Initial Presentation

Tom was seventeen when he came to our clinic asking for help. For years he had been struggling with depression. Due to the severity of his symptoms, he had developed self-harming behaviors as a pathological coping mechanism. He often cut his forearms and thighs with a razor, raising alarm and concern from his parents. In addition, Tom struggled with addiction to cannabis and benzodiazepines, having crushed and snorted Xanax tablets that had been prescribed for his father.

His family history included depression with both his mother and sister, while his father struggled with panic attacks. Due to limited funds, laboratory testing was constrained to what insurance would cover:

Initial relevant labs

• Total cholesterol: 92 mg/dL
• 25-hydroxy vitamin D: Low at 13 ng/mL
• Vitamin B12: Normal at 543 pg/mL

Initial Treatment

• Sonic® Cholesterol: 2 tabs three times per day
• Vitamin D3: 10,000 IU per day
• Creon® (pancrelipase) with meals and snacks

Explanation

Lower cholesterol levels have been associated with self-harming behaviors and suicide (Groschwitch 2012, Li 2020). Other studies have also shown correlations between low cholesterol and addiction, cravings and relapse (Fatemi 2008, Lin 2021, Buydens-Branchey 2003).

Unfortunately, no clinical trials exist on raising low cholesterol levels and the effects on mental health. However, my own clinical experience has found cholesterol supplementation to be very helpful in patients with low levels.

Similarly, low vitamin D is associated with suicidal behaviors and addiction (Mohammadi 2023, Kemeny 2021). And vitamin D supplementation has been found to be helpful for reducing symptoms of depression (Srifuengfung 2023).

Due to the depressive symptoms, self-harming behaviors and addiction issues, both cholesterol and vitamin D were provided as supplements. Pancrelipase, a prescription digestive enzyme, was also prescribed to help with cholesterol digestion.

Follow-up Presentation

At the two month follow up, Tom had reduced cutting behaviors and was actively pursuing outpatient addiction treatment. He was also starting to discuss a desire to attend university.

Follow-up Testing

• Total cholesterol: 100 mg/dL
• 25-hydroxy Vitamin D: normal at 33 ng/mL

Follow-up Treatment

• Sonic® Cholesterol: 2 tabs three times per day
• Vitamin D3: 5000 IU per day
• Creon® (pancrelipase) with meals and snacks

Explanation for Follow-up Treatment

When supplementing cholesterol, symptoms often improve although blood levels are slow to respond and often increase by only small amounts. The main goal of cholesterol supplementation is symptom improvement or relief. Tracking actual cholesterol levels may not reflect symptomatic improvements and cholesterol supplementation can still be helpful even if blood levels remain relatively low.

Additional Follow-up

While Tom still struggled with some mild depressive symptoms, he was motivated to pursue realistic goals for his future. He signed up for community college classes and started working towards a degree. Throughout the next few years, he managed to stay sober and attend university.

Case Summary

Depression, suicidal behaviors and addiction can all have correlations with both low cholesterol and vitamin D levels. These symptoms can improve with supplemental cholesterol and vitamin D treatment. Upon testing, the highest Tom’s total cholesterol ever reached was 103. The case highlights how even standard laboratory testing, when interpreted properly, can yield important clues as to some of the underlying causes of a patient’s mental illness.