Am J Psychiatry 2011; 168:511-521
(published online March 15, 2011; doi: 10.1176/appi.ajp.2010.10071064)
© 2011 American Psychiatric Association
Association of Cerebrovascular Events With Antidepressant Use: A Case-Crossover Study
Chi-Shin Wu, M.D., M.Sc., Sheng-Chang Wang, M.D., M.Sc., Yu-Cheng Cheng, M.Sc., and Susan Shur-Fen Gau, M.D., Ph.D.
From the Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei; Division of Mental Health and Substance Abuse Research, Institute of Population Health Sciences, National Health Research Institutes, Taipei; Department of Psychiatry, National Taiwan University College of Medicine; and Graduate Institute of Epidemiology, National Taiwan University College of Public Health, Taipei.
Objective: The authors sought to assess the risk of cerebrovascular events associated with use of antidepressant medications.
Method: The authors conducted a case-crossover study of 24,214 patients with stroke enrolled in the National Health Insurance Research Database in Taiwan from 1998 to 2007. The authors compared the rates of antidepressant use during case and control time windows of 7, 14, and 28 days. Adjustments were made for time-dependent variables, such as health system utilization and proposed confounding medications. Stratified analyses were performed for valuing the interaction between the stroke risk of antidepressant use and age, sex, presence of mood disorder, stroke type, severity of chronic illness, and duration of antidepressant treatment. A conditional logistic regression model was used to determine the odds of antidepressant use during case time windows.
Results: The adjusted odds ratio of stroke risk with antidepressant exposure was 1.48 (95% confidence interval=1.37–1.59) using 14-day time windows. Stroke risk was negatively associated with the number of antidepressant prescriptions reported. Use of antidepressants with high inhibition of the serotonin transporter was associated with a greater risk of stroke than use of other types of antidepressants.
Conclusions: These findings suggest that antidepressant use may be associated with an increased risk of stroke. However, the underlying mechanisms remain unclear.