SSRI Antidepressants May Up Stroke Risk After Menopause

Post-menopausal women taking <"">selective serotonin reuptake inhibitor (SSRI) antidepressants have a small, though statistically higher risk of stroke, according to a newly published study. SSRIs include the drugs Prozac, Paxil, Zoloft, Lexapro, and Celexa.

Antidepressant use in the US has more than quintupled since the early 1990s, and SSRIs have replaced older medications called tricyclic antidepressants, which can be toxic the heart. According to a press release announcing this latest study, SSRI antidepressants have fewer side effects in general and are known to have aspirin-like effects on bleeding, which could protect against clot-related cardiovascular disorders. But not much is known about how SSRIs affect the heart. This is especially true in the case of postmenopausal women, who are at increased risk for both heart disease and depression.

The study, which was published in the December 14 Archives of Internal Medicine, involved 136,000 participants in the Women’s Health Initiative (WHI). None of the women were taking antidepressants when they enrolled in the WHI.

The women included in the analysis had their first follow-up visit either one or three years after enrolling in WHI. At that time, 5,500 women reported taking either tricyclic or SSRI antidepressants. After six years, there was no association between antidepressant use and heart disease. However, researchers did find that women taking SSRIs had a 45 percent increase in risk of stroke and a 32 percent increase in risk of dying from any cause during follow up, compared with nonusers. Use of older tricyclic antidepressants wasn’t linked to stroke, but it did increase by 67 percent the risk of death during follow-up.

The authors of the study said it wasn’t clear if the increased risk was the result of antidepressants or depression itself. Depression is a known risk factor for cardiovascular problems.

“There are a lot of things this study couldn’t tell us, such as whether this risk truly is attributable to the drugs and not to depression itself and whether participants were being treated for depression or for anxiety, which also has cardiovascular risks,” Jordan W. Smoller, MD, ScD, of the Massachusetts General Hospital (MGH) Department of Psychiatry, the study’s lead author, said in a press release. “We also don’t know whether there is any similar association in younger women or in men, since they were not part of this study.”

The authors of the study called for more research into the relationship between antidepressants and death.

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