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Post-Marketing Surveillance of Statins-A Descriptive Analysis of Psychiatric Adverse Reactions in EudraVigilance. Pharmaceuticals (Basel) 2022; 15:ph15121536. [PMID: 36558987 PMCID: PMC9787673 DOI: 10.3390/ph15121536] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Statins are included in the category of high-frequency prescription drugs, and their use is on an upward trend worldwide. In 2012, the FDA issued a warning about possible cognitive adverse drug reactions (ADRs) related to statins, some of which are listed in the Summary of Product Characteristics, but there are still concerns about their potential risk of psychiatric events. The aim of this research was to investigate spontaneous reports containing psychiatric ADRs associated with statins by analyzing the EudraVigilance (EV) database. From January 2004 to July 2021, a total of 8965 ADRs were reported for the Systems Organ Class (SOC) "psychiatric disorders", of which 88.64% were registered for atorvastatin (3659), simvastatin (2326) and rosuvastatin (1962). Out of a total of 7947 individual case safety reports (ICSRs) of the 3 statins mentioned above, in 36.3% (2885) of them, statins were considered the only suspected drug, and in 42% (3338), no other co-administered drugs were mentioned. Moreover, insomnia has been reported in 19.3% (1536) of cases, being the most frequent adverse reaction. A disproportionality analysis of psychiatric ADRs was performed. The Reporting Odds Ratio (ROR) and 95% confidence interval (95% CI) were calculated for simvastatin, atorvastatin and rosuvastatin compared with antiplatelets and antihypertensive drugs. The reporting probability for most ADRs of these statins compared to antiplatelets was higher. The reporting probability for insomnia, nightmares and depression produced by statins compared to antihypertensive drugs was also higher. The results of this analysis augment the existing data about a possible correlation between the administration of statins and the occurrence of psychiatric side effects.
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Postolache TT, Medoff DR, Brown CH, Fang LJ, Upadhyaya SK, Lowry CA, Miller M, Kreyenbuhl JA. Lipophilic vs. hydrophilic statins and psychiatric hospitalizations and emergency room visits in US Veterans with schizophrenia and bipolar disorder. Pteridines 2021; 32:48-69. [PMID: 34887622 PMCID: PMC8654264 DOI: 10.1515/pteridines-2020-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective – Psychiatric hospitalizations and emergency department (ED) visits are costly, stigmatizing, and often ineffective. Given the immune and kynurenine activation in bipolar disorder (BD) and schizophrenia, as well as the immune-modulatory effects of statins, we aimed to compare the relative risk (RRs) of psychiatric hospitalizations and ED visits between individuals prescribed lipophilic vs. hydrophilic statins vs. no statins. We hypothesized (a) reduced rates of hospitalization and ER utilization with statins versus no statins and (b) differences in outcomes between statins, as lipophilia increases the capability to penetrate the blood–brain barrier with potentially beneficial neuroimmune, antioxidant, neuroprotective, neurotrophic, and endothelial stabilizing effects, and, in contrast, potentially detrimental decreases in brain cholesterol concentrations leading to serotoninergic dysfunction, changes in membrane lipid composition, thus affecting ion channels and receptors. Methods – We used VA service utilization data from October 1, 2010 to September 30, 2015. The RRs for psychiatric hospitalization and ED visits, were estimated using robust Poisson regression analyses. The number of individuals analyzed was 683,129. Results – Individuals with schizophrenia and BD who received prescriptions for either lipophilic or hydrophilic statins had a lower RR of psychiatric hospitalization or ED visits relative to nonstatin controls. Hydrophilic statins were significantly associated with lower RRs of psychiatric hospitalization but not of ED visits, compared to lipophilic statins. Conclusion – The reduction in psychiatric hospitalizations in statin users (vs. nonusers) should be interpreted cautiously, as it carries a high risk of confounding by indication. While the lower RR of psychiatric hospitalizations in hydrophilic statins relative to the lipophilic statins is relatively bias free, the finding bears replication in a specifically designed study. If replicated, important clinical implications for personalizing statin treatment in patients with mental illness, investigating add-on statins for improved therapeutic control, and mechanistic exploration for identifying new treatment targets are natural next steps.
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Affiliation(s)
- Teodor T Postolache
- VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC), U.S. Department of Veterans Affairs, Baltimore, MD 21201, United States of America; Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), U.S. Department of Veterans Affairs, Aurora, CO 80045, United States of America; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America; Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), U.S. Department of Veterans Affairs, Denver, CO 80045, United States of America
| | - Deborah R Medoff
- VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD 21201, United States of America; Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Clayton H Brown
- VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD 21201, United States of America; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Li Juan Fang
- Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Sanjaya K Upadhyaya
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Christopher A Lowry
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), U.S. Department of Veterans Affairs, Aurora, CO 80045, United States of America; Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), U.S. Department of Veterans Affairs, Denver, CO 80045, United States of America; Department of Integrative Physiology, Center for Neuroscience, Center for Microbial Exploration, University of Colorado Boulder, Boulder, CO 80309, United States of America; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States of America
| | - Michael Miller
- Department of Medicine, VAMC Baltimore and University of Maryland School of Medicine, Baltimore, Maryland 21201, United States of America
| | - Julie A Kreyenbuhl
- VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD 21201, United States of America; Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
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González-Castro TB, Genis-Mendoza AD, León-Escalante DI, Hernández-Díaz Y, Juárez-Rojop IE, Tovilla-Zárate CA, López-Narváez ML, Marín-Medina A, Nicolini H, Castillo-Avila RG, Ramos-Méndez MÁ. Possible Association of Cholesterol as a Biomarker in Suicide Behavior. Biomedicines 2021; 9:biomedicines9111559. [PMID: 34829788 PMCID: PMC8615563 DOI: 10.3390/biomedicines9111559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 11/25/2022] Open
Abstract
Suicides and suicidal behavior are major causes of mortality and morbidity in public health and are a global problem. Various authors have proposed changes in lipid metabolism (total cholesterol decrease) as a possible biological marker for suicidal behavior. The objective of this study was to review the studies that have demonstrated a relationship between serum cholesterol levels and suicidal behavior and to describe the possible pathophysiological mechanisms that associate changes in cholesterol concentration and suicidal behavior. Relevant literature related to serum cholesterol levels and suicidal behavior was identified through various database searches. The data from the existing literature present the findings that relate low cholesterol levels and possible pathophysiological mechanisms (neuroinflammation, serotonergic neurotransmission), genes related to cholesterol synthesis, pharmacological treatments that alter lipid metabolism and the possible participation in suicidal behavior. Nevertheless, future research is required to describe how serum cholesterol affects cholesterol metabolism in the CNS to establish and understand the role of cholesterol in suicidal behavior.
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Affiliation(s)
- Thelma Beatriz González-Castro
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez 86205, Tabasco, Mexico; (T.B.G.-C.); (Y.H.-D.)
| | - Alma Delia Genis-Mendoza
- Departamento de Genética Psiquiátrica, Instituto Nacional de Medicina Genómica, Ciudad de México 14610, Mexico;
| | - Dulce Ivannia León-Escalante
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco 86650, Tabasco, Mexico;
| | - Yazmín Hernández-Díaz
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez 86205, Tabasco, Mexico; (T.B.G.-C.); (Y.H.-D.)
| | - Isela Esther Juárez-Rojop
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86100, Tabasco, Mexico; (I.E.J.-R.); (R.G.C.-A.); (M.Á.R.-M.)
| | - Carlos Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco 86650, Tabasco, Mexico;
- Correspondence: (C.A.T.-Z.); (H.N.); Tel.: +52-9933581500 (ext. 6900) (C.A.T.-Z.); +52-53501900 (ext. 1197) (H.N.)
| | - María Lilia López-Narváez
- Secretaría de Salud de Chiapas, Hospital Chiapas Nos Une “Dr. Gilberto Gómez Maza”, Tuxtla Gutiérrez 29045, Chiapas, Mexico;
| | | | - Humberto Nicolini
- Departamento de Genética Psiquiátrica, Instituto Nacional de Medicina Genómica, Ciudad de México 14610, Mexico;
- Correspondence: (C.A.T.-Z.); (H.N.); Tel.: +52-9933581500 (ext. 6900) (C.A.T.-Z.); +52-53501900 (ext. 1197) (H.N.)
| | - Rosa Giannina Castillo-Avila
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86100, Tabasco, Mexico; (I.E.J.-R.); (R.G.C.-A.); (M.Á.R.-M.)
| | - Miguel Ángel Ramos-Méndez
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86100, Tabasco, Mexico; (I.E.J.-R.); (R.G.C.-A.); (M.Á.R.-M.)
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Shaker NM, Sultan M, Mohamed MY, Helal SA, Abd El Moneam MHED. Lipid Profile and Impulsivity in Suicidal Patients with Major Depressive Disorder. Arch Suicide Res 2021; 25:641-656. [PMID: 32252618 DOI: 10.1080/13811118.2020.1746456] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Previous observational cohort studies showed an association between low serum lipid levels and suicide. This study was undertaken to examine the relationship between lipid parameters and impulsivity in suicidal patients with major depressive disorder (MDD). METHODS The current study included 100 patients with MDD distributed as 50 patients with recent suicidal attempts and 50 patients with no lifetime history of suicide. Participants were subjected to Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) to confirm the diagnosis. The risk of suicide was assessed through the Suicide Probability Scale (SPS), while the intent and seriousness of suicide were assessed through Beck's Suicidal Intent Scale. assessment of impulsivity was carried out through Barratt Impulsivity Scale. Serum lipid levels were measured in mg/dL after an overnight fast. RESULTS Total cholesterol (TC) was found significantly lower in the suicidal group compared to the non-suicidal depressed group (p = 0.040). Low high-density lipoprotein (HDL) level was significantly correlated with suicidality and high suicide intent was correlated with hopelessness. Logistic regression for lipid profile in both groups revealed significant TC and low-density lipoprotein (LDL) as predictors for suicide. There was no significant correlation between impulsivity and characteristics of depression, suicide probability, suicide intent, and all elements of the lipid profile. CONCLUSIONS Low TC and LDL could predict suicidal behavior in patients with MDD. Impulsivity could not be a mediator or predictor of suicide risk in patients with MDD.
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Kang HR, Jang SC, Shin JY. Association between oseltamivir use and neuropsychiatric adverse events in influenza patients: a nationwide population-based cohort study. Expert Opin Drug Saf 2020; 20:245-253. [PMID: 33183123 DOI: 10.1080/14740338.2021.1850690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: A potential risk of neuropsychiatric adverse events (NPAEs) of oseltamivir has remained controversial by retrospective cohort studies. This nationwide population-based cohort study aimed to assess the risk of NPAEs in influenza patients undergoing oseltamivir treatment (users) compared with a propensity score-matched cohort of patients not receiving oseltamivir (non-users). Research design and methods: Using the Korean National Health Service-Sample Cohort Database, patients diagnosed with incident influenza during 2003-2013 were divided into two cohorts: oseltamivir users and non-users. We calculated adjusted hazard ratios (aHRs) for the 5-day treatment course with oseltamivir using Cox regression analysis. Results: The incidence rate of NPAEs during 5-day oseltamivir treatment was 0.0029 and 0.0023 in oseltamivir users and non-users, respectively. The risk of NPAEs was different according to age, with an increased risk in patients aged 10-19 years (aHR 2.69, 95% CI 1.05-6.93) and a decreased risk in patients aged 0-9 years (aHR 0.46, 95% CI 0.24-0.88). The non-significant positive associations were observed in patients aged 20-64 years and those aged greater than 65 years. Conclusions: Although the reason for the inverse association in children aged 0-9 years is unknown, oseltamivir could increase the risk of NPAEs for children or adolescents aged greater than 10 years.
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Affiliation(s)
- Hye-Rim Kang
- School of Pharmacy, Sungkyunkwan University , Suwon, Gyeonggi-do, South Korea
| | - Suk-Chan Jang
- School of Pharmacy, Sungkyunkwan University , Suwon, Gyeonggi-do, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University , Suwon, Gyeonggi-do, South Korea
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Fotso Soh J, Almadani A, Beaulieu S, Rajji T, Mulsant BH, Su CL, Renaud S, Mucsi I, Torres-Platas SG, Levinson A, Schaffer A, Dols A, Cervantes P, Low N, Herrmann N, Mantere O, Rej S. The effect of atorvastatin on cognition and mood in bipolar disorder and unipolar depression patients: A secondary analysis of a randomized controlled trial. J Affect Disord 2020; 262:149-154. [PMID: 31733459 DOI: 10.1016/j.jad.2019.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/03/2019] [Accepted: 11/02/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Statins have recently been linked to having effects on cognition and mood in mood disorders, though results are mixed. In this paper, we use data from a recent randomized controlled trial (RCT) to examine the effect of statins on cognition and mood in patients with Bipolar Disorder (BD) and Major Depressive Disorder (MDD). METHODS This is a secondary analysis of a randomized, double-blind, placebo-controlled clinical trial (n = 60) originally designed to examine the effect of atorvastatin (n = 27) versus placebo (n = 33) for lithium-induced diabetes insipidus in BD and MDD patients who were using lithium. For this analysis, the primary outcome was global cognition Z-score at 12-weeks adjusted for baseline. The secondary cognition outcomes were (1) Screen for Cognitive Impairment in Psychiatry (SCIP), and (2) executive function Z-score. The primary mood outcome (secondary outcome of this analysis) was depression relapse during 12-week follow-up (Mongomery Asberg Depression Rating Scale (MADRS) ≥10). The secondary mood outcomes were (1) relapse rate into a manic episode, and (2) relapse rate into any mood episode. RESULTS After 12 weeks follow-up, atorvastatin and placebo groups did not differ in terms of global cognition Z-score (β = -0.009287 (-0.1698,0.1512), p-value = 0.91). Similarly, composite Z-scores for SCIP and executive functions did not differ significantly. Depression relapse during 12-week follow-up was not significantly different between the groups (χ2 (1) = 0.148, p-value = 0.70). Similarly, there was no difference between groups regarding relapse into mania. CONCLUSION In BD and MDD patients with lithium-induced nephrogenic diabetes insipidus randomized to atorvastatin or placebo, we found no significant differences in cognition and mood outcomes at 12-week follow-up.
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Affiliation(s)
- Jocelyn Fotso Soh
- Geri-PARTy Research Group, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada.
| | - Ahmad Almadani
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Psychiatry, McGill University, Montreal, Canada
| | - Serge Beaulieu
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Tarek Rajji
- Department of Psychiatry, Centre for Addictions and Mental Health, University of Toronto, Canada
| | | | - Chien-Lin Su
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Health Centre, Montreal, Canada
| | - Suzane Renaud
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Istvan Mucsi
- Division of Nephrology, University Health Network, University of Toronto, Canada
| | - S Gabriela Torres-Platas
- Geri-PARTy Research Group, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada
| | - Andrea Levinson
- Department of Psychiatry, Centre for Addictions and Mental Health, University of Toronto, Canada
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Annemiek Dols
- Department of Psychiatry, GGZ, inGeest, Amsterdam, the Netherlands
| | - Pablo Cervantes
- Department of Psychiatry, McGill University Health Centre, Montreal, Canada
| | - Nancy Low
- Department of Psychiatry, McGill University Health Centre, Montreal, Canada
| | - Nathan Herrmann
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Outi Mantere
- Department of Psychiatry, McGill University, Montreal, Canada; Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Soham Rej
- Geri-PARTy Research Group, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada; Douglas Mental Health University Institute, Montreal, QC, Canada
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Agustini B, Mohebbi M, Woods RL, McNeil JJ, Nelson MR, Shah RC, Murray AM, Ernst ME, Reid CM, Tonkin A, Lockery JE, Berk M. Association Between Statin Use and Depressive Symptoms in a Large Community-Dwelling Older Population Living in Australia and the USA: A Cross-Sectional Study. CNS Drugs 2019; 33:685-694. [PMID: 31062260 PMCID: PMC6719539 DOI: 10.1007/s40263-019-00633-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Statin use has been frequently associated with depressive symptoms in an older population. However, the nature of this association is uncertain in the literature. In this study, we aimed to investigate the association of statin intake and the prevalence of depressive symptoms in healthy community-dwelling older adults living in Australia and the USA. METHODS We analysed baseline data from 19,114 participants, over 70 years of age (over 65 years of age, if from an ethnic minority). The association of self-reported statin use and prevalence of depressive symptoms, as measured by a validated depression scale [Center for Epidemiological Studies Depression Scale (CES-D 10)], was determined using logistic regression models. Multivariable logistic models were implemented to account for important demographics and other lifestyle and socioeconomic factors, such as sex, age, living status, education and smoking history. RESULTS A total of 5987 individuals were statin users. Of those, 633 (10.6%) had depressive symptoms (CES-D 10 cut-off ≥ 8), compared with 1246 (9.5%) of the non-statin users. In the unadjusted model, statin use was associated with an increase in prevalence of depressive symptoms (odds ratio 1.13, confidence interval 1.02-1.25, p = 0.02). However, after adjusting for important demographic and socioeconomic factors, the use of statins was not significantly associated with depressive symptoms (odds ratio 1.09, confidence interval 0.98-1.20, p = 0.11). In secondary analyses, only simvastatin was marginally associated with an increased prevalence of depressive symptoms. Statins were associated with a decreased prevalence of depressive symptoms in individuals with severe obesity (body mass index > 35 kg/m2) and an increased prevalence in participants between 75 and 84 years of age. CONCLUSION This study in a large community-dwelling older population did not show any association of statins with late-life depressive symptoms, after accounting for important socioeconomic and demographic factors. Confounding by indication is an important issue to be addressed in future pharmacoepidemiologic studies of statins.
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Affiliation(s)
- Bruno Agustini
- IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre), School of Medicine, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.
| | - Mohammadreza Mohebbi
- IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre), School of Medicine, Deakin University, PO Box 281, Geelong, VIC 3220, Australia,Biostatistics Unit, Deakin University, Geelong, VIC, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mark R. Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Raj C. Shah
- Department of Family Medicine and Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Anne M. Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, MN, USA
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa, IO, USA,Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa, IO, USA
| | - Christopher M. Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia,School of Public Health, Curtin University, Perth, WA, Australia
| | - Andrew Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jessica E. Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael Berk
- IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre), School of Medicine, Deakin University, PO Box 281, Geelong, VIC 3220, Australia,Orygen, National Centre of Excellence in Youth Health, Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
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8
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Kim SW, Kang HJ, Jhon M, Kim JW, Lee JY, Walker AJ, Agustini B, Kim JM, Berk M. Statins and Inflammation: New Therapeutic Opportunities in Psychiatry. Front Psychiatry 2019; 10:103. [PMID: 30890971 PMCID: PMC6413672 DOI: 10.3389/fpsyt.2019.00103] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/12/2019] [Indexed: 12/12/2022] Open
Abstract
Statins, which are widely used to treat hypercholesterolemia, have anti-inflammatory and anti-oxidant effects. These are thought to be responsible for the potential effects of statins on various psychiatric disorders. In this study, we comprehensively review the literature to investigate the effects of statins on various psychiatric disorders including depression, schizophrenia, and dementia. In addition, we review adverse effects and drug interactions of statins to give clinically useful information guiding statin use in the psychiatric field. Statins seem useful in reducing depression, particularly in patients with physical disorders such as cardiovascular disease. In patients with schizophrenia, negative symptoms may be reduced by adjuvant statin therapy. Studies on cohorts at risk for dementia have generally shown protective effects of statins, while those on treatment for dementia show inconsistent results. In conclusion, statins used in combination with conventional psychotropic medications may be effective for various psychiatric disorders including depression, schizophrenia, and dementia. Further study is required to determine optimal doses and duration of statin use for the treatment of psychiatric disorders.
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Affiliation(s)
- Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Min Jhon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Adam J Walker
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Bruno Agustini
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia.,Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia.,The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
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9
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Kang HR, Lee EK, Kim WJ, Shin JY. Risk of neuropsychiatric adverse events associated with the use of oseltamivir: a nationwide population-based case-crossover study. J Antimicrob Chemother 2018; 74:453-461. [DOI: 10.1093/jac/dky445] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 10/02/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Hye-Rim Kang
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea
| | - Woo Jung Kim
- Department of Psychiatry, Myongji Hospital, Hanyang University Medical Center, 55, Hwasu-ro 14beon-gil, Deogyang-gu, Goyang, Gyeonggi-do, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea
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10
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Ravnskov U, de Lorgeril M, Diamond DM, Hama R, Hamazaki T, Hammarskjöld B, Hynes N, Kendrick M, Langsjoen PH, Mascitelli L, McCully KS, Okuyama H, Rosch PJ, Schersten T, Sultan S, Sundberg R. LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature. Expert Rev Clin Pharmacol 2018; 11:959-970. [PMID: 30198808 DOI: 10.1080/17512433.2018.1519391] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION For half a century, a high level of total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C) has been considered to be the major cause of atherosclerosis and cardiovascular disease (CVD), and statin treatment has been widely promoted for cardiovascular prevention. However, there is an increasing understanding that the mechanisms are more complicated and that statin treatment, in particular when used as primary prevention, is of doubtful benefit. Areas covered: The authors of three large reviews recently published by statin advocates have attempted to validate the current dogma. This article delineates the serious errors in these three reviews as well as other obvious falsifications of the cholesterol hypothesis. Expert commentary: Our search for falsifications of the cholesterol hypothesis confirms that it is unable to satisfy any of the Bradford Hill criteria for causality and that the conclusions of the authors of the three reviews are based on misleading statistics, exclusion of unsuccessful trials and by ignoring numerous contradictory observations.
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Affiliation(s)
| | - Michel de Lorgeril
- b Laboratoire Coeur et Nutrition, TIMC-IMAG, School of Medicine , University of Grenoble-Alpes , Grenoble , France
| | - David M Diamond
- c Department of Molecular Pharmacology and Physiology, Center for Preclinical and Clinical Research on PTSD , University of South Florida , Tampa , FL , USA.,d Department of Psychology, Center for Preclinical and Clinical Research on PTSD , University of South Florida , Tampa , FL , USA
| | - Rokuro Hama
- e Japan Institute of Pharmacovigilance , Osaka , Japan
| | - Tomohito Hamazaki
- f Department of Internal Medicine, Toyama Jonan Onsen Daini Hospital , University of Toyama , Toyama , Japan
| | | | - Niamh Hynes
- h Western Vascular Institute, University Hospital Galway & Galway Clinic , National University of Ireland & Royal college of Surgeons of Ireland affiliated Hospital , Galway , Ireland
| | - Malcolm Kendrick
- i East Cheshire Trust, Macclesfield District General Hospital , Macclesfield , UK
| | | | - Luca Mascitelli
- k Medical Service , Comando Brigata Alpina "Julia"/Multinational Land Force , Udine , Italy
| | - Kilmer S McCully
- l Pathology and Laboratory Medicine Service, VA Boston Healthcare System West Roxbury , Harvard Medical School , Boston , MA , USA
| | - Harumi Okuyama
- m Faculty of Pharmaceutical Science , Nagoya City University , Mizuhoku, Nagoya , Japan
| | - Paul J Rosch
- n New York Medical College , The American Institute of Stress , New York , NY , USA
| | - Tore Schersten
- o Wallenberg Laboratory for Cardiovascluar and Metabolic Research, Sahlgren's Academy , University of Gothenburg , Gothenburg , Sweden.,p Department of Metabolism , Columbia University , New York , NY , USA
| | - Sherif Sultan
- h Western Vascular Institute, University Hospital Galway & Galway Clinic , National University of Ireland & Royal college of Surgeons of Ireland affiliated Hospital , Galway , Ireland
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11
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Comparative risk of lipophilic and hydrophilic statins on incident depression: A retrospective cohort study. J Affect Disord 2018; 238:542-546. [PMID: 29936394 DOI: 10.1016/j.jad.2018.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/21/2018] [Accepted: 06/04/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the risk of new-onset depression in a cohort of US adult patients initiating lipophilic statin therapy compared to hydrophilic statin therapy. DESIGN Retrospective cohort study. SETTING Large US commercial claims database PARTICIPANTS: 1:1 propensity score matched cohort of lipophilic (atorvastatin, lovastatin and simvastatin) and hydrophilic (pravastatin and rosuvastatin) statin initiators between January 2009 to June 2015. OUTCOME New onset of depression. RESULTS In a propensity-score matched cohort of 299,298 statin initiators, the crude incidence of depression in the hydrophilic and lipophilic group was 136.6 and 142.8 per 10,000 person-years respectively. Compared to hydrophilic statin use, lipophilic statin use was not associated with a statistically significant increase in the risk of depression, adjusted HR 1.05 (95% CI, 1.00-1.10, p = 0.078) and excess incidence of 6.3 (95% CI, -0.7-13.7) per 10,000 person-years. Findings were consistent across the subgroups of patients with history of psychiatric conditions HR 1.05 (95% CI, 0.94-1.16, p = 0.41), and those initiating statins for primary or secondary prevention, HR 1.03 (95% CI, 0.97-1.10, p = 0.33) and 1.07 (95% CI, 0.99-1.16, p = 0.10) respectively. Within individual lipophilic statins, only simvastatin was associated with a moderate increase in the risk of depression HR 1.09 (95% CI, 1.02-1.16, p = 0.003), followed by lovastatin HR 1.07 (95% CI, 0.93-1.24, p = 0.34) and atorvastatin HR 1.05 (95% CI, 0.97-1.13, p = 0.27). LIMITATIONS Findings are generalizable to patients with commercial insurance. CONCLUSIONS Lipophilic statin use was not associated with a significant increase in the risk of incident depression.
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Rej S, Schulte SW, Rajji TK, Gildengers AG, Miranda D, Menon M, Butters MA, Mulsant BH. Statins and cognition in late-life bipolar disorder. Int J Geriatr Psychiatry 2018; 33:1355-1360. [PMID: 30022520 DOI: 10.1002/gps.4956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/17/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Recent data suggests that statins have positive effects on cognition in older adults. Studies in patients with mood disorders have found contradicting positive and negative effects of statins on mood and cognition, with limited data in bipolar disorder (BD). The objective of this study was to assess the association between statin use and cognition in older adults with BD. METHODS In a cross-sectional sample of 143 euthymic older adults with BD (age ≥ 50), statin users (n = 48) and nonusers (n = 95) were compared for cognitive outcomes: Global and cognitive domain z-scores were calculated from detailed neuropsychological batteries using normative data from healthy comparators (n = 87). RESULTS The sample had a mean age of 64.3 (±8.9) years, 65.0% were female, with an average of 15.1 (±2.79) years of education. Statin users did not differ from nonusers on global (-0.60 [±0.69] vs -0.49 [±0.68], t[127] = 0.80, P = .42) or individual cognitive domains z-score. CONCLUSIONS In older patients with BD, statin use is not independently associated with cognitive impairment. This suggests that in older BD patients, the cognitive dysfunction associated with BD trumps the potential cognitive benefit that is associated with statins in older adults without a psychiatric disorder. Further, statins do not seem to exacerbate this cognitive dysfunction. Future longitudinal studies are needed to confirm these findings.
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Affiliation(s)
- Soham Rej
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, Canada
| | - Sarah Waters Schulte
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada
| | - Tarek K Rajji
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada
| | | | - Dielle Miranda
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada
| | - Mahesh Menon
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada
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Association between total serum cholesterol and suicide attempts in subjects with major depressive disorder: Exploring the role of clinical and biochemical confounding factors. Clin Biochem 2017; 50:274-278. [DOI: 10.1016/j.clinbiochem.2016.11.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/30/2016] [Accepted: 11/30/2016] [Indexed: 01/06/2023]
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Kei AA, Filippatos TD, Elisaf MS. The safety of ezetimibe and simvastatin combination for the treatment of hypercholesterolemia. Expert Opin Drug Saf 2016; 15:559-69. [PMID: 26898906 DOI: 10.1517/14740338.2016.1157164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION In the light of the most recent and stricter dyslipidemia treatment guidelines, the need for combination hypolipidemic therapy is increasing. Ezetimibe plus simvastatin is available as a fixed dose therapy offering an efficient hypolipidemic treatment choice. Based on the positive results of the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) trial, the use of this drug combination is expected to increase in the next years. AREAS COVERED This review discusses the current evidence regarding the safety of ezetimibe/simvastatin combination. Current evidence regarding possible associated side effects (musculoskeletal, gastrointestinal, endocrine, hematological, renal, ophthalmologic, allergic, malignancy) and drug interactions of this combination is thoroughly discussed. EXPERT OPINION Ezetimibe and simvastatin treatment, either as a single pill or the combined use of the individual compounds, offers limited additional risk compared with simvastatin monotherapy and comprises a safe and efficient choice for dyslipidemia treatment in high-risk and diabetic patients.
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Affiliation(s)
- Anastazia A Kei
- a Department of Internal Medicine, School of Medicine , University of Ioannina , Ioannina , Greece
| | - Theodosios D Filippatos
- a Department of Internal Medicine, School of Medicine , University of Ioannina , Ioannina , Greece
| | - Moses S Elisaf
- a Department of Internal Medicine, School of Medicine , University of Ioannina , Ioannina , Greece
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Koch J, Ward S, Martin B, Thomas C. A review of suicidality in nonpsychotropic medications. Ment Health Clin 2015. [DOI: 10.9740/mhc.2015.09.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The term suicidality describes the multitude of behaviors related to suicide: suicidal ideation, self-injurious behavior, suicide attempt, and completed suicide. Risk factors associated with increased suicidality in individuals include specific demographics, medical and psychologic conditions, socioeconomic status, family history, and major life events. In addition to baseline risk factors, there have been reports of numerous medications associated with increased suicidality in patients. Most of these medications are antiepileptics and antidepressants. Because of the contradictory risk posed by the exact medications prescribed to treat depression and psychologic conditions, the nonpsychotropic medications with reports of suicidality are often overshadowed.
Methods
Medications with FDA-issued warnings were reviewed for inclusion. Further medications were identified through PubMed literature review.
Results
Eight medications with various indications were identified and evidence is assessed regarding risk of suicidality.
Discussion
This review evaluates the current literature for nonpsychotropic medications that have been implicated in treatment-emergent suicidality.
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Affiliation(s)
- Jessa Koch
- PGY-1 pharmacy practice resident, Chillicothe Veterans Affairs Medical Center, Chillicothe, Ohio
| | - Sarah Ward
- PGY-1 pharmacy practice resident, Chillicothe Veterans Affairs Medical Center, Chillicothe, Ohio
| | - Bobbie Martin
- Clinical pharmacy specialist in psychiatry, Chillicothe Veterans Affairs Medical Center, Chillicothe, Ohio
| | - Christopher Thomas
- (Corresponding author) Clinical pharmacy specialist and residency director, Chillicothe Veterans Affairs Medical Center, Chillicothe, Ohio,
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Blalock DV, Young KC, Kleiman EM. Stability amidst turmoil: Grit buffers the effects of negative life events on suicidal ideation. Psychiatry Res 2015; 228:781-4. [PMID: 26070767 DOI: 10.1016/j.psychres.2015.04.041] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/18/2015] [Accepted: 04/21/2015] [Indexed: 11/19/2022]
Abstract
The goal of the current study is to examine the role of grit as a resilience factor that reduces the risk for suicidal ideation conferred by negative life events. Participants (N=209) completed measures of negative life events and grit at baseline and a measure of suicidal ideation at follow-up four weeks later. Poisson regression analyses found that higher levels of grit buffered the relationship between negative life events and suicidal ideation such that negative life events only predicted suicidal ideation if grit was low. These results suggest that high grit can abate the increased suicidal ideation associated with negative life events. Aside from absolute levels of suicidal ideation, being able to predict or buffer dramatic shifts in suicidal ideation can be a useful diagnostic tool during interventions.
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Affiliation(s)
- Dan V Blalock
- Department of Psychology, George Mason University, Fairfax, VA, USA.
| | - Kevin C Young
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Evan M Kleiman
- Department of Psychology, Harvard University, Cambridge, MA, USA
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Diamond DM, Ravnskov U. How statistical deception created the appearance that statins are safe and effective in primary and secondary prevention of cardiovascular disease. Expert Rev Clin Pharmacol 2015; 8:201-10. [DOI: 10.1586/17512433.2015.1012494] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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