The effect of concomitant treatment with selective serotonin reuptake inhibitors and statins: A population-based study
Small clinical trials have indicated that statins improve antidepressant treatment effects. We performed a register-based study including 872,216 individuals who initiated treatment with selective serotonin reuptake inhibitors (SSRIs). Individuals using SSRIs+statins were associated with a lower risk for hospitalization with depression, as compared to SSRIs alone, suggesting that concomitant treatment with SSRIs and statins may have better antidepressant treatment effects.
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About the study
Small clinical trials have indicated that the cholesterol-lowering drugs statins may improve the antidepressant treatment effects of selective serotonin reuptake inhibitors (SSRIs). This effect may be mediated by the anti-inflammatory properties of statins.
By applying the Danish nationwide registers, we sought to investigate whether the combination of SSRIs+statins had superior antidepressant effects compared to SSRIs alone. We included 872,216 individuals, who began SSRI treatment between 1997-2012. Of these, a total of 113,108 (13.0%) used statins concomitantly. We compared risk time on SSRI+statins versus risk time on SSRIs only.
When compared to SSRI use only, we found that the combination of SSRIs+statins was associated with a lower risk for any psychiatric hospitalization (hazard rate ratio=0.75; 95%-CI=0.69; 0.82) and with a lower risk for hospitalization with depression (hazard rate ratio=0.64; 95%-CI=0.55; 0.75). These effects were also significant for the most frequently used SSRI+statin combination, namely citalopram+simvastatin.
Importantly, the combination of SSRI+statins had no significant negative effects on all-cause mortality (hazard rate ratio=1.04; 95%-CI=0.96; 1.12) or suicidal behaviour (hazard rate ratio=0.85; 95%-CI=0.61; 1.18).
All of the analyses were adjusted for several potential confounders. Furthermore, the abovementioned results were supported by propensity-score matched analyses. We were able to propensity-score match 22,478 individuals using SSRIs+statins in a 1:1 matching fashion with 22,478 individuals using SSRIs only.
Hence, our results indicate that the combination of SSRIs+statins may have better antidepressant effects compared to SSRIs alone. Ideally, SSRI+statin combinations (for instance citalopram+simvastatin) should be tested against SSRI monotherapy (citalopram) in large randomized clinical trials in the future.
The paper “ The effect of Concomitant Treatment With SSRIs and Statins: A Population-Based Study” was published in the American Journal of Psychiatry, 2016 May 3 [Epub ahead of print]
Facts about the study
- Register-based study including 872,216 individuals; 759,108 using SSRIs only, and 113,108 individuals using SSRIs and statins.
- SSRIs+statins were associated with a lower risk of hospitalization due to depression and any psychiatric hospitalization.
- We performed sub-analyses on a propensity-score matched study population, yielding similar results.
- Clinical trials need to further investigate whether SSRIs+statins have better antidepressant effects compared to SSRIs alone.
Further information:
Ole Köhler, MD, PhD student at Psychosis Research Unit, Aarhus University Hospital, Risskov
E-mail: karkoe@rm.dk.