January 2011

Depression, Inflammation, and Statins
In patients who have had a recent cardiac event, statins are associated with a significant reduction in the risk of depression.

Treating BDD
Although body dysmorphic disorder is difficult to treat, serotonin reuptake inhibitors and cognitive behavioral therapy may improve symptoms.

Measurement-Enhanced Care
A measurement-enhanced care approach to psychiatry, in which symptoms are measured before and during treatment, is seldom used in clinical practice but may become more common in the future.

In Brief
Children with ADHD Have More Chromosomal Structural Abnormalities; Medicare/Medicaid Prescription Plan Switch Associated with Increases in Suicidal Ideation and Behavior

SRIs and Thinning Bone
Highly serotonergic agents may adversely affect bone density.

Stimulants in Dementia
Methylphenidate (Ritalin and others) may provide relief for apathy in patients with dementia but with the risk of adverse cardiovascular and behavioral effects.

Depression, Inflammation, and Statins

January 2011

Increased immune activation and impaired immune function have been associated with major depressive disorder. Consistent with immune dysfunction, patients with depression have increased levels of proinflammatory cytokines. Antidepressants reduce inflammatory marker levels.

Statins also have anti-inflammatory properties and reduce markers of oxidative stress. This led Stafford and Berk to examine the effects of statin treatment on the development of depression in patients hospitalized for myocardial infarction, coronary angioplasty, or coronary artery bypass graft surgery.1

These investigators identified 193 patients in an Australian hospital. Over 80% were discharged on statin therapy. After adjusting for possible confounders, researchers found that at 3 months postdischarge, statins reduced the risk of depression by 69%. At 9 months after discharge, statin therapy was associated with a 79% reduced likelihood of depression (P < .001).

The authors conclude that statins were associated with a significant reduction in the risk of depression in patients who had had a recent cardiac event. Data today are insufficient to recommend statin therapy for depression prophylaxis. But this study adds to a growing literature pointing toward a role of inflammation in the pathophysiology of depression.

1Stafford L, Berk M: The use of statins after a cardiac intervention is associated with reduced risk of subsequent depression: Proof of concept for the inflammatory and oxidative hypotheses of depression? J Clin Psychiatry, in press.