Selective Serotonin Reuptake Inhibitors and the Risk of Stroke

Abstract

Background and Purpose-Selective serotonin reuptake inhibitors (SSRIs) have been associated with increased risk of bleeding complications, possibly as a result of inhibition of platelet aggregation. Little is known about the risk of intracerebral hemorrhage in users of SSRIs and whether the effect on platelet aggregation reduces the risk of ischemic stroke. We used population-based data to estimate the risk of hemorrhagic and ischemic stroke in users of SSRIs. Methods-We performed a nested case-control study in Funen County (465 000 inhabitants), Denmark. All patients with a first-ever stroke discharge diagnosis in the period of 1994 to 1999 were identified, and a validated diagnosis of stroke was reached in 4765 cases. In all, 40 000 controls were randomly selected from the background population. Information on drug use for cases and controls was retrieved from a prescription registry with full coverage of the county. Odds ratios were adjusted for age, sex, calendar year, and use of other medication. To evaluate the effect of various potential confounders not recorded in the register data, we performed separate analyses on data from 2 large population-based surveys with more detailed information on risk factors. Results-Of 659 patients with hemorrhagic stroke, 21 were current users of SSRIs. The adjusted odds ratio of hemorrhagic stroke in current SSRI users compared with never users was 1.0 [95% confidence interval (CI), 0.6 to 1.6]. Of 2717 patients with ischemic stroke, 100 were current users of SSRIs, and the adjusted odds ratio of ischemic stroke in cases compared with controls was 1.1 (95% CI, 0.9 to 1.4). The survey data indicated that additional confounder control would not have led to an increase in the relative risk estimates. Conclusions-Current exposure to SSRIs is not associated with increased risk of intracerebral hemorrhage and is probably not associated with a decreased risk of ischemic stroke.

Timing of Stroke in Patients Undergoing Total Hip Replacement and Matched Controls

“…[11][12][13] Other drugs that may be associated with a decreased or increased risk of stroke include antiplatelet drugs, anticoagulants, statins, thiazide diuretics, estrogen-containing drugs, selective serotonin reuptake inhibitors, and antipsychotics. 1,[14][15][16][17][18] Its use in THR patients in relation with perioperative stroke, however, remains unknown.The objectives of this study were to evaluate timing of stroke after THR compared with matched control subjects Background and Purpose-Stroke is a potentially fatal complication of total hip replacements (THR). However, timing of stroke in THR patients compared with matched controls and influence of drug use remain unknown.…”

Use of Selective Serotonin Reuptake Inhibitors and the Risk of Stroke: Is There Reason for Concern?

“…Whether the current use of SSRIs has some protective effect or not is still unclear, and further research is in demand. The findings from the study by Bak et al 27 warrant further studies that should distinguish whether the increased risk for stroke is clearly attributed to previous use of SSRIs or simply because of premature withdrawal of SSRIs in the treatment of depression. In addition, the findings suggested that the current use of anticoagulation therapy or antihypertensive drugs was associated with an increased risk of hemorrhagic stroke.…”

“…A recent English cohort study 26 suggested weak evidence to support the hypothesis or the link between SSRIs and the precipitation of bleeding events at a population level. The nested case-control study from Denmark reported in this issue of Stroke, 27 however, showed that current use of SSRIs was not associated with an increased the risk of hemorrhagic and ischemic stroke. Previous publications have suggested associations between the use of SSRIs and a decreased risk of acute myocardial infarction and stroke.…”

Platelets and Anti-platelet Therapy

“…Two studies by Sauer and colleagues suggested that SSRI antidepressants, but not non-SSRI anti-depressants, reduced the incidence of MI (150,151). In contrast Meier and colleagues saw no protective effects of SSRIs against a first MI (152), and Bak and colleagues reported that SSRIs did not decrease the risk of ischemic stroke or increase the risk of intracerebral hemorrhage (153). Consequently, it appears that the critical basic and clinical studies that would establish, or otherwise, the role of SSRIs as antithrombotics remain to be carried out.…”