A Statin Island of Woe: Are Depression and Cholesterol-lowering Connected?
Are statin drugs bringing you down?
Posted August 20, 2012
Statin medications work by blocking a key enzyme involved in the body’s production of cholesterol. We are learning that these medications may also affect serotonin, a neurotransmitter that helps us maintain good mood. Lab tests using human serotonin receptors (the parts of the cell that can recognize serotonin) have shown that in the presence of statin medications, the structure and function of serotonin cell receptors will get disturbed and not work so well. Since serotonin receptors play a very important role in mood by allowing our bodies to recognize serotonin, the presence of statin drugs may not be good news for our mood. In these studies, when scientists added extra cholesterol back to the cholesterol-depleted cells treated with the statin medication, the receptors came back to normal and responded to serotonin again. According to the investigators of this study, these results show how the effect of long-term cholesterol depletion in the brain might trigger depression (3).
There may be other mood altering mechanisms of statin medications as well. Other studies have suggested that cholesterol-lowering medications will lower polyunsaturated essential fatty acids in the brain as well (4). Essential fatty acids (like those found in fish oil, olive oil and flax seeds) are key to form a healthy brain and good mood.
Statins Causing More Problems Than Helping?
In the alleged interest of saving more hearts, the medical powers-that-be lowered the normal cut off range for high cholesterol in the last few years, allowing for even more people to start statin medications. While cholesterol medication is clearly helpful for the most severe cardiac cases where patients have already had heart attacks and coronary artery disease, it is unlikely cholesterol itself is the major factor in precipating heart disease and it is very dubious as to whether cholesterol meds are actually helpful in preventing heart attacks (5).
Even more, cholesterol medications have been shown in a recent study to increase diabetes risk by 71 percent in post-menopausal women (6). Diabetes is a main cause of coronary artery disease, the ultimate issue we are trying to prevent by taking these medications. If this isn’t enough, very recent research also shows statin drugs cause an increase of 50 percent in cataracts in non-diabetics, and even more for diabetics (7).
What To Do If Statin Meds Are Not Good?
So if your cholesterol is high, especially if you tend towards having depression, then what is the best way to proceed? Consider asking your doctor to run a panel of cardiac tests to help assess your true risk of heart disease. Blood tests including vitamin D, homocysteine, fibrinogen, testosterone, and a Vertical Auto Profile (VAP) will help reveal other cardiovascular factors that can place cholesterol in a better context. Sometimes I recommend patients with a strong early family history of heart disease also consider checking their coronary arteries using a non-invasive calcium scoring test, which can visualize build up of atherosclerotic plaque. These tests will help you figure out the true risk, and how aggressive you need to work.
Of course, no matter the results, I do find that proper exercise, as well as healthy food, good fiber intake and relaxation work, are truly effective in almost all cases to rebalance cholesterol. Despite what you may have been told, most cases of cholesterol, even higher levels, are not genetic.
I find that if my patients and I sit down and take the time to figure out the obstacles to eating well and exercising and deal with stressors, we can come up with solutions that really work. Finally, if these solutions are not enough, there are many wonderful nutrients and natural remedies that can help balance lipids (such as fiber supplements, chromium, B vitamins, forms of niacin, gugulipids, red yeast rice, and many others, depending on the particular individual).
2. Steffens DC, McQuoid DR, Krishnan KR Cholesterol-lowering medication and relapse of depression. Psychopharmacol Bull. 2003;37(4):92-8.
3. Shrivastava S, Pucadyil TJ, Paila YD, Ganguly S, Chattopadhyay A. Chronic cholesterol depletion using statin impairs the function and dynamics of human serotonin(1A) receptors.Biochemistry. 2010 Jul 6;49(26):5426-35
4. Hibbeln JR, Umhau JC, George DT, Salem N Jr. Do plasma polyunsaturates predict hostility and depression? World Rev Nutr Diet. 1997;82:175-86
5. Houston M. What Doctors May Not Tell You About Heart Disease. Hacette Book, New York, NY 2012. Pp: 3 -7, 62-70
6. Culver AL, Ockene IS, Balasubramanian R, Olendzki BC, Sepavich DM, Wactawski-Wende J, Manson JE, Qiao Y, Liu S, Merriam PA, Rahilly-Tierny C, Thomas F, Berger JS, Ockene JK, Curb JD, Ma Y. Statin use and risk of diabetes mellitus in postmenopausal women in the Women's Health Initiative. Arch Intern Med. 2012 Jan 23;172(2):144-52. Epub 2012 Jan 9.
7. Machan CM, Hrynchak PK, Irving EL. Age-related cataract is associated with type diabetes and statin use. Optom Vis Sci 2012; 89:1165-1171