Real-world outcomes of concomitant antidepressant and statin use in primary care patients with depression: a population-based cohort study

Abstract

Background: Antidepressants are licensed for use in depressive disorders, but non-response and poor adherence to treatment affect a considerable number of patients. Pre-clinical and clinical evidence suggest that statins can augment the effects of antidepressants. However, the acceptability and tolerability of combining statins with antidepressants are unclear, and their add-on efficacy has only been shown in small, short-term clinical trials. Observational data can provide complementary information about treatment effects on larger samples over longer follow-ups. In this study, we therefore assessed the real-world acceptability, tolerability, and efficacy of concomitant antidepressant and statin treatment in depression.

Methods: We conducted a population-based cohort study investigating QResearch primary care research database, which comprises the anonymised electronic healthcare records of 35 + million patients over 1574 English general practices. Patients aged 18-100 years, registered between January 1998 and August 2020, diagnosed with a new episode of depression, and commencing an antidepressant were included. Using a between-subject design, we identified two study groups: antidepressant + statin versus antidepressant-only prescriptions. Outcomes of interest included the following: antidepressant treatment discontinuations due to any cause (acceptability) and due to any adverse event (tolerability) and effects on depressive symptoms (efficacy) measured as response, remission, and change in depression score on the Patient Health Questionnaire-9. All outcomes were assessed at 2, 6, and 12 months using multivariable regression analyses, adjusted for relevant confounders, to calculate adjusted odds ratios (aORs) or mean differences (aMDs) with 99% confidence intervals (99% CIs).

Results: Compared to antidepressant-only (N 626,335), antidepressant + statin (N 46,482) was associated with higher antidepressant treatment acceptability (aOR_2months 0.88, 99% CI 0.85 to 0.91; aOR_6months 0.81, 99% CI 0.79 to 0.84; aOR_12months 0.78, 99% CI 0.75 to 0.81) and tolerability (aOR_2months 0.92, 99% CI 0.87 to 0.98; aOR_6months 0.94, 99% CI 0.89 to 0.99, though not long term aOR_{12 months} 1.02, 99% CI 0.97 to 1.06). Efficacy did not differ between groups (range aOR_{2-12 months} 1.00 and 1.02 for response and remission, range aOR_{2-12 months} - 0.01 and - 0.02 for change in depression score).

Conclusions: On real-world data, there is a positive correlation between antidepressant treatment adherence and statin use, partly explained by fewer dropouts due to adverse events. The main limitation of our study is its observational design, which restricts the potential to make causal inferences.

Keywords: Antidepressant; Antidepressant efficacy; Cohort study; Depression; Epidemiology; Primary care; QResearch; Real-world effects; Statin; Treatment adherence.