Q. Drug Side-Effects?

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Dear Dr Bhark,

Following on from your very interesting talk last Saturday (@ChiangMaiExpats), may I ask you a question. 

Our daughter aged 45, suffered an unexpected ‘cardiac event’ about 18 months ago, following a period of overwork and chronic stress.   

Thankfully she fully recovered after treatment at a leading cardiac hospital in the UK.    Her own GP put her on Simvastatin 40gms, Ramipril 10gms and Congescor 2.5mgs.  Since then there has been a radical and negative change in her personality.  

Have you experienced similar personality changes with patients on statins? 

Many thanks for your guidance on this matter.

Liz Spring   

Dear Ms. Spring,

As a general rule, when someone complains of a possible drug related  side-effect, we need to give them the benefit of doubt, even if the stated side effect has not been published previously. There is always the first time. Having said that, there is also a maxim which states that when you hear hoof beats, think of horses first and zebras last. That is, the more common cause for a personality change might be explained by the fact that your daughter suffered a heart condition at a young age. At any age, a sudden cardiac event may potentially be devastating to ones psyche. This coupled with the fact that she has suffered from “chronic stress” may have placed her in a position where her coping skills may have been compromised. Cardiac rehab is highly recommended in this situation and if need be, some type of supportive therapy. A person with a known heart condition who subsequently suffers from extreme negativity or depression can potentially impair their overall prognosis.

 When one questions the possibility of an adverse drug effect, the best thing to do is to replace the possible suspect with another drug of the same class. Fortunately, there are many statins readily available. Also, change one drug at a time so that the “culprit” can readily be identified. She will be on medications for some amount of time and therefore going slow and steady is necessary.

Finally, it may be too early to mention this but for many people who have experienced a cardiac event, at some later point in life, many often state that “this is the best thing that ever happened to me”. It can truly be a life altering experience in a positive way. This possibility is always present. I wish you both good health and happiness.

Philip Bhark, M.D., FACC

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