Compared to previous findings, selective serotonin reuptake inhibitors (SSRIs) are not associated with an increased risk of intracerebral hemorrhage (ICH), results from a large observational study show. However, at least one expert urged caution in explaining its findings.
“These findings are important, especially since depression is common after a stroke and SSRIs are some of the first drugs evaluated for humans,” said Mithilesh Siddu, MD, of the University of Miami / Memorial Hospital Jackson, Miami, Florida, in a statement.
However, Siddu said “more research is needed to confirm our findings and also to examine whether SSRIs prescribed after a stroke are linked to a risk for a second stroke.”
The findings will be presented at the 2021 American Academy of Neurology (AAN) Annual Meeting in April.
Widely developed
SSRIs, the most widely prescribed antidepressant in the U.S., have previously been associated with an increased risk of ICH, possibly as a result of problematic plalet activity.
To further investigate, the researchers analyzed data from the Florida Stroke Index (FSR). They identified 127,915 patients who underwent ICH from January 2010 to December 2019 and for whom information on antidepressant use was available.
They analyzed the proportion of cases present with ICH among antidepressant users and the level of SSRI medication among stroke patients discharged on antidepressant medication.
The researchers found that 11% of those prescribed antidepressants had ICH, compared with 14% of those who did not.
Antidepressant users were more likely to be female; non-Hispanic white; hip endurance; diabetes; and use oral anticoagulants, antiplatelets, and statins before hospitalization for ICH.
In multivariate analyzes making adjustments for age, race, history of predisposition, diabetes and previous use of oral anticoagulant, antiplatelet and statin, antidepressant users were equally likely to exposure to spontaneous ICH to non-antidepressant users (odds ratio) [OR] 0.92; 95% CI, 0.85 – 1.01).
A total of 3.4% of ICH patients and 9% of those for whom specific antidepressant information was available were discharged on an antidepressant, typically SSRI (74%).
The authors note the main limitation of the study: some details regarding the duration, dosage, and type of antidepressants were not available.
Explain with caution
Reaching for comment, Shaheen Lakhan, MD, PhD, a psychologist in Newton, Massachusetts and executive director of the Global Neuroscience Initiative Foundation, urged caution in reaching strong decisions based on the this study.
“We have two questions here: One, is SSRI using a risk factor for intracerebral hemorrhage for the first time, and two, is SSRI use after ICH a risk factor for additional hemorrhages,” he said. Lakhan, who was not involved in the investigation.
“This study incompletely addresses the former because SSRIs are known to have several powers. For example, paroxetine is a strong inhibitor of serotonin reuptake, but bupropion is weak. ICH is more at risk that it did not stratify according to the type of antidepressant, it is not possible to extract these, “Lakhan said.
“The second question fully addresses this study and is a real concern in clinical practice, as the chance of relapse is much higher than the risk of ICH for the first time in the future. general population, “he said.
The study did not have specific funding. Siddu and Lakhan did not disclose any material financial relationships.
American Academy of Neurology (AAN) Annual Meeting 2021: Minute 5152. To be presented April 20, 2021.
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