Common Medications May Help People With Serious Mental Illness

Common medications used to fight cholesterol, high blood pressure, and diabetes may be useful in lowering risk of self-harm and psychiatric hospitalization for people with a serious mental illness (SMI) such as bipolar disorder, schizophrenia, or nonaffective psychosis, according to a study published last month in JAMA Psychiatry.

In the study, Joseph F. Hayes, M.B.Ch.B., Ph.D., M.Sc., a Wellcome Trust Clinical Research Career Development Fellow in the Division of Psychiatry at University College London, and an international team of colleagues analyzed data from the health records of 142,691 Swedish patients aged 15 and older who had an SMI and were treated with psychiatric medication from October 2005 through December 2016. The data also included whether the patients were treated with statins for cholesterol, L-type calcium channel blockers for high blood pressure, or metformin for type 2 diabetes. In patients who took these drugs, the researchers examined the rates of self-harm and psychiatric hospitalization during periods they were taking the medications and compared these with the times patients were not taking the medications.

“Our evolving understanding of the central nervous system mechanisms of these three classes of drugs suggested that they may have positive effects on psychiatric symptoms, and there have been a number of small and inconclusive trials of [statins and L-type calcium channel blockers],” said Hayes, who is also honorary consultant psychiatrist in the Integrated Practice Unit for Psychosis at Camden and Islington NHS Foundation Trust.

The researchers found that patients who had bipolar disorder were 8 percent to 20 percent less likely to experience psychiatric hospitalization and 19 percent to 27 percent less likely to harm themselves during the times they were taking one of the three types of medications. Patients with schizophrenia who were taking one of the three types of medications were 20 percent to 27 percent less likely to experience psychiatric hospitalization and 36 percent to 70 percent less likely to harm themselves. Patients with nonaffective psychosis who were taking statins or metformin were 20 percent and 15 percent less likely to experience psychiatric hospitalization, respectively, and those taking L-type calcium channel blockers were 44 percent less likely to harm themselves.

Hayes said that the results emphasize the importance of managing the overall health of patients with SMI.

“At this stage, we are not suggesting people with these mental illnesses change their treatment and we wouldn’t recommend using these medications instead of conventional medication for severe mental illness,” Hayes said. “However, there is evidence that people with schizophrenia, bipolar disorder, and other psychotic illnesses tend have their physical health undertreated. Particularly, they are at increased risk of cardiovascular disease, hypertension, and diabetes, illnesses these medications are designed to treat. It is therefore worth it for patient to work with their doctors to optimize prescribing for these physical conditions, which may then have additional beneficial effects on mental health.”

In the paper, Hayes and colleagues noted that the three types of medications work on some of the processes thought to cause psychiatric disorders. For example, neuroinflammation is linked to psychiatric disorders, and statins are anti-inflammatory. Additionally, high cholesterol, high blood pressure, and diabetes are more common in people with SMI.

Hayes said that their findings can lay the groundwork for future studies.

“Trials of these medications should be relatively straightforward as the medications are already licensed and there is a good understanding of their adverse effect and side effect profiles. Alongside this work, we believe it will be useful to clarify the central nervous system effects of these classes of drugs, as there may be potential for optimization of effectiveness or new drug development,” said Hayes.

This study was supported by the Wellcome Trust, the University College London Hospitals National Institute for Health Research Biomedical Research Centre, and the Swedish Research Council. ■