Psychiatric Adverse Reactions with Statins, Fibrates and Ezetimibe

Abstract

The HMG-CoA reductase inhibitors ('statins') have come into widespread use internationally. There has been a long history of their use in New Zealand and this use has increased in recent years. There has also been an increase in the number of reports to the New Zealand Centre for Adverse Reactions Monitoring (CARM) of suspected psychiatric adverse reactions associated with statins. The reactions mentioned in these reports include depression, memory loss, confusion and aggressive reactions. Convincing reports to CARM of recurrence of these reactions upon rechallenge add weight to recent studies reporting serious psychiatric disturbances in association with statin treatment. Aggressive reactions associated with statins are poorly documented in the literature. These observations emphasise the need to be vigilant in looking for these reactions as they can have a significant personal impact on a patient. The observation that other lipid-lowering agents have similar adverse effects supports the hypothesis that decreased brain cell membrane cholesterol may be important in the aetiology of these psychiatric reactions.

Cardiovascular Event Reduction and Adverse Events Among Subjects Attaining Low-Density Lipoprotein Cholesterol <50 mg/dl With Rosuvastatin

“…Both favorable and unfavorable consequences have been attributed to attainment of very low LDL-C (5,6,8,9). The JUPITER study adds to existing trial data, reinforcing the graded relationship between on-treatment LDL-C and cardiovascular event reduction, and expanding the range over which LDL-C lowering confers cardiovascular risk reduction (Fig.…”

Serum lipid levels and suicidality: a meta-analysis of 65 epidemiological studies

“…Overall, the tendencies of serum lipid levels were consistent across different types of suicidal behaviours, which means that low serum lipid level is an interesting predictive marker not only for suicidal acts, but also for suicidal ideation, suicide attempt and even suicidal tendencies. In addition, an increasing number of reports raise the possibility that statins, a class of lipid-lowering agents, may be associated with deleterious cognitive, [82][83][84] mood and behavioural adverse effects, including violence, 85 depression and suicide, 86 which have been attributed to the effect of statins' cholesterol level reduction on brain function. These results were consistent with ours.…”

Concomitant prescription of psychotropic and cardiovascular drugs in elderly patients

“…Careful assessment and sometimes simply switching to a different medication can eliminate the side effects. Druginduced psychiatric disorders can result in significant morbidity and mortality [29]. Cardiovascular drugs, such as ACE inhibitors and cholesterol-lowering statins, have been implicated in causing depression and suicide ideation in reports, but the evidence is inconclusive.…”