A study that appears in the current issue of Psychotherapy and Psychosomatics addresses the association between use of aspirin and statins and the risk of major depression.

Chronic disease states characterised by inflammation are often accompanied by depression. Furthermore, depression is commonly reported among patients following exposure to cytokine-based immunotherapy, systemic inflammation has been implicated in the development of depressive symptoms in the elderly, and recent twin studies support a genetic contribution to inflammation and the pathogenesis of depression. As statins and aspirin both have anti-inflammatory properties, the Authors of this study hypothesised that therapy with these agents would reduce the risk for depression. From an age-stratified sample of 1,494 women, randomly selected from the community and recruited for the Geelong Osteoporosis Study 1994-1997, 837 were aged at least 50 years, meeting the inclusion criterion for the study. 386 were assessed at the 10-year follow-up and agreed to a psychiatric interview.

A lifetime history of Major Depressive Disorder (MDD) and age of onset were diagnosed using the Structured Clinical Interview for DSM-IV-TR. It was decided a priori that statins and aspirin, prescribed predominantly for cardiac prophylaxis, would be the exposure variables of interest and recognised if regular use was reported for at least 6 months. Also documented was exposure to non-steroidal antiinflammatory agents, oral glucocorticoids, paracetamol (acetaminophen), hormone therapy and antidepressants.The primary design was a nested case-control study. Cases were subjects with first-episode MDD occurring >50 years of age, controls were MDD free. Use of statins and aspirin was recognised if exposure preceded MDD onset for cases and the 10-year assessment for controls.

A retrospective cohort analysis was also performed for subjects with no prior history of MDD who were followed from baseline or time of exposure to statins or aspirin, until a first episode of MDD or the 10-year follow-up. Among 386 women, 63 were diagnosed as having MDD (cases) and 323 had no history of MDD (controls). 22 cases and 323 controls were eligible for analysis. Exposure to statins was documented for 1 of 22 cases and 93 of 323 controls (5 vs. 29%, p = 0.01). Exposure to aspirin was documented for 1 of 22 cases and 103 of 323 controls (p = 0.007) (N=104). The prevalence of exposure to statins and aspirin was lower among women with MDD (p< 0.001). At the end of the investigation, the exposure to statins and aspirin appears to be associated with a reduced risk for MDD. These associations were not explained by use of other medications or by differences in lifestyle or body habitus. The findings are consistent with immune system dysregulation in the development of depression. Protective effects of statins have been reported previously, with psychological effects potentially attributable to modulation of the immune system, improvement in blood flow and reduction in oxidative damage. Within several constraints, the results of this study support the notion that statins and aspirin are protective against the likelihood of depression in women. These agents should be further investigated as a novel approach to both the treatment and primary prevention of depression. Sources: Journal of Psychotherapy and Psychosomatics, AlphaGalileo Foundation.