ARE PSYCHOACTIVE-DRUG-INDUCED CHANGES IN PLASMA-LIPID AND LIPOPROTEINLEVELS OF SIGNIFICANCE FOR CLINICAL REMISSION IN PSYCHIATRIC-DISORDERS

In the present pilot study, our aim was to investigate whether associa tions could be demonstrated in psychiatric patients between the change s in plasma lipid and lipoprotein levels expected during treatment wit h psychoactive drugs and the changes in the patients' depressive and h ostile behavior. One hundred and fourteen patients with various psychi atric disorders (depressive episode in bipolar affective disorder, dep ressive episode or recurrent depressive disorder, paranoid schizophren ia, and schizoaffective disorders) were included in the study. The fol lowing 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), hi gh-density lipoprotein (HDL), and triglycerides (TRI) were determined, and (2) the psychopathological features were recorded employing the A MDP system and the AMDP Syndrome Scales. Within the context of a natur alistic clinical setting with a choice of psychoactive drugs available , patients were subdivided at the end of treatment into eight treatmen t 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 se lective serotonin reuptake inhibitors; group 5, treatment with butyrop henones and lithium; group 6, treatment with tricyclics and lithium; g roup 7, treatment with butyrophenones, tricyclics and lithium; and gro up 8, treatment with butyrophenones, tricyclics, selective serotonin r euptake inhibitors and lithium. To compare the changes in the eight tr eatment groups, mixed general linear models including diagnosis, gende r, age, body mass index changes, and baseline values were applied usin g proc GLM of SAS. Butyrophenones induce an increase in TC, LDL, and T C/TRI ratio, whereas tricyclics lead to an increase in TC, LDL, VLDL, and TRI. In combined medication of butyrophenones and tricyclics the e ffects of tricyclics predominate. Comedication of lithium inhibits the increase in TC and LDL induced by butyrophenones and/or tricyclics. T reatment groups with lipid changes of the same type (decrease, no chan ge, or increase) were combined in ''lipid change groups''. Analyses of variance or covariance (with psychopathological admission value as co variate where there were significant differences in psychopathological admission mean values between the groups) of these lipid change group s 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, wherea s an increase in TRI with concomitant decrease in TC, or else a relati vely greater increase in TRI than in TC promotes the remission of host ility. A decrease in TRI or VLDL promotes the remission of depression. Our data and findings published in the literature may suggest that sy stemic changes in plasma lipid parameters, at the cellular level, indu ce changes in the fluidity of brain cell membranes. We hypothesize tha t an increase in plasma TC or LDL and/or a decrease in plasma TRI or V LDL may induce a relative decrease in brain cell membrane fluidity wit h 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 effe ct. Conversely, a decrease in plasma TC or LDL and/or an increase in p lasma TRI or VLDL may induce a relative increase in brain cell membran e fluidity with increased presynaptic serotonin reuptake and decreased postsynaptic serotonin function. This proposed decrease in brain sero tonin function would result in an anti-aggressive, depression-promotin g effect.