Cholesterol, Cognition, and Controversy: A Case of Mood Disturbance on Repatha

We report the case of a 52-year-old woman with no prior psychiatric history who developed severe depressive symptoms shortly after starting evolocumab (Repatha) for lipid management. Her symptoms included persistent low mood and crying spells, which resolved completely after discontinuation of the medication. Her low-density lipoprotein (LDL)-cholesterol levels decreased significantly during this period. She was later switched to bempedoic acid and remained asymptomatic. This clinical course suggests a potential link between intensive LDL reduction and mood disturbances. While psychiatric side effects of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are rarely reported, this case raises awareness and underscores the need for mental health outcomes integration into future PCSK9 investigations.