"For those who utilize an actuarial approach to life, reducing cholesterol may result in a net loss in terms of survival," Mann said. "But cholesterol creates only a subtle shift in predisposition to suicide, so this must be recognized before we order pizzas to be delivered to patients' homes."
Returning to the subject of serotonin markers, Mann addressed the development of standard tests for clinical use.
"Serotonin measures are certainly not yet routine tests outside of the laboratory," Mann said. "They're certainly taken up by researchers but not by clinicians."
The issue, said Mann, is that in psychiatry, "we're reluctant to use tests that are overly invasive. But given that this is the eighth leading cause of death, and given that people with low levels of serotonin are six to 10 times more likely to commit suicide, we may have to rethink about developing tests. Further research is needed to find more direct tests rather than relying on indirect measures, such as CSF 5-HIAA, or the prolactin response to fenfluramine. That will happen."
Concluded Mann, "Clinicians are frustrated by not knowing who is really at risk. And delivery of good treatment to depressed patients is very suboptimal. But if you can say 'here's a test,' you may raise the sense of urgency and improve the delivery of health care."