Statins, Metformin Linked to Improved Outcomes in Serious Mental Illness

Use of statins, metformin, and calcium-channel blockers are associated with improved outcomes, including lower risk of psychiatric hospitalization, in patients with serious mental illness (SMI).

In order to explore the potential benefits of commonly prescribed drugs in patients with SMI, researchers conducted a review of data from 142,691 individuals from Sweden who had a diagnosis of bipolar disorder, schizophrenia, or nonaffective psychosis. Study drugs included hydroxylmethylglutaryl coenzyme A reductase inhibitors (HMG-CoA RIs), L-type calcium channel (LTCC) antagonists, and biguanides.

Overall, exposure to HMG-CoA RIs was associated with reduced risk of psychiatric hospitalization in patients with bipolar disorder, (adjusted hazard ratio [aHR] 0.86), schizophrenia (aHR 0.75), and nonaffective psychosis (aHR 0.80). Rates of self-harm were also reduced in patients with bipolar disorder (aHR, 0.76 and schizophrenia (aHR, 0.58).

Further, LTCC antagonists were associated with reduction in the rates of psychiatric hospitalization and self-harm in patients with bipolar disorder (aHRs, 0.92 and 0.81, respectively), schizophrenia (aHRs, 0.80 and 0.30, respectively), and nonaffective psychosis (aHRs, 0.89 and 0.56 [95% CI, 0.42-0.74; P < .001], respectively).

Treatment with biguanides was associated with a reduction in the rates of psychiatric hospitalization in patients with bipolar disorder (aHR, 0.80), schizophrenia (aHR, 0.73), and nonaffective psychosis (aHR, 0.85), and self-harm was reduced in bipolar disorder (aHR, 0.73) and schizophrenia (aHR, 0.64).

“If substantiated, this study has considerable implications for clinical practice and drug development. The study drugs—HMG-CoA RIs, LTCC antagonists, and biguanides—are globally licensed, commonly used, cheap, and relatively safe medications. They are therefore ideal candidates for repurposing. Understanding their mode of action on the central nervous system may facilitate better understanding of the pathophysiology of SMI and offer opportunities for innovative pharmacotherapy development.”

—Michael Potts

Reference:

Hayes JF, Lundin A, Wicks S, et al.

Association of hydroxylmethyl glutaryl coenzyme a reductase inhibitors, l-type calcium channel antagonists, and biguanides with rates of psychiatric hospitalization and self-harm in individuals with serious mental illness [published online January 9, 2019]. JAMA Psych. doi:10.1001/jamapsychiatry.2018.3907