Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Victoria, Australia.
J Clin Psychiatry. 2011 Sep;72(9):1229-35. doi: 10.4088/JCP.09m05825blu. Epub 2010 Dec 14.
Depression is associated with immune activation as well as oxidative stress. Statins have in vitro and in vivo antiinflammatory and antioxidative properties. We prospectively investigated whether the use of statins was associated with a reduced risk of development of depression in individuals who have had a cardiac event or intervention.
Participants were recruited between May 2005 and March 2006 from the Geelong Hospital, Geelong, Australia, a tertiary hospital in regional Australia that serves a catchment area shown to be representative of the broader Australian community. Patients who were hospitalized for angioplasty, myocardial infarction, or coronary artery bypass graft surgery (N = 193) were followed up prospectively for 9 months to assess development of depression. Depression data were collected 3 months postdischarge (T1) by structured clinical interview (using the Mini International Neuropsychiatric Interview, version 5) and 9 months postdischarge (T2) by self-report (using the Hospital Anxiety and Depression Scale). Major depressive disorder, minor depression, and dysthymia were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Data on statins were collected from medical records. The association between statin therapy and depression was tested using both linear and logistic regression models controlling for clinical, psychological, and demographic confounders.
At discharge, 157 participants (81.3%) were receiving statin therapy. Adjusting for possible confounders, taking statins at discharge had a protective effect on depression at T1, reducing the likelihood of dysthymia, minor depression, or major depression by 69% (95% CI, 0.097-0.972; P = .045). At the T2 end point, statin therapy again had a protective effect and was associated with a 79% reduction in the likelihood of depression (95% CI, 0.052-0.876; P = .032). The linear regression model to predict depression at T2 was significantly different from zero (F(11,180) = 8.686, P < .001) and explained 36.3% of the variance in depression.
The use of statins was associated with significant reduction in the risk of depression in individuals who have had a cardiac event. This supports the role of oxidative and inflammatory processes in depression and opens the door to rational and novel pathophysiologically based therapies distinct from conventional antidepressants.
抑郁与免疫激活和氧化应激有关。他汀类药物具有体外和体内抗炎和抗氧化作用。我们前瞻性地研究了在发生心脏事件或接受介入治疗的个体中，使用他汀类药物是否与降低抑郁发展风险相关。
参与者于 2005 年 5 月至 2006 年 3 月在澳大利亚地区性三级医院——澳大利亚杰拉尔顿医院招募，该医院的服务人群与更广泛的澳大利亚社区相似。接受经皮冠状动脉介入治疗、心肌梗死或冠状动脉旁路移植术的患者（n=193）在出院后 9 个月内进行前瞻性随访，以评估抑郁的发展情况。抑郁数据在出院后 3 个月（T1）通过结构化临床访谈（使用 Mini 国际神经精神访谈，第 5 版）和出院后 9 个月（T2）通过自我报告（使用医院焦虑和抑郁量表）收集。根据《精神障碍诊断与统计手册》第 4 版的标准，诊断为重度抑郁障碍、轻度抑郁障碍和恶劣心境。从病历中收集他汀类药物的数据。使用线性和逻辑回归模型，控制临床、心理和人口统计学混杂因素，测试他汀类药物治疗与抑郁之间的关联。
出院时，157 名参与者（81.3%）正在接受他汀类药物治疗。调整可能的混杂因素后，出院时服用他汀类药物对 T1 时的抑郁有保护作用，使恶劣心境、轻度抑郁或重度抑郁的可能性降低 69%（95%CI，0.097-0.972；P=0.045）。在 T2 终点，他汀类药物治疗再次具有保护作用，与抑郁可能性降低 79%相关（95%CI，0.052-0.876；P=0.032）。用于预测 T2 时抑郁的线性回归模型与零显著不同（F(11,180)=8.686，P<.001），并解释了抑郁方差的 36.3%。
在发生心脏事件的个体中，使用他汀类药物与抑郁风险显著降低相关。这支持了氧化和炎症过程在抑郁中的作用，并为不同于传统抗抑郁药的合理和新颖的基于病理生理学的治疗方法开辟了道路。
