Add on statins improve adherence to antidepressant treatment in depression

Antidepressants is the classic treatment for depression around the world. Depression affects more than 350 million people worldwide and is associated with a substantial clinical, economic, and societal burden. It is reported that , only about 50% of these patients respond to first-line antidepressants, and one third still suffer from impairing depressive symptoms after four steps of treatment over 1 year.

The study in BMC Medicine found that concomitant antidepressant and statin use in people with clinical depression was associated to lower antidepressant treatment discontinuations. However, it did not enhance the efficacy of antidepressant medications.

Researchers conducted a population-based cohort study investigating QResearch primary care research database, which comprises the anonymised electronic healthcare records of 35 + million patients over 1574 English general practices. Patients aged 18–100 years, registered between January 1998 and August 2020, diagnosed with a new episode of depression, and commencing an antidepressant were included. Using a between-subject design, they identified two study groups: antidepressant + statin versus antidepressant-only prescriptions.

Outcomes of interest included the following: antidepressant treatment discontinuations due to any cause (acceptability) and due to any adverse event (tolerability) and effects on depressive symptoms (efficacy) measured as response, remission, and change in depression score on the Patient Health Questionnaire-9. All outcomes were assessed at 2, 6, and 12 months using multivariable regression analyses, adjusted for relevant confounders, to calculate adjusted odds ratios (aORs) or mean differences (aMDs) with 99% confidence intervals (99% CIs).

The key findings of the study are

• On comparision of 626335 were grouped in antidepressants only 46482 in antidepressant + statin was associated with higher antidepressant treatment acceptability (aOR2months 0.88, 99% CI 0.85 to 0.91; aOR6months 0.81, 99% CI 0.79 to 0.84; aOR12months 0.78, 99% CI 0.75 to 0.81)

• Tolerability (aOR2months 0.92, 99% CI 0.87 to 0.98; aOR6months 0.94, 99% CI 0.89 to 0.99, though not long term aOR12 months 1.02, 99% CI 0.97 to 1.06).

• Efficacy did not differ between groups (range aOR2-12 months 1.00 and 1.02 for response and remission, range aOR2-12 months − 0.01 and − 0.02 for change in depression score).

Researchers concluded that “On real-world data, there is a positive correlation between antidepressant treatment adherence and statin use, partly explained by fewer dropouts due to adverse events. The main limitation of our study is its observational design, which restricts the potential to make causal inferences.”

Reference: De Giorgi, R., De Crescenzo, F., Cowen, P.J. et al. Real-world outcomes of concomitant antidepressant and statin use in primary care patients with depression: a population-based cohort study. BMC Med 21, 424 (2023). https://doi.org/10.1186/s12916-023-03138-5.