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 Table of Contents    
LETTER TO EDITOR
Year : 2017  |  Volume : 39  |  Issue : 5  |  Page : 717-718  

Cholesterol and mental health: A balanced perspective


1 Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
2 Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, Karnataka, India
3 Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Date of Web Publication24-Oct-2017

Correspondence Address:
Vikas Menon
Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPSYM.IJPSYM_189_17

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How to cite this article:
Menon V, Ghosh A, Andrade C. Cholesterol and mental health: A balanced perspective. Indian J Psychol Med 2017;39:717-8

How to cite this URL:
Menon V, Ghosh A, Andrade C. Cholesterol and mental health: A balanced perspective. Indian J Psychol Med [serial online] 2017 [cited 2019 Nov 15];39:717-8. Available from: http://www.ijpm.info/text.asp?2017/39/5/717/217011



Sir,

Pereira[1] described a systematic review that examined the importance of cholesterol in psychopathology. The methods section of the paper listed the search terms but not the search date and the search strategy; in fact, the review lacked most of the characteristics that make a systematic review Preferred Reporting Items for Systematic Reviews and Meta-analyses compliant.[2] The single most important limitation of the review is that the findings of the identified studies were merely listed in a table. There was no critical evaluation of the literature, synthesis of findings, or discussion of the findings. There was neither take-home message nor new learning from the review. As a side comment, the review examined only studies published from January 2010 onward with no justification provided for the cutoff date. This is important because, when evaluating a field, there should be a good reason for excluding a substantial body of evidence that is relevant to the field.

A quarter of a century ago, a meta-analysis of six primary prevention randomized controlled trials (RCTs) suggested that lowering serum cholesterol levels was associated with an increased risk of mortality related to accidents, suicide, or violence;[3] a decade later, a meta-analysis of 19 RCTs showed that deaths due to these causes were not increased in patients treated with statins for either primary prevention or secondary prevention.[4] Subsequent studies were also reassuring.[5] In fact, meta-analysis of epidemiological as well as RCT data suggests that there is a lower risk of depression in statin users, and that statin augmentation of selective serotonin reuptake inhibitors has an antidepressant effect.[6],[7] Against this is the finding from a meta-analysis of epidemiological data that lower serum cholesterol levels are associated with a higher risk of suicide attempt and completion.[8] We believe, as should all scientists, that RCT data comprise a superior quality of evidence and that the findings of the RCT meta-analyses[4],[7] should therefore receive more weightage than the findings of the epidemiological data meta-analysis.[8]

Finally, and most important of all, it is important to reduce serum cholesterol in patients with major mental illness if only because such patients are at an increased risk of metabolic syndrome; statin treatment in such patients could, in the long run, significantly reduce medical morbidity and mortality, much as it does in the general population. The risk–benefit ratio clearly favors the reduction of serum cholesterol through statin treatment.[5],[9]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Pereira H. The importance of cholesterol in psychopathology: A review of recent contributions. Indian J Psychol Med 2017;39:109-13.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and explanation. BMJ 2015;349:g7647.  Back to cited text no. 2
    
3.
Muldoon MF, Manuck SB, Matthews KA. Lowering cholesterol concentrations and mortality: A quantitative review of primary prevention trials. BMJ 1990;301:309-14.  Back to cited text no. 3
    
4.
Muldoon MF, Manuck SB, Mendelsohn AB, Kaplan JR, Belle SH. Cholesterol reduction and non-illness mortality: Meta-analysis of randomised clinical trials. BMJ 2001;322:11-5.  Back to cited text no. 4
    
5.
Andrade C. Primary prevention of cardiovascular events in patients with major mental illness: A possible role for statins. Bipolar Disord 2013;15:813-23.  Back to cited text no. 5
    
6.
Parsaik AK, Singh B, Murad MH, Singh K, Mascarenhas SS, Williams MD, et al. Statins use and risk of depression: A systematic review and meta-analysis. J Affect Disord 2014;160:62-7.  Back to cited text no. 6
    
7.
Salagre E, Fernandes BS, Dodd S, Brownstein DJ, Berk M. Statins for the treatment of depression: A meta-analysis of randomized, double-blind, placebo-controlled trials. J Affect Disord 2016;200:235-42.  Back to cited text no. 7
    
8.
Wu S, Ding Y, Wu F, Xie G, Hou J, Mao P. Serum lipid levels and suicidality: A meta-analysis of 65 epidemiological studies. J Psychiatry Neurosci 2016;41:56-69.  Back to cited text no. 8
    
9.
Andrade C. Cardiometabolic risks in schizophrenia and directions for intervention, 1: Magnitude and moderators of the problem. J Clin Psychiatry 2016;77:e844-7.  Back to cited text no. 9
    




 

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