The Effect of SSRIs on Total Cholesterol Levels in Subjects with Major Depression

Abstract

Major depression has been associated with early death as the result of cardiovascular mechanisms secondary to increased lipids and/or the metabolic syndrome. Psychiatric drugs have been implicated in deleterious effects on weight, lipids, and glucose. The 5HT2-D2 antagonists are especially damaging in this regard; a significant proportion of subjects have been reported to gain weight and exhibit complications of high lipid levels and diabetes. Current treatment of major depression involves the administration of specific serotonin reuptake inhibitors (SSRIs), which affect serotonin receptors. Fluoxetine and sertraline have been shown to have less antidepressant effect in subjects with elevated cholesterol. Furthermore, they have been shown to have a cholesterol-elevating effect in depressed subjects. The elevation is similar in HDL and LDL cholesterol fractions. The effect in subclasses of depression has not been measured. Classic depression (major depressive disorder [MDD]) is associated with loss of appetite and insomnia, whereas atypical depression (atypical depressive disorder [ADD]) is associated with hyperphagia and hypersomnia.