Serum Cholesterol in Treatment-Resistant Depression

Abstract

Objective: Patients with major depressive disorder (MDD) may have significant differences in cholesterol levels compared with healthy controls. A previous study by our group reported that depressed patients with elevated cholesterol levels (≧200 mg/dl) were significantly more likely to be nonresponders to fluoxetine treatment than depressed patients with nonelevated cholesterol levels. However, very little is known regarding cholesterol in patients with treatment-resistant depression (TRD). The purpose of this study was to compare cholesterol levels at baseline between depressed patients with and without TRD and to test whether cholesterol levels at baseline can predict clinical response in patients with TRD treated with open-label nortriptyline (NT). Methods: Ninety-two patients with TRD entered a 6-week open trial of NT. Baseline cholesterol levels were randomly collected for 59 of these patients. Controlling for age and gender, we compared baseline cholesterol and triglyceride levels for 35 patients with TRD who did not respond to NT with 205 non-TRD patients who responded to an 8-week open trial of fluoxetine. Furthermore, with the use of logistic regression, we tested whether baseline cholesterol levels predicted clinical response to NT in the patients with TRD. Results: Patients with TRD had higher triglyceride levels at baseline compared with depressed patients without TRD. Cholesterol defined as a dichotomous variable being elevated if equal to or greater than 200 mg/dl, predicted poor response to a 6-week open trial of NT in patients with TRD. Conclusions: The results of this study confirm the relationship between hypercholesterolemia and poor outcome in the treatment of MDD for patients with TRD.

Association between Depression and Anxiety Symptoms and Major Atherosclerosis Risk Factors in Patients with Chest Pain

“…Statin treatment was shown to increase the tendency for depression; for example, simvastatin was shown to increase depression level significantly but did not affect anxiety level (Hyyppa et al 2003). In another study, depressive patients refractory to antidepressant treatment had significantly increased blood cholesterol level (Papakostas et al 2003). Patients with hypercholesterolemia had also the higher anxiety scores in the present study.…”

The lack of association between components of metabolic syndrome and treatment resistance in depression

“…In one study (Papakostas et al 2003) a higher TG level was found in patients with TRD compared to non-TRD patients. Elevated cholesterol levels were associated with poor treatment response to noradrenergic antidepressants in TRD patients (Papakostas et al 2003).…”

“…In one study (Papakostas et al 2003) a higher TG level was found in patients with TRD compared to non-TRD patients. Elevated cholesterol levels were associated with poor treatment response to noradrenergic antidepressants in TRD patients (Papakostas et al 2003). A poor treatment response and high cholesterol levels were also observed in patients with MDD treated with SSRI fluoxetine (Iosifescu et al 2005) or paroxetine (Muck-Seler et al 2011).…”

“…We have found that TRD was associated with current suicidality and that TRD patients more frequently had at least one prior suicide attempt, which suggest more frequent suicidal behaviour in TRD study population. So far, only one study (Papakostas et al 2003) investigated the suicidality in TRD and found that more than half of patients with TRD reported thoughts or wishes of death. The higher number of previous suicide attempts in our TRD compared to non-TRD patients is in line with the results of Amital et al (2008).…”

Simvastatin treatment exerts antidepressant-like effect in rats exposed to chronic mild stress

“…Cholesterol is an important component in the structure of cell membrane, and plays a critical role in many functions in neural circuits, thus regulating mood state and antidepressant response (De Berardis et al, 2009;Papakostas et al, 2003;Pucadyil and Chattopadhyay, 2006). These functions include monoaminergic neurotransmission, energy metabolism, and synaptic plasticity (Bjork et al, 2010;Maxfield and Tabas, 2005;Sebastiao et al, 2013).…”