Paradoxical effect of statin medication on depressive disorder in first-ever ischemic stroke patients: possible antidepressant-like effect prestroke and the opposite in continuous medication poststroke

Statins and the incidence of post-stroke depression: a systematic review and meta-analysis

Introduction

Post-stroke depression (PSD) can lead to poorer functional outcomes and prognosis. Brain inflammation is a risk factor for PSD. Statins might be beneficial due to their anti-inflammatory properties. Different studies have yielded varying results regarding the effects of statins. Therefore, this meta-analysis aims to clarify the effect of statins on PSD.

Methods

Objectives: To evaluate the relationship between PSD and the use of statins. Data Sources: Databases including PubMed, Web of Science, Embase, and Cochrane Library. Eligibility Criteria: Original observational cohort studies. Participants: Patients with ischemic stroke. Interventions: Use of statins. Appraisal and Synthesis Methods: Forest plot to display pooled results; I 2 test to evaluate heterogeneity.

Results

Of the 37 studies selected, four were eligible. The four studies included 93,893 patients (with statins: 45,598) and more than 17,470 PSD patients. The mean age ranged from 62.1 to 70.8 years. The percentage of female participants ranged from 42.1% to 57.9%. For PSD in different regions, the pooled OR for all regions using random-effects methods was 1.21 (95% CI: 0.44-3.33). The pooled OR for Asian populations was 1.42 (95% CI: 0.37-5.40), and for European populations, it was 0.76 (95% CI: 0.73-0.78). The pooled OR for all regions using fixed-effects methods was 0.84 (95% CI: 0.81-0.86). The pooled OR for Asian populations was 2.62 (95% CI: 2.34-2.93).

Conclusion

Depending on the pooling method used, statin use in Asia either increased or had no relationship with PSD. For European patients, statin use reduced the incidence of PSD.

Mortality and adverse events associated with statin use in primary care patients with depression: a real-world, population-based cohort study

BACKGROUND

New National Institute for Health and Care Excellence (NICE) guidance endorses the prescription of statins in larger population groups for the prevention of cardiovascular and cerebrovascular morbidity and mortality, especially in people with severe mental illness. However, the evidence base for their safety and risk/benefit balance in depression is not established.

OBJECTIVES

This study aims to assess the real-world mortality and adverse events of statins in depressive disorders.

METHODS

Population-based, nationwide (England), between-subject, cohort study. We used electronic health records (QResearch database) of people aged 18-100 years with first-episode depression, registered with English primary care practices over January 1998-August 2020 for 12(+) months, divided into statin users versus non-users.Primary safety outcomes included all-cause mortality and any adverse event measured at 2, 6 and 12 months. Multivariable logistic regression was employed to control for several potential confounders and calculate adjusted ORs (aORs) with 99% CIs.

FINDINGS

From over 1 050 105 patients with depression (42.64% males, mean age 43.23±18.32 years), 21 384 (2.04%) died, while 707 111 (67.34%) experienced at least one adverse event during the 12-month follow-up. Statin use was associated with lower mortality over 12 months (range aOR2-12months 0.66-0.67, range 99% CI 0.60 to 0.73) and with lower adverse events over 6 months (range aOR2-6months 0.90-0.96, range 99% CI 0.91 to 0.99), but not at 1 year (aOR12months 0.99, 99% CI 0.96 to 1.03). No association with any other individual outcome measure (ie, any other neuropsychiatric symptoms) was identified.

CONCLUSIONS

We found no evidence that statin use among people with depression increases mortality or other adverse events.

CLINICAL IMPLICATIONS

Our findings support the safety of updated NICE guidelines for prescribing statins in people with depressive disorders.

A New Perspective in the Treatment of Ischemic Stroke: Ferroptosis

Ischemic stroke is a common neurological disease. Currently, there are no Food and Drug Administration-approved drugs that can maximize the improvement in ischemic stroke-induced nerve damage. Hence, treating ischemic stroke remains a clinical challenge. Ferroptosis has been increasingly studied in recent years, and it is closely related to the pathophysiological process of ischemic stroke. Iron overload, reactive oxygen species accumulation, lipid peroxidation, and glutamate accumulation associated with ferroptosis are all present in ischemic stroke. This article focuses on describing the relationship between ferroptosis and ischemic stroke and summarizes the relevant substances that ameliorate ischemic stroke-induced neurological damage by inhibiting ferroptosis. Finally, the problems in the treatment of ischemic stroke targeting ferroptosis are discussed, hoping to provide a new direction for its treatment.

The Anti-Depressant Effects of Statins in Patients With Major Depression Post-Myocardial Infarction: An Updated Review 2022

Statins are the most commonly prescribed lipid-lowering agents in patients with cardiovascular disease, and more than half of the patients with cardiovascular disease have associated depressive symptoms, particularly post-myocardial infarction, which is a major trigger for depression. In our research, we tried to understand the anti-depressant effects of statins, the mechanisms, risks and benefits, and potential drug-drug interactions with anti-depressant medications. We reviewed all the relevant information from inception up to September 2022 regarding the anti-depressant effects of statins. The database used was PubMed, and the keywords were statins, major depression, post-myocardial infarction, and hydroxy methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors. We have screened each of the articles carefully, including both human and animal studies, and found a positive correlation between reduction in depressive symptoms with statin therapy as adjunctive treatment with conventional anti-depressants. In conclusion, statins as a monotherapy are not an effective treatment for depression post-myocardial infarction but are good add-on options along with standard therapy such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). Statins are safe and have no serious drug-drug interactions with anti-depressants. We would like to encourage large-scale observational studies and further post-marketing surveillance to improve our knowledge regarding the effectiveness of statins in the treatment of depression.

Statins and Antidepressants: A Comprehensive Review and Clinical Outlook of the Risks and Benefits of Co-prescription (2022)

Antidepressants are the most prescribed medications in the United States, and the most frequently prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs) followed by serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), serotonin antagonist and reuptake inhibitors (SARIs), and norepinephrine-dopamine reuptake inhibitors (NDRI). On the other hand, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, also known as statins, are the most prescribed lipid-lowering medications, and because the majority of patients with cardiovascular disease (CVD) have depressive symptoms, it is essential to understand the possible drug-drug interactions these two classes of medications can have, their potential synergistic mechanisms, and possible risks. In our research, we tried to understand the facts and uncover any missing links regarding the potential risks and benefits of statins and antidepressant co-prescription in the current clinical scenario. We reviewed all the relevant information from inception up to October 2022 regarding the antidepressant and statin polypharmacy. The databases we used were PubMed and PubMed Central, and the 11 keywords were "statins," "SSRI," "SNRI," "selective serotonin reuptake inhibitors," "serotonin-norepinephrine reuptake inhibitors," "antidepressants," "HMG-CoA reductase inhibitors," "tricyclic antidepressants," "monoamine oxidase inhibitors," "serotonin antagonist and reuptake inhibitors," and "norepinephrine-dopamine reuptake inhibitors." We carefully screened each of the relevant articles, including animal and human studies. In our study, we concluded that co-prescription of statins and SSRIs/SNRIs was generally safe and should be encouraged due to the potential synergistic nature of their effects in patients with CVD and major depression, and caution is advised with all other classes of antidepressants. We would like to encourage the undertaking of large-scale observational studies and proactive postmarketing surveillance to improve our knowledge regarding this topic considering the immense clinical importance it holds by directly and indirectly affecting half the population worldwide.

Association between C-reactive protein levels and development of post-stroke depression: A systematic review and meta-analysis

BACKGROUND AND AIMS

Different prospective cohort studies have focused on the C-reactive protein (ie, a pentameric protein) biomarker as a predictor of post-stroke depression. In this review and meta-analysis, we will attempt to synthesize the evidence for the association between C-reactive protein and the development of post-stroke depression.

METHODS

We systematically searched five academic databases for relevant studies according to the PRISMA guidelines. We evaluate the comparative levels of C-reactive protein in patients with stroke and/without depression, and analyzed the hazard ratio to evaluate the overall risk of C-reactive protein levels in patients with stroke.

RESULTS

We selected eligible studies with 2534 patients (mean age: 65.2  ±  5.9 years) from the initial 10 926 studies in the databases. Increased C-reactive protein levels (Hedge's g, 0.84) in patients with stroke and depression as compared to patients with stroke without depression. Increased levels of C-reactive protein were associated with the onset of depression (Hazard's ratio, 1.6) in patients with stroke.

CONCLUSION

Our findings provide an association of C-reactive protein with the development of post-stroke depression, and present higher levels than patients with stroke without depression. Additionally, our findings support the role of C-reactive protein levels as markers for predicting depression in patients with stroke.