Stroke Risk Up With Serotonin Reuptake Inhibitor Use

Risk of intracerebral and intracranial hemorrhage is increased with exposure to SSRIs

THURSDAY, Oct. 18 (HealthDay News) -- Exposure to selective serotonin reuptake inhibitors (SSRIs) is associated with an increased risk of intracerebral and intracranial hemorrhage, according to a study published online Oct. 17 in Neurology.

To determine the risk of central nervous system hemorrhage associated with SSRI use, Daniel G. Hackam, M.D., Ph.D., and Marko Mrkobrada, M.D., of Western University in London, Canada, conducted a meta-analysis of data from 16 controlled, observational studies involving more than 500,000 participants.

The researchers found that, in both unadjusted and adjusted analyses, intracranial hemorrhage was related to SSRI exposure (rate ratio [RR], 1.48 and 1.51, respectively). SSRI exposure was also associated with intracerebral hemorrhage in unadjusted (RR, 1.68) and adjusted (RR, 1.42) analyses. In a subset of five studies, exposure to a combination of SSRI and oral anticoagulants was linked to an increased risk of bleeding (RR, 1.56), compared with oral anticoagulants alone. There was an increased risk seen across all cohort studies, case-control studies, and case-crossover studies (odds ratios, 1.61, 1.34, and 4.24, respectively).

"SSRI exposure is associated with an increased risk of brain hemorrhage (largely due to intracerebral bleeding)," the authors write. "While the data we reviewed were not randomized, we believe clinicians might consider alternate classes of antidepressants in patients with intrinsic risk factors for intracerebral hemorrhage, such as those receiving long-term oral anticoagulation, individuals with previous intracranial bleeding, and patients with cerebral amyloid angiopathy or severe alcohol abuse."

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