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Are Some People More Aggressive on Statins?

Are some people more aggressive on statins? Low cholesterol levels have been linked to depression and aggression. A doctor shares his story.

Most people are aware that statin-type cholesterol-lowering drugs can cause muscle pain and weakness. Similar statin side effects include muscle cramping and soreness. In the worst case scenario, some people experience something called rhabdomyolysis. This rare condition involves muscle breakdown and death of tissue. There is also myositis or muscle inflammation which can be incredibly debilitating. Far less common or recognized adverse reactions involve the brain. We have heard from many people who complain of brain fog and/or memory problems. But what about something called “statin psychosis?” Do some people become more aggressive on statins?

Can People Become Aggressive on Statins?

It is estimated that nearly 50 million Americans swallow a statin-type cholesterol-lowering medicine every day. Even a relatively “rare” side effect could show up in a lot of people.

A doctor became aggressive on statins:

Q. A few years ago, my doctor prescribed atorvastatin for high LDL cholesterol. It lowered my LDL to normal levels promptly.

Before long, though, I noticed side effects: lowered testosterone levels; muscle aches; gynecomastia; and prediabetes (rising HbA1c). I tolerated all these effects, trying to prevent any vascular complications from atherosclerosis. As a physician, I know that is important.

Then waves of nausea began. That was bad enough, but loss of appetite made me lose weight despite trying to eat more. At this point I became grumpy and angry, verbally abusing my wife. I became upset with fellow church members for no reason. My wife got so upset and afraid of me that she moved out. I was strongly considering suicide.

When I looked up statin therapy, I found it can cause nausea, so I reluctantly stopped it. Two days later the nausea went away and my appetite slowly improved. About a week after that, my anger dissipated, and I began to feel empathy again. I immediately wrote my wife to apologize. We are now back together.

Reviewing the medical literature revealed that psychiatric adverse effects sometimes arise in patients receiving statins. These can include irritability and aggression, anxiety or depression, violent behavior, sleep problems and even suicidal ideation (Drug Safety Case Reports, Dec. 2016). I am glad I’m still alive!

Please warn your readers to be aware of statin psychosis. It might well go unnoticed because it can come on gradually.

A. Thank you for sharing your harrowing experience. We first became aware of a link between statins and aggressive behavior in women in 2015 (PLoS One, July 1, 2015).

The research was a randomized controlled trial designed to look at behavioral changes. (A randomized controlled trial is considered the gold standard of drug research.)

It included more than 1,000 adults put on simvastatin, pravastatin or placebo for six months. The participants kept detailed diaries each week and the investigators counted actual aggressive acts towards others, self or objects. They also measured sleep problems and testosterone levels.

The researchers found that women over 45 years old were more aggressive on statins. Those who were least aggressive at the start had the greatest increase in aggressive behavior.

Three men became aggressive on statins. The lead author, Dr. Beatrice Golomb, suggested that “statins don’t affect all people equally.” According to Dr. Golomb, “Either men or women can experience increased aggression on statins, but in men the typical effect is reduction.”

Why Would Some People Become Aggressive on Statins?

Beatrice Golomb, MD, PhD, was the lead author of the article in PLoS One, July 1, 2015.

She and her colleagues introduce their research this way:

“Low cholesterol has been linked to aggression and to violent death or ‘non-illness mortality’ (i.e. death from suicide, homicide and accident) in many observational studies. Lowered cholesterol has been linked to aggression in primate experimental studies and meta-analysis of pre-statin randomized trials that show increased violent death with non-statin lipid reduction. Cholesterol supports cell energy and many forms of cell energy deficit are linked to aggression.”

A study published in the journal Current Opinion in Endocrinology, Diabetes and Obesity (April, 2018) offered this observation:

“Cholesterol may play a role as a moderator of the serotonergic function and interact with associations between relevant gene variants and impulsivity. Lowering cholesterol levels with statins brings about several changes in the serotonergic system, nerve cell membrane microviscosity and behaviour, and needs to be done with precaution in susceptible individuals. Cholesterol levels could serve as a biological risk marker for violence and suicidal tendencies in psychiatric patients with depression and schizophrenia.”

Are Fish More Aggressive on Statins?

Brazilian scientists performed an interesting experiment with Nile tilapia (Oreochromis niloticus). This is an aggressive fish species “with a clear dominant subordinate relation.”

The authors monitored the effects of statins on cholesterol and aggression in this species (Biology Open, Dec. 10, 2018):

“This is the first study to show that a low cholesterol level increases aggression in fish, corroborating the cholesterol-serotonin hypothesis so far only investigated in humans and other mammals. Statin-treated fish had reduced cholesterol, which increased the number of emitted aggressive behaviors and DI [dominance index]. Moreover, there was a correlated reduction of central serotonergic activity. This supports that the association between low cholesterol and aggression can be a causal phenomenon.”

The doctor who became aggressive on statins shared this article (Drug Safety Case Reports, Dec. 2016). The authors discussed “drug-induced behavioral and mood changes that may affect self or others.”

They described the impact of cholesterol-lowering drugs:

“Behavioral and psychiatric changes in the cases presented range from violent nightmares to aggression, mood/personality change, violent or homicidal ideation (in some instances culminating in suicide), each in apparent association with statin use. The temporal association between the drug initiation and mood and behavior change, and again between drug discontinuation and resolution of symptoms where this occurred, suggests a causal connection in a number of these cases.”

Statins and Cognitive Dysfunction?

If some people become more aggressive on statins, are there others who experience different brain disruption? Remember, there is cholesterol in the brain for a reason.

Here is an overview in the journal Experimental Neurobiology, Oct. 2019):

“In humans, the brain contains the highest level of cholesterol in the body; it contains approximately 20% of whole body cholesterol. Abnormal cholesterol metabolism in the brain is also associated with many neurodegenerative disorders, such as AD [Alzheimer’s disease], PD [Parkinson’s disease], Huntington’s disease (HD), and amyotrophic lateral sclerosis [ALS].”

Most cardiologists are concerned about one thing: heart health. They believe that there is no such thing a too low cholesterol. But neuroscientists think more about the brain. They worry about low levels of cholesterol.

Here is one article from Frontiers in Aging Neuroscience, March 31, 2020:

“…individuals with TC [total cholesterol] levels ranging from 100 to 160 mg/dl had the lowest GMv [gray matter volume] in the medial temporal regions. These findings suggest that low-normal TC level may be associated with reduced cognitive function and brain atrophy in regions implicated in neurodegenerative diseases, adding to a growing body of literature supporting a probable non-linear relationship between cholesterol level and brain health.”

The FDA and Statins:

If you read the official prescribing information for atorvastatin (Lipitor) under the heading “Postmarketing Experience,” you will find this under the heading “Nervous system disorders:”

“There have been rare reports of cognitive impairment (e.g., memory loss, forgetfulness, amnesia, memory impairment, confusion) associated with the use of all statins. Cognitive impairment was generally nonserious, and reversible upon statin discontinuation, with variable times to symptom onset (1 day to years) and symptom resolution (median of 3 weeks).”

Many cardiologists discount that statement on the grounds that it is unscientific. Nevertheless, we have received an extraordinary number of accounts of brain fog and memory problems associated with statins. Here are some links, should you wish to read about them.

Can Statins Make You Stupid?

Can Statins Cause Memory Loss and Transient Global Amnesia?

Do Statins Affect memory or Scramble Your Brain?

Final Words:

Most reviews stress that the benefits of statins far outweigh the risks. That holds true primarily for people who have had heart attacks and have not developed serious side effects. Comparisons with other cardiovascular drugs show a possible correlation between statins and psychiatric side effects (Pharmaceuticals, Dec. 10, 2022).

We discuss the pros and cons of statins in our eGuide to Cholesterol Control and Heart Health. This online resource can be found under the Health eGuides tab.

Do you know someone who became aggressive on statins? Please share your own experience with statins in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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