A study published in Neurology revealed that individuals who use common antidepressants called selective serotonin reuptake inhibitors (SSRIs) could have a heightened risk of suffering a stroke.
A team of investigators looked at past studies to analyze the connection between antidepressant use and stroke. Evidence from 16 studies was pooled, with over 500,000 total participants included. Overall antidepressant users were about 40 to 50 percent more likely to suffer bleeding in or around the brain.
Researchers focused on the popular antidepressants including; Celexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine), Viibryd (vilazodone), and Zoloft (sertraline).
“Overall, these results should not deter anyone from taking an SSRI when it is needed,” explained the study’s author Daniel G. Hackam, a researcher at Western University in London, Ontario in a prepared statement. “In general these drugs are safe, and obviously there are risks to having depression go untreated. But doctors might consider other types of antidepressants for people who already have risk factors for these types of strokes, such as those taking blood thinners, people who have had similar strokes already or those with severe alcohol abuse.”
The researchers noted that approximately 24.6 of the strokes happen among every 100,000 people annually. Use of antidepressants heightens the risk to one extra stroke for every 10,000 people in a year.
One of the limitations noted of the study was that it didn’t factor in the possibility that patients who use SSRIs are “sicker” that individuals who did not take the medications. These factors include habits like smoking and drinking. The study also didn’t take into account chronic disease like diabetes that may plague patients who take SSRIs.
“We can’t infer cause and effect from this,” said Hackam on how the findings of the study do not show direct correlation between antidepressants and bleeding in the brain.
Reuters reported that biological factors could be at play. SSRIs can make it difficult for the platelets, otherwise known as blood cells, to clump and create clots. As a result, there may be a decline in the activity of a person’s platelets.
Even with the results of the study, the researchers believe the medications are still safe
“I think that overall, these medications are quite safe,” Hackam told Reuters Health.
An editorial, compiled by Emer McGratgh and Martin O’Donnell, accompanied the published study in the journal and emphasized the study as “best current evidence of an association between SSRI use and risk of ICH.” They also advised that the uptick in ICH should not stop medical professionals from prescribing SSRIs.
“These findings emphasize the importance of appropriate patient selection and avoidance of inappropriate prescribing, which assumes particular importance in patients at increased risk of ICH,” wrote the authors in the editorial. “SSRIs may be associated with an increased risk of ICH but the absolute risk in populations is low. These findings add to the totality of evidence for efficacy and safety of antidepressants overall and within drug classes, used to inform evidence-based prescribing.”