No association between SSRIs and risk of ICH

Antidepressants are commonly prescribed to patients with intracerebral haemorrhage (ICH) in routine clinical practice. A new preliminary population-based study has found that the most commonly prescribed antidepressants, selective serotonin-reuptake inhibitors (SSRIs), are not associated with an increased risk of ICH.

“By interfering with serotonin, which also plays a role in blood clotting, SSRIs may increase the risk of bleeding,” explained Dr Mithilesh Siddu (University of Miami, FL, USA). “To determine if these antidepressants increase the risk of bleeding strokes, we looked at a large population of stroke patients.” This study population consisted of 127,915 cases in whom information on antidepressant use was available [1]. Of these, 17,009 patients were prior SSRI users, while the other 110,906 had never had an SSRI prescription. The rate of ICH in both groups was 11% and 14%, respectively. Prior antidepressant users were more likely to be female, non-Hispanic white, have hypertension, diabetes mellitus, use oral anticoagulants, antiplatelets, and/or statins prior to hospital presentation.

After adjusting for other factors that could affect stroke risk, such as age, race, hypertension, diabetes mellitus, prior oral anticoagulant, antiplatelet, or statin use, SSRI users had the same ICH risk as non-users (OR 0.92, 95% CI 0.85–1.01). A total of 3.4% of all ICH patients and 9% of those for whom antidepressant information was available, were discharged from the hospital on an antidepressant (74% SSRI). “These findings are important, especially since depression is common after stroke and SSRIs are some of the first drugs considered,” Dr Siddu said. “More research is needed to confirm our findings and to examine if SSRIs prescribed after a stroke may be linked to risk of a second stroke.”

1. Siddu M, et al. Association Between Antidepressants Use and Intracerebral Hemorrhage: Florida Stroke Registry. P5.080, AAN 2021 Virtual Congress, 17-22 April.

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Posted on 16 June 202129 February 2024