Hemorrhagic stroke associated with antidepressant use in patients with depression: does degree of serotonin reuptake inhibition matter?

Authors

  • Yan Chen MD, MPH, PhD,

    Corresponding author
    1. Division of Pharmacy Practice and Administrative Sciences, University of Cincinnati Medical Center, Cincinnati, OH, USA
    • Division of Pharmacy Practice and Administrative Sciences, School of Pharmacy, University of Cincinnati Medical Center, 3225 Eden Ave, Cincinnati, OH 45267-0004, USA.
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    • Research Scientist of Pharmacoepidemiology.

  • Jeff J. Guo PhD,

    1. Division of Pharmacy Practice and Administrative Sciences, University of Cincinnati Medical Center, Cincinnati, OH, USA
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    • Associate Professor of Pharmacoepidemiology & Pharmacoeconomics.

  • Nick C. Patel PharmD, PhD

    1. Lifesynch, Fort Worth, TX, USA
    2. Medical College of Georgia, Augusta, GA, USA
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    • Clinical Pharmacist, Lifesynch, Fort Worth, TX; Clinical Assistant Professor of Psychiatry & Health Behavior.


Abstract

Objective

This study aimed to determine whether the degree of serotonin (5-HT) reuptake inhibition affects risk of hemorrhagic stroke associated with antidepressant use in patients with depression.

Method

A population-based, nested case-control study was performed using a managed care medical claims database. Ninety two depressed patients with a diagnosis of hemorrhagic stroke were identified and matched with 552 controls by age, sex, and year of index date of depression (IDD). Diagnoses of depression, hemorrhagic stroke, and other medical comorbidities were identified using ICD-9 codes. Antidepressants were classified as high, medium, or low reuptake inhibition based on their affinities for the 5-HT reuptake transporter, determined using their respective equilibrium dissociation constants (KD; high: KD < 1 nM; medium: 1 ≤ KD < 10 nM; low: KD ≥ 10 nM). Conditional logistic regression analysis was performed to estimate the crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of the risk of hemorrhagic stroke.

Results

Compared to non-users of antidepressants, risk of hemorrhagic stroke did not significantly differ between patients who had ever used antidepressants with high (OR = 0.82; 95% CI = 0.44–1.55), medium (OR = 0.93; 95% CI = 0.37–2.31), or low (OR = 0.38; 95% CI = 0.11–1.41) 5-HTT inhibition.

Conclusion

Risk of hemorrhagic stroke associated with antidepressant use may not be related to an antidepressant's degree of 5-HT reuptake inhibition. Given the limitations of this study, additional studies are needed to confirm these findings. Copyright © 2009 John Wiley & Sons, Ltd.

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