Mark, a 43 year-old executive, saw his doctor for his annual physical. Reviewing his laboratory tests, the doctor noted that Mark's total cholesterol level was for the first time over 200mg/dL.
As a preventative measure the doctor prescribed a statin, a class of cholesterol-lowering drugs. His cholesterol levels declined, but so did his mood. Mark was now struggling with anxiety and depression.
Over the years I've seen many patients like Mark, being treated by physicians with the mantra of "the lower the better" when it comes to cholesterol levels.
Although cholesterol-lowering medications might lower the risk of heart attacks or strokes our obsession with lowering cholesterol completely ignores the potential psychological consequences that may occur with low cholesterol.
A few years ago an excellent study was published in the Journal of Psychiatric Research with little attention from the press and essentially no reaction from my colleagues. The simple study followed nearly 4,500 US veterans for 15 years. At the end of the study the researchers found that men with low total cholesterol levels and depression were 7 times more likely to die prematurely from unnatural causes such as suicide and accidents than the other men in the study!
For many years, scientific studies have linked low cholesterol to depression and impulsive behaviors, including suicide and violence.
The vast majority of the research leads to the same conclusion; low cholesterol leads to higher rates of depression or depressive symptoms.
For many with depression suicide is a tragic reality. As low cholesterol is linked to depression, low cholesterol is also a risk factor in suicide attempts.
Suicide is not the only type of violence associated with lower cholesterol levels. Homicide and other acts of violence committed against others have been found to be associated with low cholesterol.
When Swedish researchers compared cholesterol measurements of nearly 80,000 men and women to subsequent arrests for violent crime, they came to the conclusion that "low cholesterol is associated with increased subsequent criminal violence."
Scientists, however, don't exactly know why low cholesterol is linked to depression, suicide, and violence. Some researchers theorize that low levels of cholesterol alter brain chemistry, suppressing the production and/or availability of serotonin or other neurotransmitters in the brain.
But what is clear and what many overlook is the fact that cholesterol plays a vital role in the human body. Foremost, it is valuable and necessary for optimal brain function as the brain is the most cholesterol-rich organ in the body.
Among its many other roles cholesterol also
Despite cholesterol's vital role in human health and healthy brain function, cholesterol continues to be vilified by the medical profession. With constant ads about the dangers of high cholesterol leading to heart disease, heart attacks and strokes, many millions of Americans every year are prescribed statins to lower their cholesterol.
It's important to set aside this marketing hype and to appreciate the critical role that cholesterol plays in both physical and mental health, especially its role in depression.
Low cholesterol is one of the most common factors I see in treatment refractory depression.
In stating that, I evaluate total cholesterol levels of all patients suffering from depression. I find that a total cholesterol level below 150 mg/dL is often a contributing factor to depression. Raising cholesterol levels by dietary interventions or adjusting statin medication for some patients may be the key to treating their depression.
I am going to end this blog with a list of references that support the link between low cholesterol and mental health. Please be sure to check out the references below.