Lipidmetabolismus und Insulinresistenz bei depressiven Patienten

 

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Zusammenfassung

Depression ist mit einem erhöhten kardiovaskulären Risiko verbunden. Hierzu trägt die Tatsache bei, dass depressive Patienten häufiger als die Allgemeinbevölkerung von einem metabolischen Syndrom betroffen sind, bei dem Diabetes mellitus Typ 2, bauchbetonte Adipositas, Hypertonie und/oder eine Dyslipidämie mit einer Insulinresistenz verknüpft sind. Cholesterin ist dagegen paradoxerweise in manchen Studien an depressiven Patienten erniedrigt. Unsere Daten zeigen erstmals einen Zusammenhang zwischen erniedrigtem Cholesterin und dem Hypercortisolismus Möglicherweise ist erniedrigtes Cholesterin ein Kennzeichen des melancholischen, hypercortisolämischen Subtyps der Depression. Klassische Antidepressiva wie das von uns untersuchte Amitriptylin und der SSRI Paroxetin zeigen einen neutralen oder sogar günstigen Einfluss auf Insulinresistenz und die Architektur der Lipoproteine. Damit kann eine medikamentöse antidepressive Therapie vermutlich dazu beitragen, auch das erhöhte kardiovaskuläre Risiko zu senken.

Summary

Major depression conveys an increased cardiovascular risk. This is in part due to a higher prevalence of the metabolic syndrome in depressed patients, when compared to the general population. The metabolic syndrome is defined as an association of type-2 diabetes mellitus, visceral obesity, hypertension and dyslipidemia with insulin resistance. Paradoxically, depression has been linked to low cholesterol by some studies. We found a negative correlation between cortisol and cholesterol in a subgroup of depressed patients, suggesting that low cholesterol may be a feature of the melancholic, hypercortisolemic subtype of depression. Classical antidepressant drugs such as amitriptyline and SSRI such as paroxetin have neutral or slightly beneficial effects on insulin resistance and architecture of lipoproteins. Therefore, pharmacological treatment of depression may help lowering the increased cardiovascular risk.

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Korrespondenzadresse:

Dr. Daniel Kopf

Zentralinstitut für Seelische Gesundheit

Postfach 21 21 20

68072 Mannheim

Email: kopf@zi-mannheim.de