Köhler-Forsberg Ole, Otte Christian, Gold Stefan M, Østergaard Søren Dinesen
Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark; Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Charité - Universitätsmedizin Berlin, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany.
Pharmacol Ther. 2020 Nov;215:107625. doi: 10.1016/j.pharmthera.2020.107625. Epub 2020 Jul 8.
Many patients with depression do not respond sufficiently to antidepressant treatment, necessitating other treatment approaches. HMG-CoA reductase inhibitors (i.e. statins), which are frequently used for their cardioprotective properties, have also been studied regarding potential antidepressant effects. Possible mechanisms underlying an antidepressant effect of statins may include the anti-inflammatory, antioxidant and lipid lowering properties of this class of drugs. This review provides an overview of this field by reviewing the following aspects: 1) Candidate mechanisms that could mediate putative antidepressant effects of statins; 2) The evidence for and against antidepressant effects of statins in patients with major depressive disorder and among individuals with a medical disease and depressive symptoms; and 3) The safety of statin treatment. Three small placebo-controlled trials conducted in Iran (total N=172) have found that statins as add-on to selective serotonin reuptake inhibitors (SSRIs) have antidepressant effects in patients with major depressive disorder (MDD). Statin treatment in individuals without MDD do not seem to affect mood or protect against development of depression. Treatment with statins - including the combination with SSRIs - is generally considered to be safe. While the initial evidence for the antidepressant effect of the combination of an SSRI and a statin is promising, larger clinical trials, appropriately powered, and with depression as a pre-defined primary endpoint are needed.
许多抑郁症患者对抗抑郁治疗反应不足，因此需要其他治疗方法。3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（即他汀类药物），因其心脏保护特性而经常被使用，人们也对其潜在的抗抑郁作用进行了研究。他汀类药物抗抑郁作用的潜在机制可能包括这类药物的抗炎、抗氧化和降脂特性。本综述通过回顾以下几个方面对该领域进行了概述：1）可能介导他汀类药物假定抗抑郁作用的候选机制；2）支持和反对他汀类药物对重度抑郁症患者以及患有内科疾病并伴有抑郁症状的个体具有抗抑郁作用的证据；3）他汀类药物治疗的安全性。在伊朗进行的三项小型安慰剂对照试验（总样本量N = 172）发现，他汀类药物作为选择性5-羟色胺再摄取抑制剂（SSRI）的附加治疗，对重度抑郁症（MDD）患者具有抗抑郁作用。在没有MDD的个体中进行他汀类药物治疗似乎不会影响情绪或预防抑郁症的发生。使用他汀类药物治疗——包括与SSRI联合使用——通常被认为是安全的。虽然SSRI与他汀类药物联合使用具有抗抑郁作用的初步证据很有前景，但仍需要进行更大规模、有足够效力且将抑郁症作为预先定义的主要终点的临床试验。
