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Statins can produce ataxia in bipolar disorder: two case reports.

To the Editor: Aggressive cholesterol reduction via HMGCoA reductase inhibitors (statins) in individuals at risk for vascular disease is currently standard of care, perhaps even the modal intervention, given compliance issues with diet and exercise changes. These recommendations, however, do not generally cite the results of large double-blind trials suggesting modest adverse central nervous system (CNS) effects of insomnia and cognitive impairment with statin use. Sporadic case reports of more severe CNS effects (dementia, irritability, and central fatigue) have also appeared, suggesting important individual vulnerabilities. We report 2 cases of acute ataxia coincident with statin onset in individuals with bipolar disorder, referencing these reports to the growing literature on mitochondrial encephalopathies.