Common antidepressants won't raise risk for bleeding strokes, shows new study

The most widely prescribed antidepressants in the United States don't appear to increase the risk of the deadliest type of stroke, according to a new preliminary study.

It examined the association between selective serotonin reuptake inhibitors (SSRIs) and intracerebral hemorrhage. This is when a brain blood vessel bursts and blood spreads into the surrounding tissue.

The most common causes of this type of stroke are high blood pressure and head trauma, but some earlier research had suggested that SSRIs may increase the risk. SSRIs include drugs such as Prozac (fluoxetine) and Zoloft (sertraline).

"Selective serotonin reuptake inhibitors work by preventing reabsorption of the chemical serotonin, which regulates mood, into the cells, making more of it available in the brain," said study author Dr. Mithilesh Siddu, who did the research while at the University of Miami. He's now an assistant professor of neurology at the Medical College of Georgia at Augusta University.

"However, by interfering with serotonin, which also plays a role in blood clotting, SSRIs may increase the risk of bleeding. Therefore, to determine if these antidepressants increase the risk of bleeding strokes, we looked at a large population of people with stroke," Siddu said in an American Academy of Neurology news release.

The study included nearly 128,000 people who had a stroke between 2010 and 2019. Of those, just over 17,000 had been prescribed antidepressants before their stroke, and nearly 111,000 had never had an SSRI prescription.

Rates of intracerebral hemorrhage were 11% in people who'd been prescribed antidepressants and 14% in those who had not, according to the findings. The results will be presented at the American Academy of Neurology's virtual annual meeting, April 17-22.

After they adjusted for other stroke risk factors—such as age, high blood pressure and diabetes—the study authors concluded that the risk of intracerebral hemorrhage was the same in people who took antidepressants as those who didn't take the medications.

"These findings are important, especially since depression is common after stroke, and selective serotonin reuptake inhibitors are some of the first drugs considered for people," Siddu said.

"More research is needed to confirm our findings and to also examine if SSRIs prescribed after a stroke may be linked to risk of a second stroke," he added.

Research presented at meetings is generally considered preliminary until peer-reviewed for publication in a medical journal.

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