LDL cholesterol relates to depression, its severity, and the prospective course

Background: Major depressive disorder (MDD) is a highly prevalent and burdening mental illness. Approximately 30% of the major depressive episodes (MDE) are classified as therapy-refractory. Further knowledge of the pathophysiological mechanisms underlying MDD and predictive biomarkers are needed to improve treatment options. Methods: Serum lipid levels were compared between patients with a current MDE (n = 130) or remitted MDD (n = 39) and healthy control subjects (n = 61) and associated with the severity (17-item Hamilton Depression Rating Scale [HAMD] scores) and the prospective course of depression (direct follow-up of at median 20 days post-inclusion). Results: We found higher levels of LDL cholesterol (152.5 vs. 134.0 mg/dl, U = 3021, P = 0.008) and LDL/HDL ratio (2.82 vs. 2.21, U = 2912, P = 0.003) in patients with a current MDE than in healthy control subjects. In patients with a current MDE, higher HAMD scores correlated also with higher values of triglycerides (rho = 0.213, P = 0.015), total cholesterol (rho = 0.199, P = 0.023), LDL cholesterol (rho = 0.224, P = 0.010), and LDL/HDL ratio (rho = 0.196, P = 0.026). Moreover, higher total cholesterol (rho = -0.233, P = 0.010), LDL cholesterol (rho = -0.235, P = 0.010), and LDL/HDL ratio (rho = -0.199, P = 0.029) were associated with a stronger decline in HAMD score between study inclusion and direct follow-up. Limitations: We employed an associational study design, performed only a short-term follow-up, and excluded suicidal study subjects. Conclusions: Serum lipid levels are associated with depression per se, the depression severity, and the prospective 3-week course. These observations build the basis for future investigations on individualized lipid metabolism-related treatment strategies in depressed patients.