of hypercholesterolemia on the treatment of major depressive disorder (MDD). We then propose possible mechanisms that would account for the relationship between elevated cholesterol and treatment non-response in MDD.
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Affiliation(s)
- George I Papakostas
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 15 Parkman Street, WACC #812, Boston, MA 02114, USA.
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Aghanwa H. The determinants of attempted suicide in a general hospital setting in Fiji Islands: a gender-specific study. Gen Hosp Psychiatry 2004; 26:63-9. [PMID: 14757305 DOI: 10.1016/j.genhosppsych.2003.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective of the study was to examine the sociodemographic and clinical factors influencing gender-specific attempted suicide. Suicide attempters, 40 males and 88 females, seen on a consultation-liaison psychiatric service over a period of 42 months (from January 1, 1999 to June 30, 2002) were compared on sociodemographic and clinical variables. The female attempters [22.99 years (SD 8.1)] were younger than their male counterparts [25.15 years (SD 9.5)] [P = 0.0002]. A higher proportion of the male attempters were engaged in outside occupations, compared with their female counterparts who were mainly full-time housewives or engaged in domestic duties [P = 0.003]. Alcohol misuse was more associated with male suicide attempts [P = 0.001]. Ninety percent of male attempters and 54.6% of the female attempters had the intention to die [P = 0.001]. Although depressive episode was the most common psychiatric disorder in male attempters, followed by neurotic and stress-related disorders, while neurotic and stress-related disorders ranked first in female attempters followed closely by depressive episode, the difference was not significant. However, significantly more male attempters required pharmacotherapy and psychological intervention than their female counterparts [P = 0.002]. More females had marital difficulties, although comparing the two groups on social difficulties did not yield a significant difference. Method used, personality disorders, previous attempt, repeat attempt, race, religion, and marital status were not significant distinguishing factors. Younger age, lack of employment outside home, marital problems, and nondeath motives were more influential in female attempted suicide, while alcohol misuse and severe psychiatric morbidity were more frequently associated with male attempted suicide. The findings support gender-specific preventive and interventional strategies.
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Affiliation(s)
- Henry Aghanwa
- Department of Psychiatry, School of Medical Sciences, Fiji School of Medicine, Suva, Fiji Islands.
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Deisenhammer EA, Kramer-Reinstadler K, Liensberger D, Kemmler G, Hinterhuber H, Fleischhacker WW. No evidence for an association between serum cholesterol and the course of depression and suicidality. Psychiatry Res 2004; 121:253-61. [PMID: 14675744 DOI: 10.1016/j.psychres.2003.09.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In a number of previous reports, an association of altered, in most cases lower, serum cholesterol levels with depression, suicidal ideation and current or past suicidal behavior has been suggested. In this investigation, the course of serum cholesterol concentrations was measured in depressed patients during treatment. Ninety-two inpatients with a major depressive episode were included. Serum lipid concentrations were assessed at admission, after 1 week and after 4 weeks of antidepressant treatment. Degrees of depression and suicidality were measured with the Hamilton Depression Rating Scale. Although there was a significant reduction in depression and suicidality scores, neither a significant change in serum cholesterol levels nor a correlation between cholesterol levels and clinical improvement was found. Further, there were no significant differences in lipid levels between patients with and without a history of attempted suicide. In patients who had used a violent method, there was a trend for lower total cholesterol levels compared to those who had poisoned themselves. The results of this study do not support the hypothesis of an association of serum cholesterol with the course of depression and suicidal ideation. Cholesterol levels do not appear to be an appropriate biological marker for suicidality during the first 4 weeks of treatment in patients with a major depressive episode.
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Affiliation(s)
- Eberhard A Deisenhammer
- Department of General Psychiatry, Innsbruck University Hospital, Anichstrasse 35, A-6020, Innsbruck, Austria.
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Pozzi F, Troisi A, Cerilli M, Autore AM, Lo Castro C, Ribatti D, Frajese G. Serum cholesterol and impulsivity in a large sample of healthy young men. Psychiatry Res 2003; 120:239-45. [PMID: 14561435 DOI: 10.1016/s0165-1781(03)00192-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Studies that have investigated the association between cholesterol levels and impulsivity are relatively few in number and have yielded equivocal results. In this study, we investigated the relationship between impulsivity, depression and serum lipids [total cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides] in a large sample (N=2051) of healthy young men who were remarkably homogeneous in terms of age, educational level, and socioeconomic conditions. Depression was assessed using the depression scale of the Minnesota Multiphasic Personality Inventory-2, and impulsivity was measured using the impulse control scale of the Big Five Questionnaire (BFQ). We found that subjects with a low serum cholesterol, defined as the lowest tenth of the total cholesterol distribution (< or =3.7 mmol/l), scored significantly lower on the impulse control scale of the BFQ. There was no significant association between depression and cholesterol concentrations. In addition, in a multiple regression model, both lower levels of total cholesterol and higher levels of HDL cholesterol emerged as significant predictors of impulsivity. However, since the regression model accounted for only 0.6% of the variance in the score on the impulse control scale of the BFQ, the biological significance of these correlations was negligible. Taken together, these findings suggest that, in healthy young men, a relationship between cholesterol and impulsivity emerges only when the statistical analysis focuses on subjects with very low levels of cholesterol.
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Affiliation(s)
- Flavio Pozzi
- Department of Internal Medicine, Unit of Endocrinology, University of Tor Vergata, Via di Tor Vergata 135, 00133, Rome, Italy.
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Ormiston T, Wolkowitz OM, Reus VI, Manfredi F. Behavioral implications of lowering cholesterol levels: a double-blind pilot study. PSYCHOSOMATICS 2003; 44:412-4. [PMID: 12954916 DOI: 10.1176/appi.psy.44.5.412] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The treatment of hypercholesterolemia may be associated with greater noncardiac mortality. This current pilot study sought to determine which behaviors, if any, are associated with decreases in cholesterol level. Twelve subjects received one of two cholesterol-reducing drugs or placebo. Cholesterol and behavioral ratings were measured at baseline, 4, and 52 weeks with standardized scales. Cholesterol levels markedly declined with concomitant significant increases in impulsivity ratings at 4 weeks. At 52 weeks, the increase in impulsivity ratings was no longer apparent, but depression ratings showed a significant improvement. This pilot study, although limited in size, raises the possibility that cholesterol-lowering drugs are associated with mild, time-limited increases in impulsivity and with mild, time-delayed improvements in depression ratings.
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Affiliation(s)
- Tom Ormiston
- Santa Clara Valley Medical Center, San Jose, CA 95128, USA.
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Abstract
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.
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Affiliation(s)
- Heon-Jeong Lee
- Department of Psychiatry, Korea University, College of Medicine, Ansan City, Korea
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Academy of Psychosomatic Medicine: Proceedings From the 49th Annual Meeting November 21–24, 2002, Tucson, Arizona. PSYCHOSOMATICS 2003. [DOI: 10.1176/appi.psy.44.2.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
A meta-analysis was performed on studies exploring the link between low levels of serum cholesterol and increased risk of suicide. Follow-up studies found that those with lower cholesterol levels do have a tiny but statistically significant increased risk of completing suicide. Individuals who have attempted suicide in the past have lower cholesterol levels, especially if they used violent methods for suicide. Cholesterol lowering studies, however, did not lead to a significant increase in completed suicide.
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Affiliation(s)
- David Lester
- Psychology Program, The Richard Stockton College of New Jersey, Pomona 08240-0195, USA.
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Strik JJMH, Lousberg R, Crijns HJGM, Maes M, Honig A. Relation of levels of serum lipoproteins to depression after acute myocardial infarction. Am J Cardiol 2002; 90:1368-70. [PMID: 12480046 DOI: 10.1016/s0002-9149(02)02874-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Jacqueline J M H Strik
- Department of Psychiatry, Academic Hospital Maastricht/University of Maastricht, Maastricht, The Netherlands
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Guillem E, Pélissolo A, Notides C, Lépine JP. Relationship between attempted suicide, serum cholesterol level and novelty seeking in psychiatric in-patients. Psychiatry Res 2002; 112:83-8. [PMID: 12379454 DOI: 10.1016/s0165-1781(02)00193-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Eric Guillem
- Service de Psychiatrie, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, 200, rue du Faubourg Saint-Denis, 75010, Paris, France.
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Kim YK, Lee HJ, Kim JY, Yoon DK, Choi SH, Lee MS. Low serum cholesterol is correlated to suicidality in a Korean sample. Acta Psychiatr Scand 2002; 105:141-8. [PMID: 11954543 DOI: 10.1034/j.1600-0447.2002.10352.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
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.
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Affiliation(s)
- Yong-Ku Kim
- Department of Psychiatry, College of Medicine, Korea University, Ansan City, Kyunggi province
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Paavola P, Repo-Tiihonen E, Tiihonen J. Serum lipid levels and violence among Finnish male forensic psychiatric patients. ACTA ACUST UNITED AC 2002. [DOI: 10.1080/0958518021000019425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chapter 5 Omega-3 fats in depressive disorders and violence: the context of evolution and cardiovascular health. ACTA ACUST UNITED AC 2002. [DOI: 10.1016/s0167-7306(02)35034-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Roy A, Gonzalez B, Marcus A, Berman J. Serum cholesterol, suicidal behavior and impulsivity in cocaine-dependent patients. Psychiatry Res 2001; 101:243-7. [PMID: 11311927 DOI: 10.1016/s0165-1781(01)00217-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Relationships between serum cholesterol and suicidal behavior have been reported. As suicidal behavior is common in cocaine dependence, we looked for a relationship with serum cholesterol. To do this, we compared 57 cocaine-dependent patients who had attempted suicide with 111 cocaine-dependent patients who had never attempted suicide for their admission total serum cholesterol levels. We found that there were no significant differences between cocaine-dependent patients who had or had not attempted suicide in their total serum cholesterol levels. Also, there were no significant correlations between total serum cholesterol levels and scores on the Barratt Impulsivity Scale. Thus, admission total serum cholesterol does not appear to be clinically useful in the assessment of suicidal behavior in cocaine-dependent patients.
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Affiliation(s)
- A Roy
- Psychiatry Service (116A), Department of Veterans Affairs, New Jersey Healthcare System, 385 Tremont Avenue, East Orange, NJ 07018, USA.
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Muldoon MF, Manuck SB, Mendelsohn AB, Kaplan JR, Belle SH. Cholesterol reduction and non-illness mortality: meta-analysis of randomised clinical trials. BMJ (CLINICAL RESEARCH ED.) 2001; 322:11-5. [PMID: 11141142 PMCID: PMC26598 DOI: 10.1136/bmj.322.7277.11] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2000] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the association between cholesterol lowering interventions and risk of death from suicide, accident, or trauma (non-illness mortality). DESIGN Meta-analysis of the non-illness mortality outcomes of large, randomised clinical trials of cholesterol lowering treatments. STUDIES REVIEWED 19 out of 21 eligible trials that had data available on non-illness mortality. INTERVENTIONS REVIEWED: Dietary modification, drug treatment, or partial ileal bypass surgery for 1-10 years. MAIN OUTCOME MEASURE Deaths from suicides, accidents, and violence in treatment groups compared with control groups. RESULTS Across all trials, the odds ratio of non-illness mortality in the treated groups, relative to control groups, was 1.18 (95% confidence interval 0.91 to 1.52; P=0.20). The odds ratios were 1.28 (0.94 to 1.74; P=0.12) for primary prevention trials and 1.00 (0.65 to 1.55; P=0.98) for secondary prevention trials. Randomised clinical trials using statins did not show a treatment related rise in non-illness mortality (0.84, 0.50 to 1.41; P=0.50), whereas a trend toward increased deaths from suicide and violence was observed in trials of dietary interventions and non-statin drugs (1.32, 0.98 to 1.77; P=0.06). No relation was found between the magnitude of cholesterol reduction and non-illness mortality (P=0.23). CONCLUSION Currently available evidence does not indicate that non-illness mortality is increased significantly by cholesterol lowering treatments. A modest increase may occur with dietary interventions and non-statin drugs.
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Affiliation(s)
- M F Muldoon
- Center for Clinical Pharmacology, University of Pittsburgh School of Medicine, PA 15260, Pittsburgh, USA.
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Manfredini R, Caracciolo S, Salmi R, Boari B, Tomelli A, Gallerani M. The association of low serum cholesterol with depression and suicidal behaviours: new hypotheses for the missing link. J Int Med Res 2000; 28:247-57. [PMID: 11191718 DOI: 10.1177/147323000002800601] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Several observational studies indicate that reduction of serum cholesterol levels is related to an increase in violent deaths and suicide but the nature of this possible relationship remains unclear. Many confounding factors, e.g. poor health, depression and loss of appetite may play a role in the apparent relationship between serum cholesterol levels and suicide. Two separate phenomena should be considered: lowering total cholesterol and low total cholesterol. This review considers the evidence from epidemiological studies on serum cholesterol lowering and psychiatric disturbances. The available evidence does not seem to substantiate the view that large-scale intervention to reduce cholesterol concentrations could lead to more violent and aggressive behaviour, and generally greater unhappiness. In recent trials using statin treatment, there were slightly fewer deaths from accidents and suicide in the treated group compared with the placebo group. We believe that clinicians should not be deterred from prescribing cholesterol-lowering drugs, to reduce the risk of death from coronary heart disease, when they are indicated.
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Affiliation(s)
- R Manfredini
- Department of Clinical and Experimental Medicine, University of Ferrara, Italy.
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