The effects of statins on mood: a review of the literature

Aim: To investigate the association between hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) and mood disturbance. Background: The confirmation that high serum cholesterol levels increase the risk of coronary heart disease has resulted in statins becoming the most widely prescribed drugs in the treatment of hypercholesterolaemia. However, a positive relationship between low serum cholesterol levels and increased non-illness mortality from accidents and suicide has been reported. Method: Eight papers reporting the effect of statins on one or more of six mood states: depression, anxiety, anger, hostility, fatigue, confusion and vigour in adults older than 18 years were identified from a search of Cinahl, Medline and Cochrane electronic databases. The review focused on studies where the outcome of interest was self-reported mood disturbance as non-illness mortality is problematic. Key findings: Three papers reported some evidence of a positive association with depression, whilst another reported a decreased incidence of depression and the remainder reported no association. Of the six papers which studied anxiety, only one reported a statistically significant decrease in the incidence of anxiety. Two out of six papers reported increased aggression with statin usage, with one study further indicating a stronger effect with lypophylic statins. In contrast one paper reported an outcome of decreased hostility. Conclusion: This review found conflicting evidence of a relationship between statins and mood. Further research is recommended in particular with older, female and lower socioeconomic samples. However, nurses should be alert to the risk and ready to intervene in cases of mood disturbance.