Most stroke survivors could safely take two kinds of commonly used antidepressants, based on a preliminary study to be presented on the American Stroke Association’s 2024 International Stroke Conference. The meeting will happen in Phoenix on February 7–9 and is a very powerful global meeting for researchers and clinicians dedicated to the science of stroke and brain health.

Amongst individuals with ischemic (clot-related) stroke, those that began taking an antidepressant drug generally known as an SSRI (selective serotonin reuptake inhibitor) and/or SNRI (serotonin norepinephrine reuptake inhibitor) to treat common post-stroke depression and anxiety had no increased risk of hemorrhagic stroke (bleeding) or other serious bleeding. This included people taking anticoagulants. Nevertheless, an increased risk of hemorrhagic stroke has been shown in stroke patients taking two antiplatelet drugs, also called dual antiplatelet therapy or DAPT.

Mental health conditions resembling depression and anxiety are quite common but treatable conditions that may develop after a stroke. Our results should reassure clinicians that almost all stroke survivors must be prescribed SSRI and/or SNRI antidepressants early after stroke to treat poststroke depression and anxiety, which can help optimize patients’ recovery. Nevertheless, caution must be exercised when considering the risk-benefit profile in stroke patients receiving dual antiplatelet therapy, as we indeed found an increased risk of bleeding on this group.”

Kent P. Simmonds, DO, senior writer of the study, third-year resident in physical medicine and rehabilitation, University of Texas Southwestern Medical Center at Dallas

In line with the 2024 update of heart disease and stroke statistics published by the American Heart Association, stroke, when considered individually from other cardiovascular diseases, ranks fifth amongst all causes of death, behind heart disease, cancer, COVID-19 and unintentional injuries /accidents. About one third of stroke survivors develop post-stroke depression. Untreated depression can affect your quality of life and reduce your possibilities of optimal recovery from a stroke, resembling returning to every day activities without assistance.

The most well-liked classes of antidepressants are SSRIs or SNRIs, that are widely used and effective in treating anxiety and depression. Nevertheless, they is probably not prescribed in any respect, or early after a stroke, when the chance of depression or anxiety is especially high, as a consequence of concerns that they could increase the chance of a hemorrhagic stroke or other serious sort of bleeding.

The researchers checked out the incidence of major bleeding amongst tons of of 1000’s of stroke survivors taking various kinds of SSRI and/or SNRI antidepressants (resembling sertraline, fluoxetine, citalopram, venlalfaxine). Major bleeding was defined as bleeding within the brain, gastrointestinal tract; and shock, which occurs when bleeding prevents blood from reaching the body’s tissues.

Researchers also studied major bleeding in stroke survivors who took antidepressants together with various kinds of blood thinners, used to forestall future blood clots. Blood thinning medications may include anticoagulants or antiplatelet medications. Anticoagulants are prescribed as a single drug and include drugs resembling warfarin, apixaban and rivaroxaban. Antiplatelet drugs could also be prescribed as a single drug (normally aspirin), or two kinds of antiplatelet drugs could also be utilized in dual antiplatelet therapy. DAPT includes aspirin and one other antiplatelet drug called P2Y₁₂ an inhibitor (resembling clopidogrel, prasugrel or ticagrelor).

The study showed:

• Starting SSRIs and SNRIs was generally protected within the necessary early stages of recovery because the chance of major bleeding was no greater in patients taking these drugs compared with stroke survivors who weren’t taking antidepressants. This included patients after ischemic stroke who’re also taking anticoagulant therapy.
• An increased risk of significant bleeding occurred when taking SSRIs or SNRIs together with DAPT therapy (aspirin and blood thinners). Nevertheless, the general risk remained low because major bleeding events were rare.
• Amongst ischemic stroke patients taking antidepressants, a 15% increase in the chance of major bleeding was observed with drug classes resembling mirtazapine, bupropion, and tricyclics compared with SSRIs/SNRIs.

“Maximizing rehabilitation early after a stroke is vital because recovery is somewhat time-dependent and most functional gains occur throughout the first few months after a stroke,” Simmonds said. “Fortunately, dual antiplatelet therapy is usually administered for 14, 30, or 90 days, so if indicated, clinicians may not have to withhold antidepressant therapy for an prolonged time frame. Future studies should investigate the chance of bleeding related to antidepressant use. -sedatives and anxiolytics in patients with hemorrhagic or hemorrhagic stroke.

In line with a 2022 scientific statement from the American Heart Association, social isolation and loneliness are related to an roughly 30% increased risk of heart attack or stroke or death from them. “Depression can result in social isolation, and social isolation can increase the likelihood of depression. This study helps answer questions of safety related to the usage of antidepressants to treat mental health problems that will develop after a stroke,” said Crystal Wiley Cené, M.D. M.D., MPH, FAHA, chair of the Association’s scientific statement writing group, and professor of clinical medicine and administrative director of health equity, diversity, and inclusion on the University of California, San Diego Health. Dr. Cené was not involved on this study.

Study details and design:

• The retrospective study included electronic health record data from 666,150 ischemic stroke patients from greater than 70 large health care centers in the USA: 35,631 were taking SSRI/SNRI antidepressants and 23,241 were taking other antidepressants; nonetheless, the bulk (607,278) weren’t taking any antidepressants.
• For 20 years, patients were treated in 70 health care facilities.
• Patients were identified based on electronic medical records for the years 2003–2023.

The study had some limitations. The researchers used statistical methods to correct for differences between groups, which can not have accounted for all necessary differences between groups. The study also didn’t keep in mind the dose, duration or variety of antidepressants participants were taking, which could have influenced the outcomes.