Артериальная гипертензия, липопротеины низкой плотности и депрессия

Abstract
Background
Clinicians generally agree on the association between depression and hypertension. Less clear is if the nature of the link is direct or indirect and if this should be considered confined only to syndromal forms or if it concerns also subsyndromal affective presentations. This study investigated the nature of the association between hypertension and subsyndromal depression in hospitalized hypertensive patients.
Methods
196 hypertensive and 96 non hypertensive inpatients underwent a SCID interview, to exclude patients positive for any Axis I or Axis II diagnosis. Symptomatic Subsyndromal Depression (SSD) was identified according to criteria proposed by Judd. Psychopathological assessment was performed with Anxiety Sensitivity Index (ASI) and Hopkins Symptom Checklist-90 (SCL-90). Clinical assessments included blood pressure measurement, evaluation of general health conditions and screening cardiovascular risk factors (smoke, alcohol, body weight, sedentary life style).
Results
Hypertensives met more frequently criteria for SSD. They also scored higher on ASI and SCL-90. However, those with more severe physical conditions, if compared with more healthy patients, did not show increased psychopathological severity. Similarly, psychopathological symptom severity did not differ among hypertensives positive for other cardiovascular risk factors, commonly more frequent among depressed subjects.
Limitations
Further analyses are needed to explore the potential advantage obtained on blood pressure control by treating SSD.
Conclusions
Hospitalized hypertensives, more frequently satisfied criteria for Symptomatic Subsyndromal Depression. These milder affective forms are probably directly linked to the presence of hypertension, rather than being indirectly associated to physical impairment or to higher prevalence of other cardiovascular risk factors.

Symptomatic subsyndromal depression in hospitalized hypertensive patients

Objective
Serum cholesterol was reported to be associated with depressed mood, but the studies conducted among household population are rare.
Methods
We used the data of 4115 men and 4275 women aged 18 or older, who completed a depression screening interview and had blood collected as a part of the National Health and Nutrition Examination Survey, 2005–2008. The serum concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were gender-specifically categorized into lower, intermediate, and upper quartiles. Depression was measured using the Patient Health Questionnaire, a 9-item screening instrument asking about the frequency of depression symptoms over the past 2weeks.
Results
After adjustment for socio-demographics and behavioral risks, a U-shaped association was detected between severe depression and LDL-C among men. The odds ratios (ORs) of severe depression were 5.13 (95% CI=1.74–15.09), 1 (reference) and 2.28 (1.07–4.86) respectively for the men with lower (<169mg/dL), intermediate (169–221mg/dL), and upper quartile (≥222mg/dL) LDL-C. Among women, lower HDL-C was significantly associated with an elevated odds of severe depression [OR=2.96 (1.59–5.52)] compared with upper quartile of HDL-C, the association diminished after adjustment for covariates [OR=1.24 (0.66–2.32)]. No clear pattern of association between cholesterol and moderate depression was observed from either men or women.
Limitation
The inherent limitation of cross-sectional design prevented the authors from investigating causality.
Conclusions
A U-shaped association was identified between LDL-C and severe depression among men. Further studies are necessary to explore the biological mechanism and identify the clinical implication among populations vulnerable to psychiatric disorders.

Low cholesterol is associated with depression among US household population 

Статины, холестерин и аффективные расстройства

New research into cholesterol-lowering statin drugs and serotonin-1A receptors may help explain the relationships between cholesterol levels and symptoms of anxiety and depression.

Shrivastava and colleagues1 explored the effect of chronic cholesterol depletion induced by mevastatin on the function and dynamics of the human serotonin-1A receptors stably expressed in animal cells. Statins are competitive inhibitors of HMG-CoA reductase, the key rate-limiting enzyme in cholesterol biosynthesis.

Statins, Cholesterol Depletion—and Mood Disorders: What’s the Link?

Низкий уровень холестерина как фактор риска аффективных расстройств

In the early 1990s several studies suggested a link between low cholesterol (< 160 mg/dL) and unnatural deaths, including suicide.2-4 Follow-up studies confirmed associations between low cholesterol and suicide attempts, especially violent ones.5 These associations are compelling given the neurobiologic effects of cholesterol, such as a net reduction of serotonergic function (Box 1). Low cholesterol may predispose an individual to aggression, impulsivity, and violence (Table 1).6 Many studies have found that patients with mood disorders have lower cholesterol levels;7 however, other research suggests they are at increased risk of hyperlipidemia, typically hypertriglyceridemia rather than hypercholesterolemia.

The neurobiologic effects of low cholesterol—particularly those related to serotonergic hypofunction—are thought to be mediate impulsive, aggressive, and violent behaviors that may predispose an individual to suicide.a,b The CNS contains one-fourth of the body’s free cholesterol,c which is synthesized primarily in situ.

Cholesterol improves membrane stability, reduces permeability, and may influence serotonergic function. Cholesterol depletion may impair function of 5-HT1A and 5-HT7 receptorsd,e and serotonin transporter activity.f Reduced cholesterol after treatment with simvastatin—an HMG-CoA reductase inhibitor that readily crosses the blood-brain barrier—resulted in acute (1-month) increases in serotonin transporter activity followed by subacute (>2 months) decreases.g Lower cholesterol levels may further decrease expression of serotonin receptors and cause a net reduction in serotonergic activity.

In addition, cholesterol is necessary for synapse formation and myelin production. Cholesterol depletion may have more diffuse effects on neurotransmission, such as gamma-aminobutyric acid receptors,hN-methyl-D-aspartate receptors,i opioid signaling,j and excitatory amino acids transport.k

Impulsivity associated with low serotonergic function and low total cholesterol has been suggested as a potential pathway for suicide.l Low cholesterol is associated with self-report measures of impulsivity;m however, increased impulsivity associated with lipid-lowering therapy may be temporary,n which is similar to the time-limited changes in serotonin transporter activity.g Human and animal data have suggested that low cholesterol may be linked to violent behaviors, including suicide.o

Multiple randomized controlled trials have not shown increased depression and suicide with use of lipid-lowering agents in healthy populations

Closely monitor individuals with mood disorders for changes in behavior or mental status after starting a lipid-lowering agent

Cholesterol, mood, and vascular health: Untangling the relationship

Лекарства снижающие уровень холестерина и депрессия

The scientists turned to the statin medication mevastatin to find out.

In lab tests using human serotonin receptors expressed in animal cells, they showed that long-term use of the drug caused significant changes in the structure and function of serotonin cell receptors.

Adding cholesterol to cells treated with mevastatin restored them to normal.

The results represent the first report describing the effect of long-term cholesterol depletion on this type of cell receptor and suggest that chronic, low cholesterol levels in the brain might trigger anxiety and depression, the scientists say.

Link Between Cholesterol Drug and Depression