In the present pilot study, our aim was to investigate whether associations could
be demonstrated in psychiatric patients between the changes in plasma lipid and lipoprotein
levels expected during treatment with psychoactive drugs and the changes in the patients'
depressive and hostile behavior. One hundred and fourteen patients with various psychiatric
disorders (depressive episode in bipolar affective disorder, depressive episode or
recurrent depressive disorder, paranoid schizophrenia, and schizoaffective disorders)
were included in the study. The following examinations were carried out in each patient
on admission and at discharge: (1) the plasma lipid parameters total cholesterol (TC),
low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), high-density lipoprotein
(HDL), and triglycerides (TRI) were determined, and (2) the psychopathological features
were recorded employing the AMDP system and the AMDP Syndrome Scales. Within the context
of a naturalistic clinical setting with a choice of psychoactive drugs available,
patients were subdivided at the end of treatment into eight treatment groups, as follows:
group 1, treatment with butyrophenones; group 2, treatment with tricyclics; group
3, treatment with butyrophenones and tricyclics; group 4, treatment with butyrophenones,
tricyclics and selective serotonin reuptake inhibitors; group 5, treatment with butyrophenones
and lithium; group 6, treatment with tricyclics and lithium; group 7, treatment with
butyrophenones, tricyclics and lithium; and group 8, treatment with butyrophenones,
tricyclics, selective serotonin reuptake inhibitors and lithium. To compare the changes
in the eight treatment groups, mixed general linear models including diagnosis, gender,
age, body mass index changes, and baseline values were applied using proc GLM of SAS.
Butyrophenones induce an increase in TC, LDL, and TC/TRI ratio, whereas tricyclics
lead to an increase in TC, LDL, VLDL, and TRI. In combined medication of butyrophenones
and tricyclics the effects of tricyclics predominate. Comedication of lithium inhibits
the increase in TC and LDL induced by butyrophenones and/or tricyclics. Treatment
groups with lipid changes of the same type (decrease, no change, or increase) were
combined in "lipid change groups". Analyses of variance or covariance (with psychopathological
admission value as covariate where there were significant differences in psychopathological
admission mean values between the groups) of these lipid change groups with regard
to the changes in the Depressive Syndrome Scale and the Hostility Syndrome Scale gave
results which are interpreted as follows: an increase in TC or LDL inhibits the remission
of hostility, whereas an increase in TRI with concomitant decrease in TC, or else
a relatively greater increase in TRI than in TC promotes the remission of hostility.
A decrease in TRI or VLDL promotes the remission of depression. Our data and findings
published in the literature may suggest that systemic changes in plasma lipid parameters,
at the cellular level, induce changes in the fluidity of brain cell membranes. We
hypothesize that an increase in plasma TC or LDL and/or a decrease in plasma TRI or
VLDL may induce a relative decrease in brain cell membrane fluidity with decreased
presynaptic serotonin reuptake and increased postsynaptic serotonin function. This
proposed increase in brain serotonin function would finally result in an anti-depressive,
aggression-promoting effect. Conversely, a decrease in plasma TC or LDL and/or an
increase in plasma TRI or VLDL may induce a relative increase in brain cell membrane
fluidity with increased presynaptic serotonin reuptake and decreased postsynaptic
serotonin function. This proposed decrease in brain serotonin function would result
in an anti-aggressive, depression-promoting effect.
