Indian Journal of Psychological Medicine

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

Cholesterol and mental health: A balanced perspective


Vikas Menon1, Abhishek Ghosh2, Chittaranjan Andrade3,  
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

Correspondence Address:
Vikas Menon
Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry - 605 006
India




How to cite this article:
Menon V, Ghosh A, Andrade C. Cholesterol and mental health: A balanced perspective.Indian J Psychol Med 2017;39:717-718


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 2020 Feb 28 ];39:717-718
Available from: http://www.ijpm.info/text.asp?2017/39/5/717/217011


Full Text



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

1Pereira H. The importance of cholesterol in psychopathology: A review of recent contributions. Indian J Psychol Med 2017;39:109-13.
2Shamseer 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.
3Muldoon MF, Manuck SB, Matthews KA. Lowering cholesterol concentrations and mortality: A quantitative review of primary prevention trials. BMJ 1990;301:309-14.
4Muldoon 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.
5Andrade C. Primary prevention of cardiovascular events in patients with major mental illness: A possible role for statins. Bipolar Disord 2013;15:813-23.
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8Wu 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.
9Andrade C. Cardiometabolic risks in schizophrenia and directions for intervention, 1: Magnitude and moderators of the problem. J Clin Psychiatry 2016;77:e844-7.