Popular Antidepressants Linked to Stroke

Selective serotonin reuptake inhibitors (SSRIs)—the most widely used group of antidepressants—are associated with an increased risk of strokes caused by bleeding in the brain, based on new research in Neurology. For the research, scientists analyzed the combined data from 16 previous studies with more than half a million participants.

SSRIs Increase Stroke Risk

SSRIs increase the brain’s available supply of serotonin, a chemical messenger that helps regulate mood, sleep, appetite, and sexual drive. Antidepressants in this group include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft).

The new study found that people taking SSRIs were 40 percent more likely to have an intracerebral hemorrhage—a type of stroke that occurs when a blood vessel bleeds deep within the brain—compared to those not taking the drugs. SSRI users were 50 percent more likely to have an intracranial hemorrhage—any bleeding within the skull.

What’s the connection? Besides being present in the brain, serotonin is found in platelets—little pieces of blood cells that help prevent bleeding by forming clots. Scientists believe that SSRIs may reduce the concentration of serotonin within platelets, increasing the risk for dangerous bleeding.

But the Risk Is Still Low

Yet the authors of the new study stress that it’s important to keep the risk in perspective. Most strokes are caused by a blockage in a blood vessel supplying the brain, not by bleeding.

Because intracerebral hemorrhages are uncommon, even when the chance of having one is increased, the risk for the average person is still low. The authors calculate that SSRI use increases the risk by one additional stroke per 10,000 people per year.

“Overall, these results should not deter anyone from taking an SSRI when it is needed,” says lead author Daniel Hackam, MD, PHD, of Western University in a statement about the study. It’s worth remembering that untreated depression can also be life-threatening, if someone is suicidal.

When to Talk with Your Doctor

Dr. Hackam says that doctors might consider non-SSRI antidepressants for people who already have other risk factors for this type of stroke or who have suffered a similar stroke in the past. Before starting an SSRI, talk with your doctor about risk factors for intracerebral hemorrhage, including:

  • Uncontrolled high blood pressure
  • Excessive alcohol drinking
  • Cigarette smoking
  • Blood-thinning medications, particularly at higher doses
  • Illegal drug abuse, especially cocaine and amphetamines

If you’re currently taking an SSRI and have concerns, discuss them with your doctor. But don’t just throw out your medication, because stopping an SSRI abruptly can lead to unpleasant symptoms—and allowing depression to return can be dangerous, too.

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