Multi-use medications: Using anti-inflammatory medications to treat depression

By Lauren DeSouza- Master of Public Health, Simon Fraser Public Research University – Canada
https://cshmke.com/our-team/

Staff Research and Content Writer

In recent years, there has been growing interest in how inflammation in the body might be linked to depression. Research is starting to show that inflammation can contribute to depression and vice-versa, through chronic stress, the immune system, the endocrine system, and more. This new evidence has led to growing research into the potential for using anti-inflammatory drugs to treat depression. Statins, primarily known for their cholesterol-lowering effects, have been studied for their potential anti-inflammatory properties. These properties may contribute to their impact on depressive symptoms.

There is a debate on whether statins can effectively treat depression. Although some small clinical trials have reported positive anti-depressive effects, real-world studies have suggested that statins may worsen symptoms of anxiety and depression. To resolve this controversy, a new study comprehensively reviewed the available evidence regarding the efficacy of using statins for treating major depressive disorder (MDD).

What is the relationship between inflammation and depression?

Studies have consistently shown elevated levels of inflammatory markers, such as cytokines (small proteins involved in cell signaling during the immune response), in individuals with depression. Inflammation can influence the balance of neurotransmitters, such as serotonin and dopamine, which affect mood regulation. Neuroinflammation (inflammation in the brain) may play an especially prominent role in depression. The immune cells in the brains of people with depression have been observed not to function correctly, suggesting a link between neuroinflammation and mood disorders.

Image via Freepik

Anti-inflammatory medications such as statins may have antidepressant side effects through various pathological mechanisms. These include:

Anti-inflammation: Suppressing the production of inflammatory molecules such as cytokines
Immune regulation: Regulating immune cell function, which reduces inflammation
Neuroprotection: Protecting neurons from inflammation-related damage
Neurotrophic: Influencing neurotransmitter systems, which play a role in mood management
Antioxidant: Reducing oxidative stress in cells, which is linked to inflammation

What did this study do?

This study was a systematic review and meta-analysis. This means that researchers looked at all studies that aimed to answer the question they were interested in. The research question in this study was, “What is the effect of statin on depressive mood and inflammation status among patients with major depressive disorder (MDD)?” They specifically looked for randomized controlled trials (RCTs) as these studies use the most rigorous methods to test the effectiveness of a drug, either against a placebo or another treatment.

In the included studies, patients were given either a combination of statin with a selective serotonin reuptake inhibitor (SSRI), a standard treatment for MDD, or given just the SSRI. for a study to be included in the review, its participants had to be given either an SSRI or an SSRI plus statin for a minimum of 6 weeks. In total, 6 studies were included in the review.

The researchers were primarily interested in whether the treatment with statin reduced patients’ depressive symptoms, which were measured with the Hamilton Depression Rating Scale. They also wanted to understand how statin affected patients’ response to treatment and how many relapsed into major depression during treatment with statin. Finally, they looked at how many patients in each study experienced adverse effects from statin and what these effects were.

What were the results?

Compared with using SSRIs alone, treatment with statin plus SSRIs was associated with significantly decreased depressive symptoms among patients with MDD. When used as an add-on to SSRIs, treatment with statin safely and effectively improved the severity of depressed mood and lowered inflammation. In addition, patients treated with stain had a similar rate of relapse and similar response to treatment as using SSRIs alone, suggesting that these treatments are comparably effective and well-tolerated.

The positive effects of statin treatment were most prominent in studies with mid- to long-term follow-up periods. However, most of the included studies had short follow-up periods. The authors note that more studies with longer follow-ups are needed to ascertain the risks and benefits of statin treatment for MDD. Large RCTs are warranted to confirm the value of statin therapy in patients with MDD, especially among those with diseases of the cardiovascular system and nervous system.

Image via Freepik

What are the key takeaways?

There is a growing awareness of the link between inflammation and depression.
Researchers are exploring the use of anti-inflammatory medications as an adjunct treatment for depression.
The use of statin, an anti-inflammatory medication, is controversial in the treatment of depression.
A systematic review and meta-analysis of existing literature found a net positive effect of treatment with statins in combination with SSRIs on depressive mood.
Larger studies with more extended follow-up periods are needed to draw conclusions about the use of statins to treat depression.

References

Xue Xiao, Hu Deng, Peng Li, Jifei Sun, Jing Tian. Statin for mood and inflammation among adult patients with major depressive disorder: an updated meta-analysis. Front. Psychiatry, 15 November 2023. Sec. Psychological Therapy and Psychosomatics

Volume 14 – 2023 | https://doi.org/10.3389/fpsyt.2023.1203444