Research Summary

Survivors of Stroke May Safely Take Two Common Antidepressants

Jessica Ganga

Most survivors of stroke can safely take two types of common antidepressants—selective serotonin reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitor (SNRI)—according to a preliminary study presented at the American Stroke Association’s International Stroke Conference 2024 in Phoenix, Arizona.1

“Mental health conditions, such as depression and anxiety, are very common yet treatable conditions that may develop after a stroke,” lead author Kent P. Simmonds, DO, PhD, a third-year physical medicine and rehabilitation resident at the University of Texas Southwestern Medical Center in Dallas, said in a press release. “Our results should reassure clinicians that for most stroke survivors, it is safe to prescribe SSRI and/or SNRI antidepressants early after stroke to treat post-stroke depression and anxiety, which may help optimize their patients’ recovery.”

Stroke ranks fifth among all causes of death,2 and approximately one-third of patients who survived stroke develop poststroke depression, which can make the rehabilitation process more challenging.3

Researchers looked at the frequency of serious bleeding among patients who survived stroke that took different types of SSRI and/or SNRI antidepressants (ex. sertraline). For their study, “serious bleeding” was defined as bleeding in the brain, digestive track, and shock (bleeding that prevents blood from reaching the body’s tissue). The study included data from 666,150 patients with ischemic stroke from over 70 large health care centers in the United States. Of the total, 35,631 were taking SSRI/SNRIs, 23,241 were taking other antidepressants and 607,278 were not taking any antidepressant.

Further, researchers also looked at serious bleeding among stroke survivors who took a combination of antidepressants with different types of blood-thinning medications, such as anticoagulants or antiplatelet medications.

Among patients who survived stroke, researchers found that SSRIs and SNRIs were generally safe to take during the early stages of recovery compared to those who did not take antidepressants. This also included patients with ischemic stroke who were also taking anti-coagulation medications. However, among patients with ischemic stroke, there was a 15% increase in risk of serious bleeding when taking both antidepressant medications and medications from classes such as mirtazapine, bupropion and tricyclics compared to SSRI/SNRIs.

Researchers found there was an increased risk of serious bleeding when SSRIs or SNRIs were taken in combination with dual antiplatelet therapy treatments, such as aspirin and blood thinners. Overall, the risk remained low; serious bleeding events were found to be rare.

The study included some limitations, such as researchers using statistical methods to adjust for differences among age groups that may not have accounted for all the important differences among the groups. Additionally, the study did not account for the dosage, duration, and number of antidepressants taken by participants, which could have further affected the results.

 

References:

  1. 2 common types of antidepressants were safe for most stroke survivors. News release. American Heart Association; February 1, 2024. Accessed March 28, 2024. newsroom.heart.org/news/2-common-types-of-antidepressants-were-safe-for-most-stroke-survivors?preview=16e6&preview_mode=True
  2. Martin SS, Aday AW, Almarzooq ZI, et al. 2024 heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circ. Published online January 24, 2024. doi:10.1161/CIR.0000000000001209
  3. Depression and stroke. American Stroke Association. March 3, 2023. Accessed March 28, 2024. www.stroke.org/en/about-stroke/effects-of-stroke/emotional-effects-of-stroke/depression-and-stroke