Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-03T08:57:50.080Z Has data issue: false hasContentIssue false
  • English
  • Français

Low Serum Cholesterol and Suicide

Published online by Cambridge University Press:  02 January 2018

Keith Hawton ,
Philip Cowen ,
David Owens ,
Alyson Bond  and
Martin Elliott
Keith Hawton
Affiliation:
University Department of Psychiatry and Warneford Hospital, Oxford OX3 7JX
Philip Cowen
Affiliation:
Research Unit, Littlemore Hospital, Oxford OX4 4XN
David Owens
Affiliation:
University of Leeds, Academic Unit of Psychiatry, 15 Hyde Terrace, Leeds LS2 9LT
Alyson Bond
Affiliation:
Department of Psychiatry, Institute of Psychiatry, De Crespigny Park, London SE5 8AF
Martin Elliott
Affiliation:
Oxford University SmithKline Beecham Centre for Applied Neuropsychobiology, University Department of Clinical Pharmacology, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE
Get access Rights & Permissions [Opens in a new window]

Abstract

“Primary prevention trials which have shown that the lowering of serum cholesterol concentrations in middle-aged subjects by diet, drugs, or both leads to a decrease in coronary heart disease have also reported an increase in deaths due to suicide or violence. There has been no adequate explanation for this association. I have reviewed the relevant published work and describe a physiological mechanism that might account for this curious finding. One of the functions of serotonin in the central nervous system is the suppression of harmful behaviour impulses. When mouse brain synaptosomal membrane cholesterol is increased there is a pronounced increase in the number of serotonin receptors. Low membrane cholesterol decreases the number of serotonin receptors. Since membrane cholesterol exchanges freely with cholesterol in the surrounding medium, a lowered serum cholesterol concentration may contribute to a decrease in brain serotonin, with poorer suppression of aggressive behaviour.”

Type
The Current Literature
Information
The British Journal of Psychiatry , Volume 162 , Issue 6 , June 1993 , pp. 818 - 825
Copyright
Copyright © The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anderson, I. M., Parry-Billings, M. & Newsholme, E. A. (1990) Dieting reduces plasma tryptophan and alters brain 5-HT function in women. Psychological Medicine, 20, 785–791.CrossRefGoogle ScholarPubMed
Apter, A., Van Praag, H. M., Plutchik, R., et al (1990) Interrelationships among anxiety, aggression, impulsivity, and mood: a serotonergically linked cluster? Psychiatry Research, 32, 191–199.CrossRefGoogle Scholar
Ball, M. J., Griffiths, D. & Thorogood, M. (1991) Asymptomatic hypothyroidism and hypercholesterolaemia. Journal of the Royal Society of Medicine, 84, 527–529.CrossRefGoogle ScholarPubMed
Block, E. R. & Edwards, D. (1987) Effect of plasma membrane fluidity on serotonin transport by endothelial cells. American Journal of Physiology, 253, 672–678.CrossRefGoogle ScholarPubMed
Bradford Hill, A. (1953) Observation and experiment. New England Journal of Medicine, 248, 995–1001.CrossRefGoogle Scholar
Bradford, R. H., Shear, C. L., Chremos, A. N., et al (1991) Expanded clinical evaluation of lovastatin (EXCEL) study results. I. Efficacy in modifying plasma lipoproteins and adverse event profile in 8245 patients with moderate hypercholesterolemia. Archives of Internal Medicine, 151, 43–49.CrossRefGoogle ScholarPubMed
Brown, G. L. & Linnoila, M. I. (1990) CSF serotonin metabolite (5-HIAA) studies in depression, impulsivity, and violence. Journal of Clinical Psychiatry, 51, 31–41.Google ScholarPubMed
Canter, D. (1990) Lowering cholesterol concentrations and mortality. British Medical Journal, 301, 814.Google Scholar
Coccaro, E. F., Siever, L. J., Klar, H. M., et al (1989) Serotonergic studies in patients with affective and personality disorders. Archives of General Psychiatry, 46, 587–599.CrossRefGoogle ScholarPubMed
Davey Smith, G., Shipley, M. J., Marmot, M. G., et al (1990) Lowering cholesterol concentrations and mortality. British Medical Journal, 301, 552.Google Scholar
Davey Smith, G., & Pekkanen, J. (1992) Should there be a moratorium on the use of cholesterol lowering drugs? British Medical Journal, 304, 431–434.CrossRefGoogle ScholarPubMed
Davey Smith, G., & Phillips, A. N. (1992) Confounding in epidemiological studies: why “independent” effects may not be all they seem. British Medical Journal, 305, 757–759.CrossRefGoogle Scholar
Depue, R. A. & Spoont, M. R. (1986) Conceptualizing a serotonin trait: a behavioral dimension of constraint. Annals of the New York Academy of Science, 487, 47–62.CrossRefGoogle ScholarPubMed
Detsky, A. S., Naylor, C. D., O'Rourke, K., et al (1992) Incorporating variations in the quality of individual randomized trials into meta-analysis. Journal of Clinical Epidemiology, 45, 255–265.CrossRefGoogle ScholarPubMed
Engelberg, H. (1992) Low serum cholesterol and suicide. Lancet, 338, 727–729.CrossRefGoogle Scholar
Feinstein, A. R. (1985) Clinical Epidemiology: The Architecture of Clinical Research. Philadelphia: W.B. Saunders.Google Scholar
Foulds, G. (1965) Personality and Personal Illness. London: Tavistock.Google Scholar
Fowler, P. B. S. (1977) Premyxoedema - a cause of preventable coronary heart disease. Proceedings of the Royal Society of Medicine, 70, 297–299.CrossRefGoogle ScholarPubMed
Frick, M. H., Elo, O., Haapa, K., et al (1987) Helsinki heart study: primary prevention trial with gemfibrozil in middle-aged men with dyslipidemia. New England Journal of Medicine, 317, 1237–1245.CrossRefGoogle ScholarPubMed
Friedman, M., Thoresen, C. D., Gill, J. J., et al (1986) Alteration of type A behaviour and its effect on cardiac recurrences in postmyocardial infarction patients: summary results of the recurrent coronary prevention project. American Heart Journal, 112, 653–665.CrossRefGoogle Scholar
Gedye, A. (1991) Buspirone alone or with serotonergic diet reduced aggression in a developmentally disabled adult. Biological Psychiatry, 30, 88–91.CrossRefGoogle ScholarPubMed
Guicheney, P., Derynck, M. A., Cloix, J. F., et al (1988) Platelet 5-HT content and uptake in essential hypertension: role of endogenous digitalis-like factors and plasma cholesterol. Journal of Hypertension, 6, 873–879.CrossRefGoogle ScholarPubMed
Heron, D. S., Shinitzky, M., Hershkowitz, M., et al (1980) Lipid fluidity markedly modulates the binding of serotonin to mouse brain membranes. Proceedings of the National Academy of Science, USA, 77, 7463–7467.CrossRefGoogle ScholarPubMed
Lindberg, G., Rastam, L., Gullberg, B., et al (1992) Low serum cholesterol concentration and short term mortality from injuries in men and women. British Medical Journal, 305, 277–279.CrossRefGoogle ScholarPubMed
Lipid Research Clinics Program (1984) The lipid research clinics coronary primary prevention trial results. Journal of the American Medical Association, 251, 351–374.CrossRefGoogle Scholar
Mann, J. J., Arango, A., Marzuk, P. M., et al (1989) Evidence for the 5-HT hypothesis of suicide: a review of post-mortem studies. British Journal of Psychiatry, 155, 7–14.CrossRefGoogle Scholar
Muldoon, M. F., Manuck, S. B. & Matthews, K. A. (1990) Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials. British Medical Journal, 301, 309–314.CrossRefGoogle ScholarPubMed
O'Keane, V., Moloney, E., O'Neill, H., et al (1992) Blunted prolactin responses to d-fenfluramine in sociopathy. Evidence for subsensitivity of central serotonergic function. British Journal of Psychiatry, 160, 643–646.CrossRefGoogle ScholarPubMed
Pekkanen, J., Nissinen, A., Punsar, S., et al (1989) Serum cholesterol and risk of accidental or violent death in a 25-year follow-up: the Finnish cohorts of the seven countries study. Archives of Internal Medicine, 149, 1589–1591.CrossRefGoogle ScholarPubMed
Prieto, J. C., Hueso, C. & Carmena, M. J. (1990) Modulation of the β-adrenergic stimulation of cyclic AMP accumulation in rat prostatic epithelial cells by membrane fluidity. General Pharmacology, 21, 931–933.CrossRefGoogle ScholarPubMed
Ratey, J., Sovner, R., Parks, A., et al (1991) Buspirone treatment of aggression and anxiety in mentally retarded patients: a multiple-baseline, placebo lead-in study. Journal of Clinical Psychiatry, 52, 159–162.Google ScholarPubMed
Roy, A., Adinoff, B., Linnoila, M., et al (1988) Acting out hostility in normal volunteers: negative correlation with levels of 5H1AA in cerebrospinal fluid. Psychiatry Research, 24, 187–194.CrossRefGoogle Scholar
Royal College of General Practitioners (1993) Guidelines for the Management of Hyperlipidaemia in General Practice. London: Royal College of General Practitioners.Google Scholar
Sackett, D. L., Haynes, R. B., Guyatt, G. H., et al (1991) Clinical Epidemiology: A Basic Science for Clinical Medicine. Boston: Little, Brown & Company.Google Scholar
Shaper, A. G. & Cook, D. G. (1990) Lowering cholesterol concentrations and mortality. British Medical Journal, 301, 553.CrossRefGoogle Scholar
Shih, J. C. & Ohsawa, R. (1983) Differential effect of cholesterol on two types of 5-hydroxytryptamine binding sites. Neurochemical Research, 8, 701–710.CrossRefGoogle ScholarPubMed
Szabadi, E. (1992) Fluvoxamine withdrawal syndrome. British Journal of Psychiatry, 160, 283–284.CrossRefGoogle ScholarPubMed
Thacker, S. B. (1988) Meta-analysis: a quantitative approach to research integration. Journal of the American Medical Association, 259, 1685–1689.CrossRefGoogle ScholarPubMed
Tsutsumi, S., Tsuji, K., Ogawa, K., et al (1988) Effect of dietary salt and cholesterol loading on vascular adrenergic receptors. Blood Vessels, 25, 209–216.Google ScholarPubMed
Virkkunen, M. (1979) Serum cholesterol in antisocial personality. Neuropsychobiology, 5, 27–30.CrossRefGoogle ScholarPubMed
Tsutsumi, S. (1983) Serum cholesterol levels in homicidal offenders. A low cholesterol level is connected with a habitually violent tendency under the influence of alcohol. Neuropsychobiology, 10, 65–69.Google Scholar
Tsutsumi, S. & Pentinnen, H. (1984) Cholesterol in aggressive conduct disorder: a preliminary study. Biological Psychiatry, 19, 435–439.Google Scholar
Watts, G. F., Lewis, B., Brunt, J. N. H., et al (1992) Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St Thomas' Atherosclerosis Regression Study (STARS). Lancet, 339, 563–569.CrossRefGoogle ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.