Simvastatin versus atorvastatin for improving mild to moderate depression in post-coronary artery bypass graft patients: A double-blind, placebo-controlled, randomized trial

•We compared the antidepressant effects of simvastatin and atorvastatin.•We assessed changes in Hamilton Depression Rating Scale scores in post-CABG cases.•Simvastatin resulted in greater reduction in depressive symptoms than atorvastatin.•Treatment with simvastatin seems to be well tolerated with no serious adverse event.•Simvastatin may be the statin of choice in patients with post-CABG depression.

BackgroundA decreased risk of developing depression has been reported among statin users. Aside from their lipid-lowering effects, statins are considered immunomodulatory agents and have protective effects against oxidative stress and inflammation which are well known for their association with depression. The aim of the present study was to compare the probable antidepressant effects of simvastatin and atorvastatin among post-coronary artery bypass graft (CABG) surgery patients with high and low potentials for blood-brain-barrier penetration, respectively.MethodForty-six outpatients who had undergone CABG in the last 6 months and suffered from mild to moderate depression participated in a parallel, double-blind, placebo-controlled trial, and were randomized to undergo 6 weeks of treatment with either simvastatin (20 mg/day) or atorvastatin (20 mg/day). Participants were evaluated using Hamilton depression rating scale (HDRS) at baseline and weeks 3 and 6. The primary outcome was to evaluate the efficacy of simvastatin in improving the depressive symptoms.ResultGeneral linear model repeated measures demonstrated significant effect for time×treatment interaction on the HDRS scores [F (1.62, 71.06)=3.41, P=0.048]. There was no significant difference between the treatment groups regarding the adverse events. No one experienced serious adverse event.LimitationThe limitations of the present study were its small sample size and the short-term follow-up period.ConclusionTreatment with simvastatin seems to be well tolerated with superior antidepressant effects compared to atorvastatin in post-CABG patients. Long-term outcomes of this practice and its probable influence on other psychological aspects are yet to be investigated in future studies.Trial registrationIranian registry of clinical trials (http://www.irct.ir): IRCT201410271556N68.