Antidepressants may increase risk of rare stroke

Taking Lexapro, Zoloft or other popular antidepressants may increase the risk of certain types of stroke, according to a study published in the journal Neurology.

But experts caution that the risk of this type of stroke, which causes bleeding in the brain, is still extremely low.

“Because these types of strokes are very rare, the actual increased risk for the average person is very low,” said the study's author Dr. Daniel G. Hackam, of Western University in London, Ontario.

Past research has found an association between the use of selective serotonin reuptake inhibitors (SSRIs), the most commonly used antidepressants, and major bleeding, such as gastrointestinal bleeding. SSRI’s are thought to inhibit the aggregation, or clumping together, of platelets, which could lead to bleeding.

The Canadian researchers searched the literature for studies on antidepressant use and stroke. They included 16 studies in their analysis. Of the combined 500,000 participants, those taking SSRIs were 51 percent more likely to have an intracranial hemorrhagic stroke and about 42 percent more likely to have an intracerebral hemorrhagic stroke than those not taking SSRIs.

Still, since these strokes are rare, occurring in 24.6 out of 100,000 people annually, SSRIs would only increase the risk by one additional stroke per 10,000 per year.

The study did find that the risk of stroke appears mostly within the first few months of taking an SSRI.

“Drug studies show that SSRIs result in acute blood thinning within a couple of weeks of first exposure,” said Hackam. “Therefore, if an event is likely to occur, it is going to happen within the first few weeks to months of exposure."

“For patients with a clear indication for SSRI use, the absolute increase in risk of [stroke] should not deter clinicians from prescribing these agents, “ wrote Drs. Emer McGrath and Martin O’Donnell of the National University of Ireland,  who authored an accompanying editorial in the journal.

“In general these drugs are safe, and obviously there are risks to having depression go untreated,” Hackam said.

He recommended considering non-SSRI antidepressants like Wellbutrin for people who already have risk factors for these types of strokes, such as those taking blood thinners and those who have had similar strokes.

“People on anticoagulants like Coumadin are at higher risk of brain hemorrhage anyway. Adding an SSRI would further increase that risk,” Hackam added.