The Effect of Concomitant Treatment With SSRIs and Statins: A Population-Based Study
Publication: American Journal of Psychiatry
Abstract
Objective:
Both preclinical studies and clinical trials have indicated that the combination of a selective serotonin reuptake inhibitor (SSRI) and a statin may have superior antidepressant effects compared with SSRI treatment alone. The authors sought to assess whether this beneficial effect can be generalized to a more heterogeneous population of SSRI users.
Method:
In a nationwide cohort study that included all incident SSRI users in Denmark between 1997 and 2012, the authors compared people who had periods of concomitant use of SSRIs and statins with people who had periods of SSRI treatment alone. Outcomes included the rates of psychiatric hospital contacts (any cause), psychiatric hospital contacts due to depression, suicidal behavior, and all-cause mortality. Using Cox regression and competing risk analysis, the authors calculated crude and adjusted hazard ratios for these outcomes.
Results:
The authors identified 872,216 incident SSRI users, of whom 113,108 (13.0%) used a statin concomitantly. Compared with SSRI treatment alone, the combined use of an SSRI and a statin was associated with a significantly lower risk for both psychiatric hospital contacts (adjusted hazard ratio=0.75 (95% CI=0.69, 0.82) and psychiatric hospital contacts due to depression (adjusted hazard ratio=0.64, 95% CI=0.55, 0.75). Compared with SSRI treatment alone, the concomitant use of SSRIs and statins was not associated with significant increases in all-cause mortality (adjusted hazard ratio=1.04, 95% CI=0.96, 1.12) or suicidal behavior (adjusted hazard ratio=0.85, 95% CI=0.61, 1.18).
Conclusions:
In a large naturalistic cohort, concomitant treatment with SSRIs and statins resulted in robust advantages compared with SSRIs alone.
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History
Received: 13 April 2015
Revision received: 27 January 2016
Revision received: 4 March 2016
Accepted: 21 March 2016
Published online: 3 May 2016
Published in print: August 01, 2016
Authors
Competing Interests
Dr. Gasse has received unrestricted research grants from Eli Lilly and Lundbeck, funding through research collaboration with LASER Analytica, funding from the European Union Seventh Framework Programme (FP7/2007-2013) under grant agreement 279227, and support from the Innovative Medicines Initiative Joint Undertaking resources, which were composed of financial contributions from the European Union Seventh Framework Programme and in-kind contributions from members of the European Federation of Pharmaceutical Industries and Associations. Dr. Nierenberg has served as a consultant for Abbott Laboratories, the American Psychiatric Association, Appliance Computing, Inc. (Mindsite), Basilea, Brain Cells, Brandeis University, Bristol-Myers Squibb, Clintara, Corcept, Dey Pharmaceuticals, Dainippon Sumitomo (now Sunovion), Eli Lilly, EpiQ, L.P./Mylan, Forest, Genaissance, Genentech, GlaxoSmithKline, Healthcare Global Village, Hoffman–LaRoche, Infomedic, Lundbeck, Janssen, Jazz Pharmaceuticals, MedAvante, Merck, Methylation Sciences, Naurex, Novartis, Pamlab, Parexel, Pfizer, PGx Health, Otsuka, Ridge Diagnostics, Shire, Schering-Plough, Somerset, Sunovion, Takeda, Targacept, and Teva; he has also served as a consultant through the MGH Clinical Trials Network and Institute for AstraZeneca, Brain Cells, Dainippon Sumitomo/Sepracor, Johnson & Johnson, Labopharm, Merck, Methylation Sciences, Novartis, PGx Health, Shire, Schering-Plough, Targacept, and Takeda/Lundbeck; he has received grants or research support from the American Foundation for Suicide Prevention, the Agency for Healthcare Research and Quality, the Brain and Behavior Research Foundation, Bristol-Myers Squibb, Cederroth, Cephalon, Cyberonics, Elan, Eli Lilly, Forest, GlaxoSmithKline, Janssen, Lichtwer Pharma, the Marriott Foundation, Mylan, NIMH, Pamlab, the Patient-Centered Outcomes Research Institute, Pfizer, Shire, the Stanley Foundation, Takeda, and Wyeth-Ayerst; he has received honoraria from Belvoir Publishing, University of Texas Southwestern Dallas, Brandeis University, Bristol-Myers Squibb, Hillside Hospital, American Drug Utilization Review, the American Society for Clinical Psychopharmacology, Baystate Medical Center, Columbia University, CRICO, Dartmouth Medical School, Health New England, the Harold Grinspoon Charitable Foundation, IMEDEX, the International Society for Bipolar Disorder, the Israel Society for Biological Psychiatry, Johns Hopkins University, MJ Consulting, New York State, Medscape, MBL Publishing, MGH Psychiatry Academy, the National Association of Continuing Education, Physicians Postgraduate Press, SUNY Buffalo, University of Pisa, University of Michigan, University of Miami, University of Wisconsin at Madison, the American Professional Society of ADHD and Related Disorders, the International Society for Bipolar Disorders, SciMed, Slack Publishing, Wolters Kluwer Publishing, the American Society of Clinical Psychopharmacology, the New Clinical Drug Evaluation Unit, Rush Medical College, Yale University School of Medicine, the National Network of Depression Centers, Nova Southeastern University, NAMI, the Institute of Medicine, CME Institute, the International Society for CNS Clinical Trials and Methodology, the World Congress on Brain Behavior and Emotion, the Congress of the Hellenic Society for Basic and Clinical Pharmacology, and the Anxiety and Depression Association of America; he owns stock in Appliance Computing, Inc. (MindSite), Brain Cells, and MedAvante; and he holds copyrights for the Clinical Positive Affect Scale and the MGH Structured Clinical Interview for the Montgomery-Åsberg Depression Rating Scale, exclusively licensed to the MGH Clinical Trials Network and Institute. The other authors report no financial relationships with commercial interests.
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