Association of cerebrovascular events with antidepressant use: A case-crossover study
American Journal of Psychiatry, 03/22/2011  Clinical Article

Wu CS et al. – The authors sought to assess the risk of cerebrovascular events associated with use of antidepressant medications. The findings of this study suggest that antidepressant use may be associated with an increased risk of stroke. The underlying mechanisms remain unclear.

• Case-crossover study of 24,214 patients with stroke enrolled in National Health Insurance Research Database in Taiwan from 1998 to 2007
• Authors compared rates of antidepressant use during case and control time windows of 7, 14, and 28 days
• Adjustments made for time-dependent variables, such as health system utilization and proposed confounding medications
• Stratified analyses performed for valuing interaction between stroke risk of antidepressant use and age, sex, presence of mood disorder, stroke type, severity of chronic illness, and duration of antidepressant treatment
• Conditional logistic regression model used to determine odds of antidepressant use during case time windows

• Adjusted OR of stroke risk with antidepressant exposure 1.48 (95% CI=1.37–1.59) using 14-day time windows
• Stroke risk negatively associated with number of antidepressant prescriptions reported
• Use of antidepressants with high inhibition of serotonin transporter associated with greater risk of stroke than use of other types of antidepressants