Cholesterin, Omega-3-Fettsäuren und Suizidrisiko

Zusammenfassung

Klinische Studien wiesen bei psychiatrischen Patienten mit verschiedenen Diagnosen auf einen möglichen Zusammenhang zwischen niedrigen Cholesterinkonzentrationen und Suizidalität, Depression, Impulsivität und Aggressivität hin. Diese Assoziation kann nicht allein durch den Gewichtsverlust im Rahmen depressiver Erkrankungen hinreichend erklärt werden. Eine Reihe von Befunden deutet darauf hin, dass ein serotonerges Defizit im präfrontalen Kortex dazu prädisponieren könnte, in psychosozialen Belastungssituationen impulsiv und autoaggressiv zu handeln. Ausgehend von den Befunden zu serotonergen Veränderungen bei suizidalen Patienten wurde eine neurobiologisch determinierte Vulnerabilität für suizidales Verhalten postuliert. In-vitro-Untersuchungen und Tierexperimente sowie humane In-vivo-Studien unterstützen die Annahme, dass eine Cholesterinreduktion in neuronalen Membranen die serotonerge Neurotransmission hemmen könnte. Aufgrund neuester Befunde wurde die Hypothese formuliert, dass ein Mangel an mehrfach ungesättigten Fettsäuren, insbesondere Omega-3-Fettsäuren, das Risiko für Depressionen und Suizidhandlungen erhöhen könnte. Untersuchungen an gesunden Probanden deuten darauf hin, dass eine erhöhte Zufuhr von Omega-3-Fettsäuren mit der Nahrung die serotonerge Aktivität erhöhen und dadurch impulsive und aggressive Verhaltensweisen hemmen könnte. Frühere epidemiologische Studien zeigten eine statistische Assoziation zwischen niedrigen Cholesterinspiegeln und einem erhöhten Suizidrisiko. Dies konnte jedoch in neueren epidemiologischen Untersuchungen mit größeren Fallzahlen und längeren Beobachtungszeiträumen nicht repliziert werden; vielmehr zeigte sich sogar eine positive Korrelation zwischen Cholesterinkonzentrationen und Suizidrisiko. Die kürzlich publizierten Interventionsstudien zeigten, dass Statine (Simvastatin, Lovastatin, Pravastatin) nicht zu einer Erhöhung der Suizidmortalität führen.

Abstract

Studies in psychiatric patients described an association between lower serum cholesterol concentrations, suicidality, depression, impulsivity, and aggression which is not entirely attributable to depression-related malnutrition and weight-loss. Several lines of evidence suggest that a serotonergic deficit in the prefrontal cortex may predispose vulnerable subjects to impulsive, autoaggressive, and suicidal behaviour in stressful life-events. In-vitro studies, animal experiments, and human in-vivo studies support the hypothesis that cholesterol reduction may contribute to the serotonergic abnormalities which have been postulated in suicidal subjects. Recently it was hypothesized that decreased consumption of polyunsaturated fatty acids, especially omega-3 fatty acids, may be a risk factor for depression and suicide. Data from human studies in healthy volunteers suggest that increasing the dietary intake of omega-3 fatty acids may increase central serotonergic activity and reduce impulsive and aggressive behaviours. Earlier epidemiological studies showed an association between low cholesterol concentrations and increased suicide risk. Recent epidemiological studies with greater samples and longer follow-up periods, however, even showed a positive correlation between cholesterol concentrations and suicide risk after controlling for potential confounding variables. Large trials of statins (simvastatin, lovastatin, pravastatin) did not show an increase of suicide mortality.

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