Statin treatment not associated with adverse neuropsychiatric outcomes

Statin use did not appear associated with suicidality, anxiety disorders or seizures, according to results of a total-population cohort study published in The Lancet Psychiatry.

“The differential effects of statins on depression and seizures have been attributed to structural differences between statin classes; however, few comparisons between classes are available,” Yasmina Molero, PhD, of the department of psychiatry at the University of Oxford in the U.K., and colleagues wrote. “Contrasting findings on the association between statins and neuropsychiatric outcomes could also be attributed to differences in study design, the extent of adjustment for confounding factors, choice of outcome measure or inadequate sample sizes.”

In the current study, the investigators used Swedish national registers to link data on dispensed statin prescriptions with data on unplanned hospital visits or specialized outpatient care for neuropsychiatric outcomes, including suicidal behavior, depressive disorders, anxiety disorders and seizures. Data were available of 1,149,384 individuals who were dispensed statins and aged 15 years or older between 2006 and 2013. They compared the incidence of the defined outcomes during periods on and off statins within each individual, and tested non-specific treatment effects by investigating these outcomes related to antihistamine and thiazide diuretic use in the same cohort.

The researchers reported 2,053,310 nontreatment periods and 2,997,545 treatment periods, as well as 957,216 individuals with a medication status change, during the study period. Results showed 0.6% of participants had suicide outcomes, 2.1% had depressive disorders, 2.6% had anxiety disorders and 2.5% had seizures. Molero and colleagues observed no clear links between periods of statin treatment and suicidal behavior or deaths from suicide (HR = 0.99; 95% CI, 0.9-1.08), anxiety disorders (HR = 0.99; 95% CI, 0.95-1.02) or seizures (HR = 1; 95% CI, 0.97-1.04). However, they did not an association between statins and reduced risk for depressive disorders (HR = 0.91; 95% CI, 0.87-0.94), which was still present after adjusting for concurrent antidepressant use (HR = 0.91; 95% CI, 0.88-0.94). Further, HRs for depressive disorders were 0.61 (95% CI, 0.38-1) with thiazide diuretic use and 0.84 (95% CI, 0.67-1.06) with antihistamine use.

“We found no associations between statin treatment and suicidal outcomes, anxiety disorders or seizures, suggesting that statin treatment is a safe therapeutic option with regard to some neuropsychiatric outcomes,” Molero and colleagues wrote. “We observed a reduction in the risk [for] depressive disorders during periods of statin treatment, but a similar (albeit non-significant) reduction was seen during treatments with two other non-psychotropic medications, and this association requires further investigation to clarify the possible contribution of nonspecific treatment factors.”