Best statin for anxiety

In this article:

• Can statins cause anxiety and panic attacks?
• Top recommended statins for people with anxiety
• Pravastatin
• Rosuvastatin (Crestor)
• Statins comparison chart
• Special considerations for people with anxiety taking statins

In this article

• Can statins cause anxiety and panic attacks?
• Top recommended statins for people with anxiety
• Pravastatin
• Rosuvastatin (Crestor)
• Statins comparison chart
• Special considerations for people with anxiety taking statins

Statins are a class of drugs that help lower cholesterol levels and reduce the risk of heart attack or stroke. Also called HMG-CoA reductase inhibitors, statins work by reducing the production of cholesterol in the liver and by helping the body to absorb cholesterol stuck to the interior walls of blood vessels. Several FDA-approved statin medications can be prescribed for high cholesterol. Most of them are well-tolerated and don’t typically cause side effects like anxiety. In the rare event that a statin seems to cause anxiety or panic attacks, your healthcare provider can recommend another statin or a different type of cholesterol-lowering medication. Statins aren’t psychiatric drugs, so they don’t treat anxiety in people who already experience it. 

Can statins cause anxiety and panic attacks?

Scientific studies have found no major connection between statins and anxiety or panic attacks, but that doesn’t mean they’re not related.

A study published in Psychopharmacology in 2022 saw a slight increase in self-reported anxiety levels among people who had just started taking simvastatin (Zocor). The uptick in anxiety was temporary, and the study authors suggest that simvastatin may have a similar effect on anxiety as antidepressants, which sometimes worsen anxiety symptoms for a short period of time. 

Despite a lack of large-scale scientific evidence, there are anecdotal reports of statin drugs causing or increasing anxiety in some individuals. “Everyone’s body and brain chemistry are different,” says Anoop Singh, MD, a board-certified psychiatrist and Regional Medical Director with Mindpath Health. “In rare cases, changes in sleep, mood, or energy might occur [with statins]—sometimes as a result of how the medication affects brain chemistry.”

Several individual cases of statins causing anxiety were documented in a 2015 report:

• After starting 20 mg of atorvastatin (Lipitor), a male teenager experienced side effects like anxiety, depression, cognitive impairment, and violent nightmares. His symptoms rapidly improved after he stopped taking atorvastatin. When he began taking statins again, all of the psychiatric side effects reappeared, and he took his own life two weeks later. 
• A man in his 30s experienced anxiety and violent thoughts after his atorvastatin dose increased from 10 mg to 20 mg to 40 mg. His psychiatric side effects went away within two weeks of his last dose of atorvastatin. 
• Within five days of starting 80 mg simvastatin, a man in his 40s began experiencing numerous psychiatric symptoms, including anxiety, depression, and irritability. He took his own life nine months later.

The 2015 report explored a total of 12 cases where statins may have caused psychiatric side effects, and anxiety was reported in only three of those cases (25%). The fact that two of the three individuals who experienced statin-related anxiety eventually died by suicide highlights just how serious psychiatric side effects can be, even if they’re rare. 

The study authors believe a previous history of mental health conditions may make certain people more likely to experience anxiety, depression, and other mood or cognitive changes while taking statins. It’s important to tell your healthcare provider if you’ve ever had mental health concerns, including generalized anxiety disorder and major depressive disorder, so they can choose the safest cholesterol-lowering drugs for you. 

Top recommended statins for people with anxiety

Some statins may be less likely to cause or increase anxiety due to the way they interact with the blood-brain barrier. This is a protective layer of tissue around the brain that keeps infectious substances out while allowing nutrients and other important substances in. Molecules surrounded by lipids have an easier time passing through the blood-brain barrier. These are called lipophilic molecules.

Some health experts believe lipophilic statins may be more likely to cause anxiety in sensitive individuals because of their ability to easily access and interact with the brain. Lipophilic statins include simvastatin, fluvastatin, pitavastatin, lovastatin, and atorvastatin. 

“In theory, some statins that can cross the blood-brain barrier may affect the processing of certain chemicals involved in mood regulation,” says Harold Hong, MD, a board-certified psychiatrist and Medical Director at New Waters Recovery. “Other statins, such as pravastatin or rosuvastatin (Crestor), tend to remain in the bloodstream for a more extended period and may be less likely to affect mood. That said, not everyone reacts the same way, and these kinds of side effects are still relatively rare.” 

Pravastatin

Pravastatin (formerly available as name-brand Pravachol) may be one of the best statins not to cause anxiety because it doesn’t easily pass the blood-brain barrier. Clinical trials support the idea that anxiety and depression are rare side effects of pravastatin. Sleep disturbances were a little more common among study participants. 

The main disadvantage of pravastatin is that it’s not quite as aggressive at lowering cholesterol as other statins. If your healthcare provider wants you to lower your LDL cholesterol by 50% or more, they may recommend a more powerful statin like rosuvastatin because pravastatin won’t decrease LDL into the goal range. 

Like most statins, pravastatin should be taken in the evening. It’s generally well tolerated and is less likely to carry a risk of myalgia (muscle pain) compared to other statins. Pravastatin is also associated with fewer drug interactions, especially with drugs known as CYP450 inhibitors or inducers. 

Rosuvastatin (Crestor)

Rosuvastatin (generic Crestor) is the only other statin aside from pravastatin that doesn’t cross the blood-brain barrier. Anxiety wasn’t recorded in clinical studies, but depression, nightmares, and insomnia occurred in rare cases. 

Rosuvastatin is one of just two statins that can be used to reduce cholesterol by 50% or more (also known as high-intensity therapy). If you need to lower your cholesterol by less than 30%, your healthcare provider may prescribe a less powerful statin like pravastatin. 

Although some statins must be taken at night or in the morning, rosuvastatin can be taken at any time of day, with or without food, and it’s associated with fewer CYP450 drug interactions. Muscle weakness (myopathy) is less common with rosuvastatin, occurring in about 11% of individuals compared to a 50% incident rate with simvastatin. 

Statins comparison chart
Name	Pros	Cons	Cost with SingleCare*	Savings
Pravastatin (formerly Pravachol)	Doesn’t cross blood-brain barrier Less likely to interact with certain medications Less likely to cause muscle pain Good for low to moderate reduction in cholesterol	Anxiety rarely reported in clinical trials Depression and sleep disturbances may occur in rare cases	$17 per 90, 40 mg tablets of generic pravastatin	Get coupon
Rosuvastatin (Crestor)	Doesn’t cross blood-brain barrier Less likely to interact with certain medications Less likely to cause muscle weakness Great for significant reduction in cholesterol	Depression, insomnia, and nightmares may occur in rare cases	$8 per 30, 10 mg tablets of generic rosuvastatin	Get coupon
Atorvastatin (Lipitor)	Great for significant reduction in cholesterol	Can cross the blood-brain barrier Interacts with CYP450 inhibitors and inducers Depression can occur in rare cases At least two known suicides related to atorvastatin	$8 per 30, 40 mg tablets of generic atorvastatin	Get coupon
Fluvastatin (Lescol)	Good for low to moderate reduction in cholesterol Lowest incidence of muscle weakness of all statins	Can cross the blood-brain barrier Interacts with CYP450 inhibitors and inducers Anxiety, insomnia, depression, and psychic disturbances reported in rare cases	$45 per 30, 20 mg capsules of generic fluvastatin	Get coupon
Simvastatin (Zocor)	Good for low to moderate reduction in cholesterol	Can cross the blood-brain barrier Interacts with CYP450 inhibitors and inducers Muscle weakness occurs in about 50% of individuals At least one known suicide related to simvastatin	$7 per 90, 20 mg tablets of generic simvastatin	Get coupon
Lovastatin (Mevacor)	Good for low to moderate reduction in cholesterol	Can cross the blood-brain barrier Interacts with CYP450 inhibitors and inducers Should be taken with food	$15 per 90, 20 mg tablets of generic lovastatin	Get coupon
Pitavastatin (Livalo)	Good for low to moderate reduction in cholesterol	Can cross the blood-brain barrier Interacts with CYP450 inhibitors and inducers May cause depression, insomnia, or cognitive impairment in rare cases	$45 per 30, 2 mg tablets of generic pitavastatin	Get coupon

*Cost at time of publication. Drug prices fluctuate and vary by pharmacy and location. 

Special considerations for people with anxiety taking statins

When discussing cholesterol treatment options with your healthcare provider, it’s important to mention that you have anxiety or a family history of anxiety. Even if your anxiety is well-controlled, some statins could cause an increase in your level of anxiety. This is rare and can be temporary. However, in some cases, the psychological side effects of statins can be so severe as to be life-threatening. Tell your healthcare provider right away if you experience anxiety or other unwanted side effects while taking statins. The national suicide hotline in the U.S. is called the 988 Suicide & Crisis Lifeline. Individuals can call or text 988 24 hours a day, 7 days a week. 

“Sometimes, switching to a different statin—especially one that does not enter the brain as much—can help. There are also non-statin options, like ezetimibe (Zetia) or PCSK9 inhibitors, that lower cholesterol through different mechanisms and may be better tolerated,” Dr. Hong says. 

Dr. Singh agrees with Dr. Hong’s advice. He adds that short-term anxiety treatments might help people adjust to the medication. “Therapy, relaxation techniques, or even temporary medication, if absolutely necessary, can help patients through the initial adjustment periods. Most importantly, this should be a shared decision between you, your primary doctor, and possibly a cardiologist or psychiatrist, depending on the situation.”