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

Jakovljević, Dimitrije; Tuomilehto, Jaakko

doi:10.1161/01.str.0000018582.96060.3e

Cited by 8 publications

(4 citation statements)

References 30 publications

(20 reference statements)

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“…Risk of intracerebral haemorrhage was not affected by current SSRI therapy (OR 1.0; 95% CI 0.6–1.6), SNRI therapy (OR 0.5; 95% CI 0.1–1.9), or other antidepressants (OR 1.5; 95% CI 0.8–2.8). However, it has been theorized that the antiplatelet effects of SSRIs may be protective against thromboembolic events such as myocardial infarction [45] or ischaemic stroke [46], but evaluation of the ischaemic stroke cases in current SSRI users yields an OR of 1.1 (95% CI 0.9–1.4), indicating there is no protective effect of SSRI therapy. Similar results were found with the SNRIs and other antidepressants.…”

Section: Observational Studiesmentioning

confidence: 99%

Clinical impact of selective serotonin reuptake inhibitors therapy with bleeding risks

Turner

May

Arthur

et al. 2007

Journal of Internal Medicine

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Section: Observational Studiesmentioning

confidence: 99%

Clinical impact of selective serotonin reuptake inhibitors therapy with bleeding risks

Turner

May

Arthur

et al. 2007

Journal of Internal Medicine

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“…SSRI use may have a protective effect against the depression-related increase in the risk of ischemic stroke (Jakovljevic and Tuomilehto, 2002). This possibility is based on the evidence that depression may increase the risk of ischemic stroke (Ramasubbu and Patten, 2003) and on the assumption that depression is a common indication for treatment with SSRIs.…”

Section: Introductionmentioning

confidence: 99%

Fluoxetine and Sertraline Attenuate Postischemic Brain Injury in Mice

Shin

Kang

Lee

et al. 2009

Korean J Physiol Pharmacol

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ABBREVIATIONS: SSRIs, serotonin reuptake inhibitors; HO-1, heme oxygenase-1; HIF-1α, hypoxia-inducible factor-1α; BBB, blood-brain barrier; rCBF, regional cerebral blood flow; MABP, mean arterial blood pressure; LL, lower limit; HSP-32, heat-shock protein. Medicine, Korea This study aimed to investigate whether selective serotonin reuptake inhibitors (SSRIs) attenuate brain injury and facilitate recovery following photothrombotic cortical ischemia in mice. Male ICR mice were anesthetized and systemically administered Rose Bengal. Permanent focal ischemia was induced in the medial frontal and somatosensory cortices by irradiating the skull with cold light laser. The animals were treated with fluoxetine or sertraline once a day for 14 d starting 1 h after ischemic insult. Treatment with fluoxetine and sertraline significantly reduced the infarct size. The Evans blue extravasation indices of the fluoxetine-and sertraline-treated groups were significantly lower than that of the vehicle group. Treatment with fluoxetine and sertraline shifted the lower limit of the mean arterial blood pressure for cerebral blood flow autoregulation toward normal, and significantly increased the expression of heme oxygenase-1 (HO-1) and hypoxia-inducible factor-1α (HIF-1α) proteins in the ischemic region. These results suggest that SSRIs, such as fluoxetine and sertraline, facilitate recovery following photothrombotic cortical ischemia via enhancement of HO-1 and HIF-1α proteins expression, thereby providing a benefit in therapy of cerebral ischemia.

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“…This review only found an association between SSRIs and increased incidence of upper gastrointestinal bleeding in patients taking NSAIDs or aspirin. However, antidepressants are not believed to be associated with an increased risk of stroke [53][54][55] or intracranial bleeding [56]. A review of 21 articles-2 case-control studies, 3 case reports and 16 clinical trials-published between 1966 and 2003 was conducted to determine SSRIs' effects on cerebrovascular function [57].…”

Section: Bleedingmentioning

confidence: 99%

Medically serious adverse effects of newer antidepressants

Mago

Mahajan²,

Thase³

2008

Curr Psychiatry Rep

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Although safer than tricyclic antidepressants and monoamine oxidase inhibitors, the newer antidepressants may be associated with certain medically serious adverse effects, of which cardiovascular adverse effects, seizures, abnormal bleeding, hyponatremia, and agranulocytosis are discussed in this review. Data regarding the incidence and risk factors are summarized, and strategies for reducing the risk of these adverse effects and managing them are suggested. Identification of risk factors, appropriate antidepressant choice, and, when possible, careful monitoring may substantially reduce the incidence of these adverse effects and the morbidity associated with them.

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

Cited by 8 publications

References 30 publications

Clinical impact of selective serotonin reuptake inhibitors therapy with bleeding risks

Clinical impact of selective serotonin reuptake inhibitors therapy with bleeding risks

Fluoxetine and Sertraline Attenuate Postischemic Brain Injury in Mice

Medically serious adverse effects of newer antidepressants

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