SSRIs associated with remission of depression following intracerebral hemorrhage
Selective serotonin reuptake inhibitors (SSRIs) were associated with remission of depression following an intracerebral hemorrhage (ICH), but also higher risk of ICH recurrence in patients with pre-existing clinical, genetic, or neuroimaging risk factors for hemorrhagic stroke.
Selective serotonin reuptake inhibitor (SSRI) use after first-ever intracerebral hemorrhage (ICH) in the general population is associated with both improvement in depressive symptoms and increased risk of recurrent hemorrhagic stroke, a study found.
To determine whether SSRI use among survivors of primary ICH was associated with recurrence and a reduction of depression, researchers conducted a longitudinal study at a tertiary care center from January 2006 to December 2017. Follow-up lasted a median of 53.2 months (interquartile range, 42.3 to 61.2 months). The study included 1,279 people (1,049 white, 89 Black, 77 Hispanic, and 64 other race/ethnicity) out of 1,335 eligible patients who presented with primary ICH and survived to hospital discharge. Study participants' mean age was 71.3 years, and 602 (47%) were women.
Researchers analyzed patients with one or more characteristics associated with high ICH recurrence risk: lobar ICH, presence of apolipoprotein ε2/ε4 gene variants, history of ICH or transient ischemic stroke, and Black or Hispanic race/ethnicity. Results were published Aug. 31 by JAMA Neurology.
Exposure to SSRIs was found to be associated with both ICH recurrence (subhazard ratio [SHR], 1.31; 95% CI, 1.08 to 1.59) and resolution of post-ICH depression (SHR, 1.53; 95% CI, 1.12 to 2.09). Among patients at high risk for recurrent ICH, SSRIs were associated with elevated ICH recurrence risk (SHR, 1.79; 95% CI, 1.22 to 2.64) compared with all other survivors of ICH (SHR, 1.20; 95% CI, 1.01 to 1.42; P=0.008 for comparison of effect sizes). The authors wrote that clinical history, neuroimaging data, and genetic biomarkers may help to identify survivors of ICH at higher risk of recurrent cerebral bleeding.
“Our findings linking SSRI exposure with recurrent ICH risk are consistent with existing evidence demonstrating an association between SSRI use and risk of first-ever ICH,” the authors wrote. “These associations are presumed to reflect the known antithrombotic effects of SSRIs. Additional potential mechanisms linking SSRIs and ICH recurrence include worsening of hypertension and increased production of inflammatory cytokines with chronic use.”