Volume 7, Number 2

Cholesterol Metabolism and Suicidality

Aleksandra Lalovic, MSc, and Gustavo Turecki, MD, PhD

Ms. Lalovic is a doctoral candidate in the Department of Neurology & Neurosurgery, McGill University, Montréal, Canada.

Dr. Turecki is the Director of the McGill Group for Suicide Studies, Douglas Hospital Research Centre, and Associate Professor of Psychiatry, Human Genetics and Neurology & Neurosurgery, McGill University.

Abstract

Most completed suicides occur within the context of a psychiatric illness, primarily major depressive disorder comorbid with substance disorders, and they are frequently associated with impulsive-aggressive behaviors. Low levels of serum total cholesterol have been linked to suicidality, impulsivity, aggression, and violence. In one study, the biological relatives of Smith-Lemli-Opitz syndrome (SLOS) carriers, a population with a partial enzyme deficiency related to cholesterol metabolism, were found to have a 6-fold greater risk of suicide attempt or completion compared with relatives of controls. Supporting evidence for these observations is presented herein along with several hypotheses that might contribute to an understanding of the mechanisms underlying the cholesterol-suicidality relationship. In some large randomized, double-blind, lipid-lowering trials, it was noted that although cardiac-related mortality decreased due to the beneficial effects of the lipid-lowering drugs on cardiovascular health, this was offset by a significant increase in violence-related deaths. These observations raise questions about what selection issues and supervision should be afforded to patients given statins to reduce cholesterol and thereby improve cardiovascular status.