N Yalın, Y Yalçın Arslan, A Topuzoglu, D Cimrin, Z Tunca, A Ozerdem

Dokuz Eylul University Faculty of Medicine, Department of Adult Psychiatry, Izmir, Turkey

Objective: There is a reciprocal relationship between mood disor- ders and cardiovascular diseases. Dyslipidemia is an independent risk factor for cardiovascular diseases. Reports on serum lipid levels in unipolar depression and different illness states of bipolar disorder are contradictory. No previous study compared unipolar and bipolar depression with regard to lipid profiles. We aimed to assess rate and predictive factors of dyslipidemia in patients with unipolar and bipolar depression in comparison to non-psychiat- ric controls.

Methods: In this retrospective, cross-sectional case-control study, serum lipid profiles [total cholesterol, trigliseride (TG), high den- sity lipoprotein (HDL), low density lipoprotein (LDL) levels] of 269 adult, medicated inpatients with DSM-IV bipolar (BD; n = 60; Females = 28) and unipolar (UD; n = 209; Females = 143) depres- sion were compared to that of control patients admitted to the der- matology outpatient clinic within a year period (CP; n = 412; Females = 313). Medical and psychiatric information and lipid profiles were provided from the hospital database of the Dokuz Eylul University. Controls had no medical record for any psychiat- ric axis I disorder. For psychiatric inpatients, lipid profiles at the time of hospital admission, for the controls, only the first lipid val- ues of the one year period providing a single set per person were included in the analysis. ANOVA, chi-square and multivariable logistic regression analysis were used where needed. Serum TSH levels, HAM-D 17 scores as well as medication use at hospital admission, illness and index episode duration, number of past episodes, previous medication use, age, gender and medical comorbidities were included as predictors of the lipid profile in the regression analysis.

Results: Age of BD (42.73 ± 12.848), UD (45.04 ± 13.656), and CP (43.92 ± 12.981) were similar. The groups differed significantly with regard to gender (p <0.0001). Serum HDL levels in BD (42.50 ± 11.30) and UD (45.28 ± 12.26) were significantly lower than controls (49.39 ± 13.72; p = 0.001for both groups). BD (166.75 ± 94.65; p = 0.04) and UD (151.85 ± 92.74; p = 0.016) Showed higher TG levels than controls (TG: 135.48  89.51). In regression analysis, there was a significant interaction of age and gender (p <0.0001 for both parameters) with serum TG levels. Gender and diagnosis showed a significant interaction with the serum HDL levels. Serum HDL levels of females were 3.808 fold lower (p <0.0001) than males before adjusting for diagnosis. After adjustment for diagnosis, HDL levels in UD revealed 1.483 fold (p = 0.049) and in BD, 2.092 fold lower (p = 0.016) values than the CP. The gender HDL interaction was the only parameter that interacted significantly with the HDL levels (p <0.0001) among all abovementioned parameters when only BD and UD were included in the regression model.

Discussion: Dyslipidemia, specifically low serum HDL level is a component of metabolic syndrome. There is a strong relationship between metabolic syndrome and cardiovascular diseases. Results of this study shows that female inpatients with depression may have higher risk for dyslipidemia. Bipolar disorder seems to be enhancing the risk more than unipolar depression for females.

Keywords: bipolar depression, unipolar depression, lipid profile, gender

Bipolar Disorders © 2013 John Wiley & Sons A/S, Bipolar Disorders, 15 (Suppl. 1) 53–103