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Antidepressants Raise Stroke Mortality in Postmenopausal Women

Antidepressants Linked to Increased Risk for Death, Stroke in Postmenopausal Women
by Pam Harrison
December 22, 2009

Women's Health Initiative (WHI) study
WHI program funded by the National Heart, Lung, and Blood Institute
tricyclic antidepressant (TCA) and selective serotonin-reuptake inhibitor (SSRI) implicated
increased risk for all-cause mortality
SSRIs increased risk for hemorrhagic and fatal stroke
the excess risk for stroke seen in association with SSRIs was largely hemorrhagic
the risk for ischemic stroke with SSRI use did not reach statistical significance
both the SSRIs and the TCAs were associated with an increased risk for all fatal strokes

absolute event risks are low
absolute differences [between users and nonusers] are very small
article published in Dec issue of Archives of Internal Medicine
Jordan Smoller, MD, from Massachusetts General Hospital, Boston
use of TCA or SSRI during a mean follow-up of 5.9 years NOT sig assoc w/ incr CHD risk
SSRIs-->45% increased relative risk of incidence stroke
SSRIs-->32% increased risk of death
TCA-->67% higher relative risk for all-cause death, incr in stroke risk was not significant

depression is a well established risk factor for cardiovascular disease
"in models stratified on propensity and adjusted for multiple covariates"
Key Q: is assoc btw antidepressant use and CV morbidity/mortality dt drugs or other risk factors incl depression?
the propensity score used in this study helped control for risk factors
but you can't be sure that you covered all of them, or got the right balance
patients who don't respond to new tx with antidepressants mb highest risk group

study looked at:
assoc btw new antidepressant use and
-first occurrence of CHD
-fatal or nonfatal stroke
-all-cause mortality
(after 1st followup visit which occurred
at 3 years in longitudinal study, 1 year in overlapping clinical trials)
n = 136,293 postmenopausal women
women taking no antidepressants at baseline who returned for 1+ followups were incl
5496 women initiated antidepressant tx during followup interval
antidepressant users had higher levels of several CVD risk factors than nonusers
confounders were addresed via obtaining a propensity score via logistic regression model

annualized rates per 1000 person-years of stroke:
no antidepressant use: 2.99
SSRI users: 4.16

non–antidepressant users: 7.79/1000 person-years
SSRI users: 12.77
TCA users: 14.14/1000 person-years.

Arch Intern Med. 2009;169: 2128-213;2140-2141.
Tags: cardiovascular, depression, menopause, pharmacology, ssri, stroke, women

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