Introduction
depressive disorder, TRD, MDD, immune-metabolic dysfunction
PATHOPHYSIOLOGY
Studies of individuals with major depressive disorder (MDD) in high-income countries and low-middle income countries (LMICs) suggest that up to one-third will not respond to first- and second-line pharmacotherapy.Replicating evidence implicates immune-metabolic dysfunction in the pathophysiology of at least a subset of individuals with MDD.In this context, we conducted a multicenter, 12-week RCT to determine the efficacy and tolerability of simvastatin as an adjunctive treatment to standard care in adults with TRD. Simvastatin was selected because it is the most lipophilic statin